Whooping Cough Makes a Comeback

If you think someone in your family may have pertussis or has been exposed to it, call your doctor right away

A physician uses a stethoscope to check on a young patient with parent supervision

by Sean Deitch, Emergency Physician

Like polio and smallpox, many of us think of whooping cough as an illness that had been all but eradicated in the United States.

After all, protection against pertussis, the infection commonly known as whooping cough, is part of the DTP vaccine series most people receive as very young children. So why is it making a comeback among adults?

As we’re finding, the pertussis immunization we received as children fades after about 10 years. As a result, adults and older children now represent more than 25 percent of pertussis cases in the United States.

What is pertussis?

Pertussis is an infection of the respiratory tract caused by the Bordetella pertussisbacteria. It is highly contagious, and can be easily contracted by inhaling contaminated droplets from an infected person’s cough or sneeze.

If you live with someone who has pertussis, you have about a 90 percent chance of catching it.

Once pertussis bacteria invade the respiratory tract, they produce toxins that cause inflammation and hamper the body’s germ-fighting ability.

Symptoms begin about a week after exposure. In its early stages, pertussis symptoms can mimic the common cold, with congestion, runny nose, low fever and a dry cough. After a week or two, the dry cough becomes a wet one, with long, violent coughing spells that produce thick mucus.

The severe coughing may make breathing very difficult, and efforts to take a breath may produce the “whooping” sound that earned the illness its nickname. In some cases, coughing may be strong enough to break a rib.

Pertussis in children and adults

In children, pertussis can be extremely serious. Coughing may be so severe that blood vessels burst, leaving tiny red spots on the skin or whites of the eyes. Prolonged coughing may lead to vomiting and difficulty eating or drinking, which in turn can cause dehydration and prevent children from getting the nutrients they need.

Some children may develop pneumonia and need hospital care. In infants and very young children, pertussis can be fatal.

Usually, symptoms in adults are milder; often, the only symptom is the cough. Because of this, adults who have pertussis may mistakenly believe they have bronchitis or a bad cold, and risk spreading the infection to others.

Severe coughing may persist for two to three weeks, followed by several more weeks of weaker, less frequent bouts.

Treatment and prevention

If you suspect someone in your family (especially a child) may have pertussis or has been exposed to it, call your doctor immediately. He or she may diagnose the infection with a culture from the nose or throat and, in some cases, order blood tests or a chest X-ray.

If your child is coughing and vomiting and you cannot reach your physician, go to the emergency room.

Pertussis is usually treated with antibiotics; however, they must be given in the early stages of the illness to be effective. Don’t try to treat pertussis at home or use over-the-counter cough medications to suppress the coughing; they won’t work and may do more harm than good.

Your physician also may recommend preventive antibiotics or vaccines for others in the household. In the past, the DTP vaccine given to children carried a risk of serious side effects in adults. Recently, a new vaccine has been developed specifically to prevent pertussis in adults.

This Scripps Health and Wellness information was provided by Sean Deitch, MD, an emergency physician at Scripps Memorial Hospital La Jolla.