Pertussis in adults

[ema-adama]

A fair amount of interest has been shown in the course of pertussis in adults.

I have read about the disease pertussis and the vaccine mostly from the perspective of protecting newborns and babies too young to have the full initial series. In my reading with this emphasis, adult infection was pretty much always referred to as atypical and the concern was that adults are acting as a silent reservoir of disease for those most at risk for serious complications - infants under 6 months of age.

I have read some literature specific to adults and there is some disparity between findings of studies. For instance, a study in Massachusetts found that pertussis was often rather sever in adults, with 84% of adults over 18 having a paroxysmal cough, and 54% suffering from post tussive vomiting (vomiting after the coughing fit). This is in contrast with a study in Japan where 7% of the adults experienced vomiting as opposed to 40% of the children experiencing vomiting. In the Japanese study, there was 100% paroxysmal cough in children and adults.

And there are many more studies besides these two.

I have started reading more on the history of pertussis in adults and am very open to discussion on the clinical course of pertussis in adults and factors that influence the course of the disease.

http://www.journals.uchicago.edu/doi/abs/10.1086/425006 You can click on the PDF and start reading there. Perhaps it would be a good place to start, if everyone starts looking at what Cherry has to say on the history of pertussis in the adult population, starting in the prevaccine/pre-antibiotic era.

I sincerely hope that those who decide to participate in this thread do so in the spirit of learning and not an attempt to push an agenda.

[carriebft]

I believe this study is very important in looking at pertussis in adults and the effect of the vaccine because they looked at every coughing episode these people had and found the vaccine to be very protective (63%+ depending on definition). It is important, like I said, because it is much less likely that they missed pertussis in adults in this study.

http://stg.jfponline.com/Pages.asp?A...uary_2006&UID=

I highly recommend taking a look at the full text.


Symptomatic pertussis in adults seems, to me, to be different than children pretty much in the whoop presence (not the prolonged coughing spasms since this seems to persist in adults as well) and also the increased likelihood of cracked ribs (6% in adults)-- this is because of a combination of things, I believe, one of which is that adults can talk about pain in ribs and have it diagnosed more easily. We can see this type of reason given in case studies of children with cracked ribs and why many are not caught. though I believe this is only one of the reasons that adults have more incidence of rib cracks.

[ema-adama]

I am surprised that there has not been more discussion. I was under the impression that this was a burning topic for some people.


The reason I put up the Cherry article on the history of pertussis in the prevaccine/preantibiotic era is that I thought it good to get an understanding of what Pertussis looked like in adults 100+ years ago. There is evidence that pertussis has always been an illness that presents in adults and that immunity has never been life long. Natural infection does not confer life long immunity.

In data available for Caucasians in the USA between 1917 and 1923, .5% of those who died of pertussis complication were over the age of 20. Clearly it was also a dangerous disease for adults, just not as dangerous. 95.1% of deaths were in under 5's.

From what I can understand in this paper, pertussis was mostly asymptomatic in adults who had previously had pertussis, with a persistent cough being the most common symptom.

Today I am quite sure that the epidemiology could be different. The population has changed considerably in the last 100 years, quite apart from the vaccine programmes. Perhaps adults are more at risk today than they were 100 years ago.

Carrie, how did you get the full article. When I downloaded the PDF, it was the abstract. In the abstract they mention that pertussis is on the rise in the adult population. I am not sure that the rise is adult infection is a true reflection of a 'new' phenomenon.

I am not convinced that vaccinating babies and young children interrupted the characteristic epidemiology of the disease, pointing to the the disease being endemic in the population. I would suspect that adults have been having pertussis for the last 100 years, whether they were vaccinated as children or not.

My question is how dangerous is pertussis for adults. There were anecdotal claims that it is a pretty horrific disease to experience as an adult. I have been under the impression that the risk of having adults with pertussis is that they transfer the disease to infants, not that they themselves are at risk for serious complications from the disease.

I have not read of 6% being a consistent number for cracked ribs. In Infection 23 (1995)No. 3 © MMV MedizinVerlag GmbH Mt~nchen,Mtinchen 1995, only one adult patient out of the 79 (1.3%) studied had a cracked rib. I know that this is a complication found in adults and children, but I do question how consistently 6% of adults with pertussis crack their ribs due to the coughing.

(sorry, the studies are PDF's and I am technologically challenged and have no idea how to link a PDF)

[karanyavel]

Aside from the same studies you folks have posted, all I have is a very recent anecdote.

DD (6 y/o) picked up pertussis, probably during a plane trip where she sat with another family. I caught it from her.

One notable thing about this incident is that we are both fully immunized against pertussis. No doubt my immunizations have long since worn off -- I haven't had any boosters. DD's, however, should be working... the most recent (she's had the full series) was a couple of years ago. My husband did NOT catch it, but he's younger and more recently vaxxed than I, so perhaps his are still working. I think he may have had a booster when he started college 4-5 years ago.

