“Doctor, I cough until I vomit." The patient’s statement stopped me. This is a classic symptom of pertussis, also sometimes called "whooping cough." I had learned about it in medical school, but had never seen a case. It was a disease of the 19th and early 20th century, seen rarely in modern times--or so I thought.
Turns out, pertussis is again on the rise. The anti-vaccine movement, coupled with the current lower potency vaccine known as dtap (diphtheria, tetanus, and pertussis) and “waning immunity” among adults have combined to permit a resurgence of the disease. The pertussis bacteria may also be evolving to resist common antibiotics. Also, pertussis is a cyclical disease, meaning the number of cases rises for a number of years, then falls again.
Historically it is more of an annoyance than a danger to adolescents and adults, but can be a very serious, and even fatal, illness in infants. It can be easily overlooked by physicians, myself included, in the early stages because the symptoms are often the same as the common cold. The diagnostic nasal swab is often inaccurate and therefore unreliable.
What can you do to protect yourself and your family from Pertussis?
1. Make sure your vaccinations are up to date. ALL adults need a tdap vaccination at least every 10 years (ask about it--adult doctors are not as focused on vaccination as pediatricians).
2. Pregnant women need to be vaccinated in the third trimester of pregnancy if they are not up to date. The vaccine is not dangerous to the fetus. In fact, it will protect the fetus via transfer of maternal antibodies--both in utero and after birth via nursing.
3. If you have a persistent cough lasting more than 7 to 10 days, ask your doctor, “Could this be pertussis?” The honest answer should be, “I’m not sure.” The differential diagnosis of persistent cough includes bronchitis, asthma, pneumonia, tuberculosis, lung cancer, heart failure and a host of other possibilities besides pertussis. But the doctor owes you, at a minimum, consideration of the various possibilities and, depending on the circumstance, reasonable diagnostic testing and treatment.
The treatment for pertussis is macrolide antibiotics (typically azithromycin), which is NOT appropriate for viral respiratory infections or “colds”, but will definitely decrease the transmissibility of pertussis and, to a lesser degree, relieve the symptoms.
The patient in the first paragraph got a Z-pak and ultimately had a positive nasal swab for pertussis. I am now more alert for this “re-emerging” infectious disease.