The sound of coughs you will hear in the upcoming months will be caused by various respiratory bugs. Some of these bugs are common, such as the common cold, COVID, the flu, and more recently, respiratory syncytial virus (RSV). However, an increasing number of coughs will be due to the bacterial infection known as pertussis, or whooping cough. This infection can be a severe experience, especially for babies who may not be strong enough to endure the intense chest spasms it causes. While it rarely leads to fatalities, it can result in infants requiring hospitalization.
The pertussis vaccine has been included in routine child immunization schedules for many years, leading to a 90 percent decrease in cases compared to the pre-vaccine era. The incidence of this infection dropped significantly during the COVID pandemic, but cases are now on the rise again, with over 16,000 reported cases in the U.S. this year as of September 28. This number is more than four times the total reported cases at the same time last year.
Pertussis, caused by a bacterium called Bordetella pertussis, spreads easily through direct contact or droplets from an infected person’s mouth or nose. The bacteria settle in the respiratory tract, where they produce toxins that cause the most harm during the infection. Early administration of antibiotics is crucial in managing the disease, as it prevents the bacteria from producing large amounts of toxins.
The initial stage of pertussis infection can be mistaken for other respiratory illnesses, making early treatment challenging. In healthy adults, pertussis may only result in a lingering cough, while older children may exhibit nonspecific symptoms like a runny nose and cough. However, the infection is highly contagious, and even individuals with mild symptoms can spread it to vulnerable groups such as young children and the elderly, who may develop severe cases.
Severe pertussis disease is characterized by intense coughing fits followed by a distinctive whooping sound as the individual inhales forcefully to catch a breath. These coughs can be severe, often leading to vomiting. Infants are particularly at risk because they may struggle to breathe through their mouths, exacerbating the effects of intense coughing. Treatment involves keeping patients hydrated with intravenous fluids and providing breathing support.
Even after the whooping cough phase subsides, the infection lingers, causing a persistent cough that can last for months. Antibiotics are ineffective during this recovery period as the bacterial toxins have already caused significant damage. The reported cases of pertussis in the U.S. this year may be lower than the actual number due to many minor infections going undiagnosed.
The recent increase in pertussis cases is not limited to the U.S., with countries like England reporting high numbers as well. Vaccination is crucial in preventing the spread of pertussis, with the current acellular vaccine being used in the U.S. The vaccine, while safer than previous versions, may not provide as strong or long-lasting protection. Vaccine uptake is highest in children and teenagers but lower in adults, with only around 40 percent of adults receiving a Tdap vaccine or booster in the past 10 years.
Low vaccination rates in adults pose a risk of transmitting the bacterium to vulnerable populations, such as young children. Pregnant individuals are advised to receive the Tdap vaccine during each pregnancy to protect their newborns until they are old enough to be vaccinated. Increasing vaccine uptake among adults is crucial in preventing the spread of pertussis and protecting vulnerable populations from severe infections.