It was definitely unpleasant for both of us, but I wouldn't call it "horrific". The biggest issue was the coughing fits (paroxysms), mostly at night. There was a lot of lost sleep for everyone. It was milder for her than it was for me. Neither of us had the "whoop".

My case lasted around 8 weeks -- I'm just now getting over it -- and it was pretty ugly. During the first couple of weeks, I'd start coughing whenever I laid down and sometimes during the night. Occasionally during the day. Coughing fits generally lasted anywhere from a few minutes to an hour (!), and I usually vomited. I learned quickly to run to the bathroom and sit on the toilet with a bucket in front of me as I sometimes emptied both my stomach and bladder simultaneously.

After the first couple of weeks, a weird thing happened... I started waking up coughing every night at exactly the same time (4:30 AM). Otherwise, I was fine. The coughing fits were just as severe as earlier, complete with vomiting, etc., but only occurred once a day, usually for 30-45 minutes at a time (brief breaks between spasms of 5 or 6 coughs, so I did get a chance to breathe).

So yeah, I'd call it unpleasant, but it wasn't a harrowing, life-altering experience by any means. It sucked -- but I certainly never felt my life was in danger or anything like that.

I'm really curious as to whether this bout of pertussis conferred permanent immunity on me or not.

--K

P.S. No cracked ribs here, but I definitely coughed harder than I ever have in my life, and aside from the vomiting/peeing, I blew out a blood vessel in my eye.

[carriebft]

If you do not want to talk vaccine, then this thread will probably be moved to health and healing, I brought up the vaccine as per the guidelines for this forum, as well as the fact that the lessening of symptoms in the vaccinated would be a subject to talk about when disucssing severity in adults.

Also, experiences with disease will always be subjective. To one poster, an 8 week disease is "pretty ugly." To another, it may be described as "horrific" while to another it will be "mildly annoying."

I've seen moms here joke about kids vomiting after pertussis coughing spells (vomit and go on their way playing...with an lol smilie after) and other have described it as heartbreaking or horrible.

To get the full text, you could email a science blogger who has access. That is how I got to read it a while back. I believe I got it from justthevax but it might have been insidevaccines...

[mama1803]

Originally Posted by karanyavel

After the first couple of weeks, a weird thing happened... I started waking up coughing every night at exactly the same time (4:30 AM). Otherwise, I was fine. The coughing fits were just as severe as earlier, complete with vomiting, etc., but only occurred once a day, usually for 30-45 minutes at a time (brief breaks between spasms of 5 or 6 coughs, so I did get a chance to breathe).

So yeah, I'd call it unpleasant, but it wasn't a harrowing, life-altering experience by any means. It sucked -- but I certainly never felt my life was in danger or anything like that.

I'm really curious as to whether this bout of pertussis conferred permanent immunity on me or not.

--K

P.S. No cracked ribs here, but I definitely coughed harder than I ever have in my life, and aside from the vomiting/peeing, I blew out a blood vessel in my eye.

Similar experience thing here. I had pertussis about 4 (while in my mid 30s)years ago, while pregnant with dd. I had not been vaccinated since childhood. Ds who did have the entire series (back when we were vaxxing) did not catch it. Dh, who also had not been vaccinated since childhood, did not catch it.

Pretty mild coughing during the day, but at night the coughing always started at exactly the same time and was more severe than during the day. I would cough for between 1-2 hours (1:30-3:30 am) usually involving vomiting. I didn't crack a rib, but I did pull a muscle in my lower abdominal region.

The lack of sleep was the worst part, I was newly pregnant but didn't know it and was really tired all the time. I never felt like my life was in danger or anything. And I never felt really sick. It did start with cold like symptoms that lasted a few days before the coughing started.

[freestylemama]

My co-worker (a super healthy, active, fit woman who was 50) got it and was sick as a dog for 3 months. She missed 3 months of work and took a really long time after that to actually recover. I know another very healthy family (they're organic farmers for a living) who got it and they were sick for 2 months.


I know these are anecdotes, but these experiences were bad enough for me to take pertussis seriously and protect myself from it.

[japonica]

And we could talk about how vaccination programs have influenced the epidemiology...the bacteria have evolved and adapted not only to become more virulent, but they favor an older, previously vaccinated population:

http://www.ncbi.nlm.nih.gov/pmc/arti...7/?tool=pubmed

Since pertussis has shifted to older age groups [11,56] in immunized populations...it has been suggested that B. pertussis has adapted to the host population with waning immunity, in order to maintain the bacterial reservoir among older hosts [18,57].

