Peter Wehrwein

No big whoop: Adult pertussis may not produce the whooping cough

Whooping cough is the nickname for pertussis, a childhood disease that is now affecting teens and adults and becoming less true to its onomatopoeic moniker.

People with pertussis make a whooping sound because they run out of breath after coughing hard several times in row; the whoop is the sound of a sudden, hard inhale.

You’ll find a good audio recording of child with whooping cough on this Web site. It really drives home just how bad the cough of whooping cough can be. And the “whoop!” is upsetting to listen to: the poor child in the recording seems to be really gasping for air.

Whooping cough is caused by Bordetella pertussis bacteria. An effective vaccine has been available for 70 years, and because of its widespread use among children, there are now far fewer cases and deaths from the disease.

In fact, in the mid-1970s in the United States, whooping cough seemed to be disappearing with only about  1,000 cases reported in 1976 (although there’s bound to be unreported cases that don’t show up in any official count).

But since then, pertussis has made a comeback  for reasons that aren’t entirely clear (some think the vaccine was weakened to reduce side effects).

In 2005, the federal health statistics tally was 25, 616 new cases. In  2007 (latest year available), the number of reported cases was down to about 10,000, suggesting that there might be up-and-down cycle in the trend line.

Pertussis is also changing in other ways.

An article about the disease in the August 25, 2010, issue of the Journal of the American Medical Association (JAMA) pointed out whooping cough was almost exclusively a childhood disease before vaccination became common. Now about half of all the cases that occur in this country are among teens and adults.

What’s more, whooping cough in teens and adults frequently doesn’t produce the classical symptoms, which, in addition to the namesake whoop, includes  “posttussive emesis”—vomiting after coughing. Instead, the main feature of whooping cough for teens and adults may be bad, lingering cough.

And, of course, any number of things can cause a bad, lingering cough.

So where does this leave us? Three points come to mind:

First, if you have a bad cough that you can’t shake, it’s possible that you have pertussis. By some estimates, 10% to 30% of prolonged coughs in adults are caused by pertussis. Mind you, there seem to be swings in the number of new cases each year, so those estimates might be high in a low incidence year.

Second, you and your doctor can’t go by the whooping and other supposedly typical  symptoms. One of the take-home messages of the JAMA article is that ”…additional testing  and treatment decisions in a patient with prolonged cough should be based on the overall clinical impression, independent of these classical clinical features of pertussis.” Additional tests include culturing the Bordetella pertussis bacteria from nose and throat secretions. And treatment consists of a course of antibiotics.

And third, the pertussis vaccination isn’t just a childhood vaccination. Teens and adults need to get the vaccine, too.  It’s given in combination with the vaccines for tetanus and diphtheria. Here is what the CDC has to say on the subject:

Vaccine protection for pertussis, tetanus, and diphtheria can fade with time. Before 2005, the only booster vaccine available contained tetanus and diphtheria (called Td), and was recommended for adolescents and adults every 10 years. Today there are boosters for adolescents and adults that contain tetanus, diphtheria, and pertussis (called Tdap). Pre-teens going to the doctor for their regular check-up at age 11 or 12 years should get a dose of Tdap. Adults who didn’t get Tdap as a pre-teen or teen should get one dose of Tdap instead of the Td booster. Most pregnant women who were not previously vaccinated with Tdap should get one dose of Tdap postpartum before leaving the hospital or birthing center. Getting vaccinated with Tdap is especially important for families with and caregivers of new infants.

The easiest thing for adults to do is to get Tdap instead of their next regular tetanus booster—that Td shot that they were supposed to get every 10 years. The dose of Tdap can be given earlier than the 10-year mark, so it’s a good idea for adults to talk to a health care provider about what’s best for their specific situation.

Comments:

  1. Grace

    I am a 40yo female RN & I’ve been severely affected by pertussis for the past 8 months. At the end of May, 2011, I had bronchitis & believe that I contracted pertussis while my lungs were still immunocompromised from the bronchitis & assume that this is why my case has been so difficult. Since June, I often cough until vomiting and/or exhaustion. I have never smoked in my life, yet sound like a 90 yo smoker-lady!
    I’ve seen multiple physicians with minimal help. It took almost 2 months to get the diagnosis of pertussis—thank God for my family practitioner! Iv been seen in the ER twice, seen a pulmonologist MULTIPLE times, 2 different ENT physicians, and asthma & allergy specialist, and even a gastroenterologist to try to help assuage the cough & affects from the cough. I am utterly exhausted & feel as if I will never be the same. I’m so tired of coughing, having to whisper bc speaking in a “real” voice causes increased , coughing. Since laughing or exerting energy causes bad coughing spells, I rarely laugh or exercise. I am exhausted almost 95% of the time. I am vacant from my own life bc of this pertussis. I personally have found only 2 other people in my life who have had a bad experience like this with adult pertussis, & without them & my faith in God, I would have given up long ago. So that is why I am writing this. To give hope to others. Although I am not well yet, I know 2 people who ARE well! One of the ladies who had it dealt with it for 6 months, the other one for 1year & 1/2. My time is right in the middle & I HAVE to hope that I will wake up any day now healthy again.

  2. D Sattley

    Your title “No Big Whoop: offends me. I had whooping cough and I had a severe case as an adult. Unless you have had it I don’t think you understand how scarey it is.I called the Haelth Dept and asked if I might have whooping cough and they scoffed at me and said no one gets it anymore (that was in 1989) I called my doctor and he said I just had a cold.I would have severe attacks at night when I would sit straight up and cough violently hardly able to get my breath. I would vomit clear phlegm. It took me over two years to stop having asthma attacks. As I get older I have been having less confidence in our health community. If you think you may have a disease persist until you get an answer.

