FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TEENAGERS, NOT JUST INFANTS, NOW NEED WHOOPING COUGH SHOTS

Question: I recently took my 14-year-old daughter in for her regular check up, and the doctor gave her a new vaccine -- a tetanus and diphtheria booster with whooping cough vaccine added. He told me that this is a new booster shot and that adults will be getting it soon. Why is there such concern about whooping cough? I thought we gave that vaccine to babies.

Answer: Whooping cough is caused by a bacterium called Bordetella pertussis. Doctors, therefore, often refer to this disease as pertussis. Up until the 1940s when a vaccine was developed, pertussis was a major killer of children. The vaccine was very effective and save many lives.

In the last 30 years or so, however, we’ve seen a dramatic increase in the number of cases of the disease. In 1976 there were just over 100 cases of pertussis in the US, and in 2004 there were over 25,000 documented cases! Of those, more than 25 percent were in adults 19 to 64 years old. Many authorities feel the number of actual cases is significantly higher, and this disease is dramatically underdiagnosed.

In young children who have not been immunized, the disease begins like the common cold, but after a couple of weeks causes violent fits of coughing, punctuated by a “whooping” sound as the child struggles to breathe. Vomiting, dehydration and weakness are often present. Without treatment, the whooping stage can last a month and may end in fatal pneumonia.

In general this disease is less serious in adults and teens. It is also more subtle and harder to diagnose accurately. Often the sufferer will come into the office with cold-type symptoms –- accompanied by a dry cough. He or she usually doesn’t whoop or vomit. However, the cough may interfere with daily activities and sleep patterns, and may even be violent enough to break a rib. Though less frequently than in children, adults can also end up with pneumonia.

The biggest risk is that adults or adolescents with pertussis can transmit the infection to infants under two months old who have not yet been immunized. This is one of the main reasons that it is now recommended by the Advisory Committee on Immunization Practices (ACIP) that all adolescents between 10 and 18 be immunized against pertussis as well as tetanus and diphtheria. Your doctor was following good public health guidelines when he gave your daughter the adolescent vaccine.

A similar vaccine for adults aged 19 to 64 is under review by the federal government upon the recommendation of the ACIP. Final recommendations are anticipated in the near future. At that time, it is anticipated that this vaccine will become widely available for adults. It will be primarily recommended for those who will have close contact with infants less than 12 months of age, including women who plan on becoming pregnant. There will also be guidelines as to who should and shouldn’t get this vaccine. Information concerning vaccination of people of 65 or older is not available at this time.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.