Communications: Patient Education

Patient Education: Stopping the Spread of Pertussis - Adults Need to Get Vaccinated

Tuesday, November 13, 2012  
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Pertussis, known to most people as whooping cough, is back. Older generations remember the disease, in the era before widespread immunization, as a scourge among infants and small children that caused spasms of rapid, short, barky coughs interrupted by gasps for air. The swelling in the windpipe and voice box of the victims gave a characteristic "whoop” sound to the inhalation from which the disease gets its common name.

"Whooping cough would last for weeks. There was no effective treatment, and once in a while the swelling would close off the windpipe or voice box completely,” said Dr. Glenn Nemec, a family physician in Monticello, MN. "Unless the child was actually in the hospital when this happened, it frequently resulted in death.”

That’s why the pertussis vaccine was hailed as a near miracle. For many decades, the disease all but disappeared. Unfortunately, that is no longer the situation. According to the Minnesota Department of Health, there have been 3,950 cases of pertussis reported in the state this year. That's the highest number since the 1940s, before the vaccine was developed. So why is it back? Where did it come from again? The original vaccine was created using crushed pertussis bordtedella bacteria injected into the muscle in a series of 5 shots over the first 5 years of life. It was very effective, but it caused a lot of sore arms, fevers, and occasionally more serious reactions. Over the years, the vaccine has been refined so that there are fewer side effects. Today, anything more than a day or so of mild soreness at the injection site, and/or a low-grade fever, are almost unheard of.

The bad news - recent evidence shows that the modern vaccine starts to wear off as soon as 5 years after the last dose. By age 15, a person only has 50% protection from the pertussis germ, and the protection becomes less and less each year. This means that adults can get pertussis fairly easily. Fortunately, (or perhaps unfortunately) adults usually do not get very sick from pertussis. Sometimes they will get the "100 day cough” where they feel like they will split a gut, but mostly it acts like a mild bronchitis and most patients never even get sick enough to seek care. If they do go in, the symptoms are often so mild that pertussis is never considered as a possibility. These adults then go out and cough on infants and children who are too young to have completed a full series of shots, and now you have outbreaks of potentially fatal whooping cough in infants and children, just like in the "old days”.

"On a positive note, supportive care for pertussis is much more advanced than in the past which means death due to the disease is very rare,” said Dr. Nemec. "That doesn’t mean pertussis shouldn’t be taken seriously. It’s not unusual for patients to be hospitalized due to the illness and some even need to be put on ventilators (breathing machines).”

Today, there are rapid tests for the germ which help detect pertussis in patients. There are also antibiotics that can decrease a person’s chance of spreading the disease, but according to Dr. Nemec, antibiotics help little, if at all, to treat the symptoms of pertussis.

"Antibiotics are prescribed to decrease the chance of epidemics and they are effective for that,” said Dr. Nemec. "They generally don’t help a patient feel better, but they do help make them less contagious.” Experts have also learned that booster doses of pertussis vaccines for adults replenish their immunity to the disease.

So what can the average person do to help? First, have your family physician check your shot record to see if you have had a pertussis shot in the last 10 years. It is almost always given as a combination vaccine with your tetanus shot (a Tdap vaccine), but was not routinely used until about 5 years ago. This is especially important if you are around infants or young children. Unvaccinated adults often unknowingly spread the disease to kids around them. By getting a vaccine when you are older, you are actually protecting others. If your last tetanus shot didn’t have pertussis in it, get a booster that does, even if you only had the shot a year or two ago. Second, if you have kids, make sure they are all up to date on their shots. Third, if you have a severe cough, a cough that comes in "spasms” (cough "attacks” interspersed with cough free intervals), or a cough that lasts over a week and is getting worse or not getting any better, see your family physician and ask about pertussis. If you have had close exposure for a prolonged time to someone who has a positive test for pertussis, you should also call your doctor, as you may be a candidate for preventive antibiotics.

"It is not likely we will ever exterminate pertussis,” said Dr. Nemec. "But if everyone gets their shots, watches for the symptoms and gets in early for testing, we can relegate whooping cough to the rare disease file.”

The Minnesota Academy of Family Physicians is a professional association of approximately 3,000 family physicians, family medicine residents and medical students organized to assist family physicians in providing quality medical care in Minnesota. The MAFP is the largest medical specialty organization in Minnesota and is a state chapter of the American Academy of Family Physicians, one of the largest national medical organizations in the United States with more than 103,000 members.

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