Pertussis (Whooping Cough) Is Making a Comback --
in People of All Ages

By Alan Peterson, M.D.

Despite widespread use of the childhood vaccine, pertussis remains a significant public health problem, with reported rates higher than they have been in many decades. It’s often milder in older persons and that can make recognition of the disease challenging. But with new vaccines licensed for use in adolescents and adults, the time is right for more prevention. 

Up until recently, all of the whooping cough vaccines were only approved up until the 7th birthday. Unfortunately, antibody levels only persist up to three years after the last dose of whooping cough vaccine and then it appears to decline. This, of course, would make most adolescents and adults unprotected against this bacterial infection. 

When to Suspect Pertussis

Whooping cough is a frequent cause of respiratory tract illness, usually causing a cough lasting more than two weeks. Most also have at least one of the following symptoms: Spells of coughing that are frequently uncontrollable, breathing usually causes a typical whoop, mostly in children. Also, the cough can sometimes be so bad as to cause vomiting. Infants that are unimmunized can develop pneumonia, brain complications, cessation of breathing (apnea), and death.

Adults can have the prolonged cough, but some can be relatively free of severe symptoms. Because of this, adults can spread the disease to others including infants. Obviously, the older individuals who have other significant medical problems can less tolerate prolonged coughing and this bacterial infection.

Disease Transmission

Pertussis is highly contagious and spread by respiratory droplets through coughing. It can develop in up to 90% of susceptible family members that are unimmunized. Because the incubation period for pertussis is from 7-13 days, transmission within the household may occur among family members over weeks, depending on the number of persons in the family. 

Making a Diagnosis

Recognizing whooping cough can be challenging. Sometimes an elevation in the white blood cells can occur. Specific antibody titers can be drawn for this disease. The preferred test is an aspirate or swab placed in the nose that can then be cultured. This can be uncomfortable to the patient, especially as it is rotated for anywhere from 15 to 60 seconds. The organism is difficult to culture, especially if the patient has been ill for some time (It’s easier to culture earlier in the disease).

Management

The traditional treatment has been with the macrolide antibiotics such as erythromycin, clarithromycin, or azithromycin. Those that are allergic to this group of antibiotics can have trimethoprim-sulfamethoxazole (a sulfa drug) used as an alternative. Unfortunately the cough illness may persist despite the treatment and cure of the infection with the antibiotic. The cough can still last for weeks even though the organism has been killed and the contagiousness of the disease decreased. 

A New Immunization to the Rescue!

In June of this year, the FDA approved a single-dose active booster immunization against tetanus, diphtheria, and pertussis in individuals aged 11-64 years. This combination vaccine now provides a pertussis component to the tetanus/diphtheria booster previously provided to adolescents and adults. Adverse reactions are not greater than a regular tetanus booster. It’s even safe enough to be used in pregnant patients. 

If you are having a tetanus booster and you are between age 11 up to your 65th birthday, you should ask for the new tetanus vaccine that includes not only diphtheria but also a pertussis immunization. This will not only boost your protection against whooping cough, but also prevents you from developing the disease and potentially transmitting it to an infant that could die of the disease.