  3. owen

    I suffered because of whooping cough in my childhood.It has now became a serious issue for both childrens and adults.Proper medical instructions should be followed instead of prevent the risk of whooping cough.

  4. Cynthia L.

    I’m so relieved to know that I’m not the only one going thru’ this. My Dr. doesn’t seem to understand how severe my coughing spasms are. I live alone & sometimes I’m afraid that I won;t stop soon enough to catch my breath. I cough so hard & so loud that I’m ‘yelling.’ I’ve had this hanging on for 11 weeks. My Dr. thinks it’s “just fall allergies” triggering my athsma. He recommended Flovent Discus 100 & a chest xray to rule out pneumonia. ‘Guess that’s standard procedure, but, in the meantime, I’m afraid to be alone & can’t remember the last time I had restorative sleep. I’m disabled by Chronic Myofascial Pain Syndrome & Fibromyalgia, so I already have more than my share. I’m trying to see this humorously as a rather bazaar weight loss program.

  5. Faiz Ahamed

    A whooping couph should do away from all foods which produce phlegm like milk, ghee, sweets, rice, refined flour products, sugar and lentils. His diet should consist of oranges, musk melon, tomatoes and rasberry. Vegetables like spinch, cabbage, gourds, should be taken in a boiled form without addition of any condiments. Wholemeal bread and roasted potatoes could also be given. The patient of pertussis should be encouraged to fast for a couple of days with the onset of the symptoms of whooping cough. The fasting period should be followed by a week of living on oranges only.

  6. marji

    I left for Europe coughing…coughed for the whole week I was there. I was put on antibiotics when I returned but later found I had developed pneumonia in my left lung. I wish I had known about the vaccine. I had thought that a bout of whooping cough as a child had protected me. It does but only for a few years.
    My next vaccine is for shingles. After struggling through these last three weeks of constantly coughing..I am going to be more prepared. As a senior I can’t take any more major risks.

  7. Janet

    I am a 54yr old medical receptionist. My cough has caused me many sleepless nights and total fatigue. After being on Doxycillian and Rulide over a period of 6weeks the penny finally dropped. I watched a current affair program and it all made sense. I was treated for sinus. I did have a consistant heavy trickle running down the back of my throat. Nightime was the worse often trying to sleep in an upright position. Sudafed night/day was taken on and off over a period of 4wks–I could never have survived without it. I continued to work unaware of my prognosis.
    Finally a test was done on 20/5 which confirmed pertussis. I had a Booster for same in June, 2010 being in the medical profession. I still have a cough especially after say 6pm and am still fatigued but feeling much better. How ill would I have become if I had not had the Booster for same?–who knows. I have felt unwell for over 2mnths. Never ignore your body telling you something!!

  8. Lynn

    I was just diagnosed with pertussis. It started off as a dry cough, then prgressed to my sinuses and now I am wheezing and coughing uncontrollably. I was misdiagnosed three times and put on three different antibiotics. I finally got the blood work confirmed today. I feel better knowing what I have, but I am worried about my husband and three children. This has been going on since April 1st.

  9. Debbie

    Had a cold over Christmas 2010. Have had a lingering cough and hoarseness/laryngitis since then. My GP said it was allergies and I had 2 courses of prednisone, second course 3x a day for 1 week. Partially got my voice back but within 1 1/2 days, the hoarseness was back. The cough never went away. I am now 4 months past the “cold” and my voice is totally gone. Saw the allergist 3 days ago, went through allergy testing with negative results. Allergist suggested my “cold” was actually pertussis. Awaiting results from blood test now. I’ve advised my husband, who has allergies and asthma and a history of pneumonia, to get a pertussis vaccination when he sees his doctor. Agree with Tom T. above that this is no fun. I am exhausted when I get home from work each day. I am very ready for this to go away. I look forward to getting my voice back.

  10. valeria

    Realized my “cold” of 12 days was pertussis when the severe coughing set in the morning of April 21st. This was my third episode with adult pertussis within the last 15 years. I did start antibiotics and a homeopathic remedy very helpful for the cough with good results within 12 hours. I am a public health nurse and every Spring have many adult clients who are totally unaware of their pertussis. Doctors need to be much more aware of the s/sx in adults and treatments that can mitigate or even shorten the course of the disease.

  11. Craig S.

    I’m just getting through this. Coughing until fainting 1 or 2 times per day for 10 days. Horrible! Get you vaccine. I’m 49 and am one of those people who rarely get sick other than seasonal allerigies.

  12. Tom T.

    Our (wife and myself) had pertussis infection and it was no fun at age 70. It began as 7 days of slowly progressive cough centered over sternum culminating in severe paroysmal (can’t stop) deep series of coughs. Minimal upper respiratory sxs. Coughing leads to near vomiting and at its peak you are washed out for several days. Thereafter, you don’t feel bad, just hit with persistent bouts of severe deep, dry hacking cough that is hard to stop. Total infection with residual cough has now lasted 10 weeks. Nyquil and cough medicined help make the nights better. We are non smokers in good health and both had DPT as infants but no adult DPaT shots. Not identified by original visit to Drs. This is NO FUN. Get your DPaT shot before infection as this is hitting more and more adults and is highly contagious. It may become an epidemic.