Anecdotally, my DH had a Tdap in 2002 but had pertussis anyway this past March and gave it to our unvaxed 23 month old DS. Our unvaxed DD didn't come down with it for some reason and I believe I had some residual immunity from when I had pertussis in my late teens (fully vaxed, coughed for approx.8 weeks). My DH did not seek treatment...his coughing was pretty intense--enough to keep him up most of the night and he said his ribs ached. Back when I had it, I was put on three different types of antibiotic (one after the other) which did nothing to alter the "bronchitis" my GP called it. Neither of us cracked any ribs (that we know of), although we were both exhausted from the paroxysmal coughing, did have episodes of vomiting afterwards. My family did not know about any other treatments at the time, which was unfortunate, as I saw how my DS did benefit from SA during his bout. My DH took SA as well, but was not consistent, often forgot or skipped doses, so his recovery was not as smooth as it could have been.

From what I've been reading, the study linked above and another,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815961/

the pertussis strains have become more virulent as a result of vaccination programs, so the cat's out of the bag on this already (by that I mean the bacteria of 60 years ago is not the same as the ones circulating today--the first study linked noted this). And I don't see how a dedicated adult booster program will fundamentally change things in the long run. Yes, some adults may have a "milder" case due to a booster (that wasn't my DH's case unless the 8 weeks of intense coughing is the "mild" case), and the bacteria will inevitably evolve and adapt again, becoming more virulent and looking for another advantage in an "immune" population.

[Emmeline II]

Originally Posted by karanyavel

Aside from the same studies you folks have posted, all I have is a very recent anecdote.

DD (6 y/o) picked up pertussis, probably during a plane trip where she sat with another family. I caught it from her.

It was definitely unpleasant for both of us, but I wouldn't call it "horrific". The biggest issue was the coughing fits (paroxysms), mostly at night. There was a lot of lost sleep for everyone. It was milder for her than it was for me. Neither of us had the "whoop".

My 2yo also developed pertussis after a plane trip, and he had the proximal coughing, mainly at night. Last year he had respiratory symptoms from pinkeye and ended up using an inhaler for a week.

At the time ds had pertussis I was 5.5 months pregnant and had all the WC symptoms but I would not call it "horrific." I thought having walking pneumonia (college) and bronchitis (from ds' pinkeye last year) were worse experiences.

[ema-adama]

I think discussing the role of the vaccine in adult pertussis is relevant. Just not to the exclusion of the history of pertussis in adults.

I personally have always been worried about post tussive vomiting. Don't ask me why, perhaps the thought of my child becoming malnourished as a result of the illness freaks me out. Others worry about cracked ribs, and others don't worry about much at all.

As my anecdote. I had pertussis when I was about 5. I was not vaccinated. I was very mildly ill with it from what I remember, and was able to trigger the whoop by running outside while playing. I do not remember suffering (as opposed to measles, where I remember feeling pretty miserable). That was about 28 years ago, which makes me think I might have had pertussis perhaps twice since then. I remember having a prolonged cough at uni just over 10 years ago. Nothing irritating, just a dry cough that went on for months, coughing a couple of times a day.

All of that aside. I do think it is relevant to look at the epidemiology of the disease and to spot any shifts over time. From what I can tell from a very brief overview of some of the literature, natural immunity was never life long and this is something that appears to hold true also for the pre vaccine era. From clinical reports of +- 100 years ago, pertussis in adults was mostly an irritating disease, with prolonged cough being the predominant symptom. It could be today that adults are more at risk for complications than they were +-100 years ago.

To the PP whose husband had no symptoms. Not all adults infected with pertussis display clinical symptoms. Anywhere from 25 - 50% can be asymptomatic.

I'll email inside vaccines or just the vax about the article. I am not a huge fan of the DTaP or DTP () and think that there could be more hope for a future vaccine to be more effective at provoking not on a humoural immune response, but also a mucosal one.

I do think it would be interesting to explore any differences in clearance of pertussis between individuals who were first exposed to pertussis via the injected vaccine and those who were first exposed via wild pertussis. To the best of my knowledge this has not been studied. I think this could be particularly relevant to the priming of the immune system to ACT and not only PT.

[13Sandals]

I think looking at the adaptability of the bacteria is important, but I'm also interested in how the diagnosing of teens and adults has changed since it was admitted that vaccine (and past natural illness) does not confer lifelong immunity.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5722a2.htm

"In 2004, the reported incidence of pertussis in the United States nearly tripled compared with 2001, and the number of reported cases exceeded any year since 1959 (8). This increase might have resulted, in part, from increased use of more sensitive PCR testing"

However, PCR can lead to false positives....here a report of a pertussis outbreak (due to PCR testing) eventually determined not to be pertussis at all:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5633a1.htm

"By June, 134 suspected pertussis cases had been identified: 98 (73%) by positive or equivocal PCR results and 36 (27%) by clinical symptoms alone... A total of 192 nasopharyngeal swabs or aspirates from symptomatic HCP, including specimens from 27 (20%) of the 134 HCP with suspected pertussis, were submitted for isolation of B. pertussis by culture throughout the course of the outbreak; none yielded B. pertussis."

