Exploding The Myths Of Adult Whooping Cough

Exploding The Myths Of Adult Whooping Cough

(And why YOU need a vaccination)

By Guest Blogger Sandy Jankowski, AARP Volunteer

 

Having come down with a case of whooping cough as a 72 year old adult, I've encountered a series of misunderstandings that need to be addressed by the medical community and patients alike, and am turning to AARP to get the word out.

Myth #1:  Whooping cough is a disease of childhood

I had been told over the years that, having received the whole cell vaccine  as a child,  I had lifetime immunity to B.pertussis, the causative bacteria of whooping cough,.  In fact, this misconception by health care providers is part of the reason that this disease is under diagnosed in the older adult age group.  In some studies, more than half the cases of whooping cough in the United States are in adolescents and adults.  I made visits to five different doctors before Dr. Richard Sargent, an excellent diagnostician at the Montana  state employee health clinic, told me that I had whooping cough.  He explained that whooping cough is usually a far more serious disease in infants and children, due to the fact that they are unable to sit up to relieve the coughing and be able to catch a breath.  They cough to death lying down.  In adults, the more common complaint is a long, lingering cough, which often leads to extensive diagnostic testing and incorrect treatment, before the diagnosis is finally made.

Myth #2:   Vaccination confers lifetime immunity:

Immunity conferred by the newer acellular vaccine, in use since about 1990, has been found to wane after just a few years, as witnessed by outbreaks among immunized adolescents. The vaccine was changed from the whole cell vaccine to address the side effects of fever and discomfort that babies experienced after administration.  This change may be a major reason that the disease, which had all but disappeared from the population,  has returned with a vengeance.

Myth #3:   The only older adults recommended for revaccination are those in contact with infants.

For several years it has been recommended that adults who will be in contact with infants receive a booster vaccine to avoid giving them the disease prior to those infants being vaccinated at 6 to 8 weeks of age.  However, older adults also need to be vaccinated for their personal protection.  It is a public health problem that adults with whooping cough are being misdiagnosed with viral bronchitis when they are in their most contagious state of whooping cough, thus passing the disease not only to unvaccinated infants and children but also  to other adults whose immunity has waned.  Current recommendations for adult vaccination for whooping cough are a single booster at or before the next scheduled diphtheria tetanus booster.  Ongoing surveillance of adult cases of whooping cough may reveal a need for even more frequent boosters.  Accurate diagnosis and counting of confirmed cases is crucial to knowing if more frequent vaccinations are needed.

Myth #4:   Whooping cough in adults is a mild illness:

My illness, and that reported by many others my age, was anything but mild.  The cough was severe enough to cause me to think I could die on the worst night from inability to catch a breath. Damage to my heart, or aspiration pneumonia from the accompanying vomiting also came to mind.  In addition, the "one hundred day cough" as it's otherwise known makes regular life chores nearly impossible for that long, often longer. Personally, I nearly had to quit my job due to the fatigue from the continuing coughing, at a time when my sick days had run out since they had been depleted earlier in the year by days spent with my terminally ill husband who then passed away four months before I contracted this illness.  Therefore, it was necessary to drag myself to work on days when I felt barely able to function.  I recently spoke to one woman who spent a week in our local hospital and was then referred to Mayo Clinic during her bout with whooping cough.

Myth #5:  Coughing is indicative of a contagious state.

The contagious period reportedly lasts for up to two weeks, less if immediately treated with antibiotics.  Coughing, on the other hand, may continue for weeks to months longer due to a windpipe toxin produced by the organisms which can damage the ability to naturally clear the airways of irritative particles.

Myth #6:    The test of choice is a molecular PCR test done on nasal secretions.

The PCR test is better than the previous reliance on the difficult to culture whooping cough germ. However, the accuracy of diagnosis with PCR or culture drops dramatically at about the same time as the severe coughing period ends, and often adults do not consult their physician until they fail to get over their cough.  By this time the test may well be falsely negative.  As clearly stated in microbiology references, the test of choice for adult whooping cough is confirmation by a different test called blood IgG and IgA serology.  Even as an experienced microbiologist, when I mentioned that I was planning to write an article and needed positive confirmation of infection,  I encountered severe resistance to getting an order for testing.

The serology test could also prevent a myriad of costs to the patient and to the health care system in the form of unnecessary or ineffective drugs prescribed and even more expensive and unnecessary diagnostic tests, both laboratory and imaging. As a microbiologist, I now wonder how many of the bronchoscopy specimens we receive to test for TB and Legionella are really from cases of lingering whooping cough.

In summary I'd suggest you consider the following: show your provider this article and discuss whether you should have a whooping cough booster vaccination.  And if you develop a severe coughing illness or a cough lasting for weeks after the initial illness has improved, ask your provider to consider this important and reemerging disease.

Submitted by Sandra Jankowski, MI(ASCP) -- Board Certified by the American Society for Clinical Pathology