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

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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.