ETA: also in MA in 2006: "Of the 32 PCR-positive specimens submitted for culture, none yielded B. pertussis."

So when we are being told there is an epidemic and there are positive test results....we mostly never have enough information on how diagnoses are being made.

[karanyavel]

I've noticed a few studies say that pertussis tends to be more severe in adults than in adolescents. I wonder if that's a result of age or because the adolescents were immunized more recently. No idea, but anecdotally, DD (age 6) had a somewhat milder case than I did. She only had the post-tussive vomiting a few times, whereas I had it over and over and over again. As I mentioned in a previous post, neither of us had the "whoop".

One thing I think is interesting is that a few people in this thread have reported getting pertussis while pregnant. I am pregnant as well (2nd trimester when I got it, now almost third trimester). I wonder if our unborn babes are conferred immunity, at least for a while.

--K

[carriebft]

studies have gone both ways on that, but I think the newest ones are showing a trend towards the belief that there is some benefit to both immunization and actual disease, with higher benefit for the actual infection, UNLESS the disease comes in the 2nd half of the 3rd trimester, which has been associated with passage to the infant.

http://www.jstor.org/pss/30078015

[jellop]

I had pertussis a couple years ago. It was the most awful illness I have ever experienced in my life. I did have the classical 'whoop'. I coughed so hard I vomited frequently - I lost over 15 lbs throughout the course of being sick. My coughing fits were so severe that I was unable to drive because a coughing fit could strike at any time. There were many times I nearly passed out from not being able to get enough air during a fit. My eyes watered during coughing fits due to pain, and I handle pain well. At points, it was so horrific I honestly thought I might die. Even after a coughing fit, my breathing would be very labored and wheezy, and would take several minutes to ease. During that time, all I could do was focus on breathing - speaking was impossible.

It was just before my 30th birthday; I am healthy and active. I was immunized as a child, but haven't had any boosters since being an adult. I have a pretty good immune system, and rarely get sick. When I do get sick, it's usually a lot milder and shorter than what everyone else around me gets. But that - at it's worst it really knocked me on my butt HARD for a couple months, and I still wasn't free from it for a couple months after the worst of it.

[clutterwarrior]

I had WC (pertussis) at the age of 4, my mother told me that she accidentally forgot to get the last one of my vaccinations. I still remember how sick I was, and can remember vividly the violent coughing. I have had weak lungs all my life as a result...or so I have been told by many doctors, that my recurrent pleurisy and pneumonia attacks are due to a weakening of the lungs due to WC.

My 8 year old son has pertussis at the moment, and I thought I would be immune due to having had it as a child, but the doctor told me that it is possible, in fact not uncommon, to be reinfected, and so I am taking antibiotics for pertussis now, to prevent the germ spreading to others in the community in case I have it. I do have a bad cough so I may in fact have it already, but am not sick in the way my son is...he has been coughing so bad he finds it hard to get air to speak, and he is exhausted.

We have an epidemic of WC here on the East Coast at the moment, and they are encouraging adults who care for young children, either parents or grandparents, to have the booster by offering it for free.

[clutterwarrior]

Originally Posted by karanyavel

I wonder if our unborn babes are conferred immunity, at least for a while.

--K

Just by chance I read today that no, babies are not conferred any immunity from their mothers.

"A mother does not pass any protection against whooping cough on to her baby while pregnant or breastfeeding."

From: http://www.betterhealth.vic.gov.au/b...Whooping_cough

As they don't get immunised till 6 weeks old (here at any rate), that leaves them vulnerable for the first few weeks of life.

[carriebft]

I dunno if maybe the authors of that aren't looking at current research. They are finding some passage of antibodies in cord, placenta, etc and moms who have whooping cough during pregnancy are passing higher numbers and stronger immunity on to the baby for a longer period of time.

for example, a swedish study of 23 unvaccinated mothers who got pertussis in 2nd-3rd trimester found that their infants sustained antibodies for 14+ months, whereas others studies who looked at moms without the disease during pregnancy found passage of antibodies was sustained for only 4-6 weeks.

http://www.cdc.gov/mmwr/preview/mmwr...cid=rr5704a1_e

here as well are a lot of cited studies that find immunity transfer with much high numbers for mothers who have the disease (followed by those who are vaccinated during pregnancy)

http://linkinghub.elsevier.com/retri...73309907701135

[ema-adama]

I just noticed that I linked the wrong study in my OP.

The study that I wanted to link to was Pertussis in the preantibiotic and prevaccine era, with emphasis on adult pertussis. You can download the PDF from this link. If anyone is interested.