Is It Pertussis, Or Just A Cough?

My husband and I got a notification from the county health department this week. A student at my son’s high school was diagnosed with pertussis.

My first thought was that s/he must have not been vaccinated. But then I looked into the data and found that isn’t necessarily so.

What is Pertussis?

Pertussis, or whooping cough, is a childhood illness that starts with typical cold symptoms and progresses to a horrible spastic cough. It is very dangerous for small children and can be fatal. 13 children in the US died from pertussis in 2017.

As a bacterial infection, pertussis does respond to antibiotics but only if they are started BEFORE the typical whooping cough begins. Unfortunately, before the typical cough starts it looks just like a cold. This is one of the reasons we vaccinate against it – there is no other way to prevent the awful, potentially fatal cough.

In case you are thinking “Oh, it’s just a cough,” here’s a video of a baby girl in the ICU with pertussis. And here’s a video of a 64-year-old man hospitalized with pertussis.

What about the vaccine?

I know you’re going to say “But Dr. Jen, if there’s a good vaccine available how does this happen?” The problem with the vaccine is that the immunity decreases over time. (The immunity you get from having whooping cough itself also appears to decrease over time, which is a scary thought.)

No vaccine is 100% effective, but the current vaccine is pretty good. Immunity is estimated at 80-90% over the first year and starting to wane about 4 years after vaccination. The pertussis vaccine was changed from whole-cell to acellular (no cells) in the 1990s because the whole cell vaccine had a lot of side effects. However, the new acellular vaccine is not as effective.

It is recommended that TDaP (tetanus, diphtheria and acellular pertussis) vaccine booster doses be given every 5-10 years. Unfortunately it is not indicated for adults over 65. Pregnant women and those who spend time with babies and small children should be particularly careful to get booster doses regularly.

Bottom Line

Even though the pertussis vaccine isn’t perfect it still does a nice job of reducing the risk of whooping cough in the US. According to the CDC, in 2015 there were about 20,000 cases of pertussis in the US and 6 deaths between 2014 and 2015. Worldwide it is estimated that there were 24 million cases of whooping cough and over 160,000 deaths in 2015. Most of these cases occurred in developing countries where vaccination coverage is low.

Community vaccination decreases the risk that someone will be exposed to pertussis. Personal vaccination decreases the risk that, if exposed, an individual will get sick. Because the most vulnerable individuals are babies under the age of 1 year (too young to be fully vaccinated) it is important that all of us get regular boosters.

We live in a country that vaccinates, and we all benefit from that. We all should roll up our sleeves and get vaccinated to protect our precious, vulnerable babies from pertussis.