•  Lung and Respiratory Problems

Most people think that whooping cough is a disease of the day-care and playground set. But adults can catch it, too: About 28 percent of reported American cases occur in adults, and the actual numbers may even be higher. In fact, adults are often even more susceptible to whooping cough than young children because the vaccinations most children receive eventually wear off -- sometimes as early as high school. (Adults can get booster shots, but few ever do.)

For a while, it seemed as though whooping cough would go the way of polio and become a disease of the past. But in recent decades, the disease has made a serious comeback. According to some estimates, as many as 1 million Americans of all ages catch whooping cough each year. Among adults, an estimated 20 to 30 percent of all lingering coughs (lasting two or more weeks) turn out to be whooping cough. Not only are adults coming down with the disease, they’re also spreading it to others. Children too young to be fully immunized are at highest risk because the five-shot DTaP vaccine series for young children isn't finished until age 4 to 6.

Whooping cough -- also called pertussis -- is caused by a highly contagious bacterial infection. The disease-causing bacterium, Bordetella pertussis, travels through the air in tiny droplets released when a person coughs or sneezes. If whooping cough germs find a home in the windpipe, the bacteria start producing toxins that irritate the surrounding tissues. The body responds by producing lots of mucus that clogs the windpipe and causes a wracking cough.

If you live with someone who has whooping cough -- and if you haven’t been vaccinated (or already had the disease) -- there’s an 80 percent chance that you’ll also get sick. Even if you've been vaccinated in the past, you can still get the disease, though it may be a milder case. Without treatment, whooping cough remains contagious for about three weeks.

In general, whooping cough isn't especially dangerous for adults, and most can expect a full recovery without complications. Many cases are probably never even diagnosed. Often, the biggest danger of adult whooping cough is the possibility that it can spread to an infant. While most children usually recover, the disease does carry the risk of severe complications, including pneumonia and brain damage.

The name "whooping cough" comes from the characteristic "whoop" or whistling sound that children make as they gasp for air while coughing. Adults usually don’t make this sound, and babies may not either.

At first, whooping cough feels a lot like a common cold, complete with sneezing, runny nose, dry cough, and low fever. After a week or two, symptoms may turn worse, especially the cough. In many adults, the symptoms are similar to bronchitis.

The coughing tends to come in rapid-fire bursts -- up to 15 coughs in a row -- and may get worse at night. In some cases, the coughing can be violent enough to crack a person’s ribs. The coughs are often dry and unproductive, but can sometimes bring up thick phlegm. Some people will even vomit right after a coughing fit. One feature that distinguishes whooping cough from other illnesses is that a person typically feels fine in between coughing spells.

Whooping cough can be tricky to diagnose. If a person has been having fits of violent coughing for two weeks or more, and there's no other known cause, the current guidelines say that your doctor should suspect whooping cough. However, many doctors still consider whooping cough a children's disease, according to an editorial in the Annals of Internal Medicine.

Doctors can run tests to confirm the disease, but don’t expect fast results. Culturing the bacteria -- which involves swabbing the nostrils and sending the sample to a lab -- takes seven to 12 days to complete because the bacteria is difficult to grow. Pertussis cultures also have a high rate of false-negatives, meaning they miss a lot of cases, especially late in the course of the disease. A PCR test that looks for telltale DNA of the whooping cough bacteria takes only one or two days. The Centers for Disease Control and Prevention (CDC) recommends doing both tests at the same time to be certain.

In the real world, doctors often don’t bother with these tests. Of the estimated 1 million cases of whooping cough in adults in the U.S. each year, only about 25,800 are formally diagnosed and reported to the CDC.

Doctors who suspect a case of whooping cough can prescribe an antibiotic such as azithromycin or erythromycin to kill the germ. These are most effective when started early in the infection. The antibiotics won’t immediately cure the disease, but they can shorten the length of time you have symptoms. Importantly, you will no longer be contagious after five days of antibiotic treatment.

If you have whooping cough, you can take a few steps to make yourself more comfortable. Namely, drink plenty of liquids and get lots of rest. Warm, moist air can soothe your airways, so consider using a humidifier or taking a lot of warm showers. You should also avoid tobacco smoke or other irritants that can trigger a coughing fit.

The most important thing you can do to prevent the spread of the illness is cover your mouth when you cough or sneeze.

Also, the CDC and the American College of Chest Physicians encourage all adults under 65 to get vaccinated for whooping cough with the Tdap vaccine (for tetanus, diphtheria, and pertussis). Vaccinations are especially important for parents, grandparents, day-care workers, health-care workers, child-care providers, and anyone else who has close contact with infants. According to the CDC, these people -- including mothers who have just had a baby -- should get the Tdap vaccine. The Tdap vaccine has not been studied for safety in adults over 65.

If you were vaccinated as a child, you can get a one-shot Tdap booster every 10 years. If you're due for a regular tetanus booster, you should get a Tdap shot instead. If you've recently had a tetanus or Td booster, the CDC recommends that you wait at least two years before getting a Tdap shot.

If you're not sure whether you were immunized against whooping cough, tetanus, or diphtheria as a child, or if you have an incomplete vaccination history, you should get the three-shot primary Td vaccine series for adults (against tetanus and diphtheria). To protect against whooping cough as well, make sure you have the Tdap vaccine substituted for any one dose of the series, ideally the first dose. Unlike children, adults don't need a whole series of pertussis shots; just one is enough.

-- Chris Woolston, MS, is a contributing editor to Consumer Health Interactive. A former staff writer for Hippocrates magazine, he has written for Health, Prevention, and other journals. He writes The Healthy Skeptic, a biweekly column in the Los Angeles Times. He is also the co-author

of Generation Extra Large: Rescuing Our Children from the Epidemic of Obesity (Perseus paperback, 2006).

Deepi Brar contributed to this report.

References

First published March 21, 2008
Copyright © 2008 Consumer Health Interactive

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