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Pertussis: Adults
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Pertussis is most contagious during its cold-like early phase. Most otherwise-healthy adults can eventually overcome the bacterium, but they can spread it to others. This "adult reservoir" of bacteria is often the source of new cases among youngsters.
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Pertussis starts as a mild, upper respiratory infection (a cold) - including sneezing, runny nose, fever and occasional cough. Within 10-14 days, the cough becomes more severe. Thick, sputum may be present. These symptoms may persist for one to two months, occurring frequently at night. Coughs often come in uncontrollable clusters and may cause vomiting. Adults rarely have the characteristic “whoop” with coughing.
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Adults and adolescents are the primary reservoir for pertussis. Pertussis is spread by contact with airborne discharges from the mucous membranes of infected people, who are most contagious during the catarrhal stage. Because the symptoms during the catarrhal stage are nonspecific, pertussis is usually not diagnosed until the appearance of the characteristic cough of the paroxysmal stage. Methods used in laboratory diagnosis include culturing of nasopharyngeal swabs on Bordet-Gengou medium, polymerase chain reaction (PCR), immunofluorescence (DFA), and serological methods. The bacteria can be recovered from the patient only during the first three weeks of illness, rendering culturing and DFA useless after this period, although PCR may have some limited usefulness for an additional three weeks. For most adults and adolescents, who often do not seek medical care until several weeks into their illness, serology is often used to determine whether antibody against pertussis toxin or another component of B. pertussis is present at high levels in the blood of the patient.
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One of the best ways to help protect your teen against pertussis is the new Tdap vaccine (Tetanus, diphtheria, acellular pertussis). The FDA approved the Tdap vaccine in 2005. It is a vaccine created for teenagers and adults to prevent three different bacterial infections: tetanus, diphtheria, and pertussis. Tdap is a booster shot, meaning it will help teens’ immune system fight against infection only if they have received the first group of pertussis shots, called DTaP (Diphtheria, Tetanus, acellular Pertussis), when they were younger.
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Estimates vary regarding how frequently pertussis is the causal agent when a person suffers prolonged cough. A recent report reviewed 13 studies carried out since 1987 addressing pertussis frequency among adolescents and adults. Results varied widely due to the criteria used to assign a diagnosis of pertussis and whether the study was performed during a pertussis outbreak. Among studies done when no known pertussis outbreak was occurring, an estimated 12% to 50% of chronic cough illnesses were associated with pertussis infection. When only the most specific diagnostic criteria were used in non-outbreak settings, a median 13% of chronic cough illnesses were due to pertussis.2
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Anyone can get pertussis. Babies are at greatest risk since they are not completely protected from pertussis until they get all their pertussis shots. By 15 to 18 months, a child should have received four pertussis shots with a fifth one just before starting school (see glossary item: DTaP). Teenagers and adults are ... at risk because the protection from these early vaccines wears off over time. Anyone living or spending time in close quarters, such as in college dormitories or in classrooms, is at risk for getting pertussis because it is so easily spread from person to person.
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