In the News

As reported by The Hartford Courant, October 19, 2006.

Illness Out Of The Past: Whooping Cough On Rise

By Kathleen Megan

Nancy Alderman was losing weight quickly in late summer and early fall, coughing relentlessly, unable to sleep or eat much more than soup. Yet she had no fever, no bronchitis or pneumonia. Blood tests and X-rays turned up nothing.

Six weeks into the coughing she went to a pulmonologist and the diagnosis surprised her:  whooping cough.

"I thought it was a disease of the past - like diphtheria," said Alderman, of Hamden. "I thought of it as something I didn't understand from a very long time ago."

Whooping cough, also known as pertussis, is back, and while once it was known mainly as a killer of infants, it is now infecting more adolescents and adults.

"The teenage years are actually the fastest-growing" group with the illness," said Dr. Scott Halperin, an expert on pertussis from Dalhousie University in Nova Scotia.

Halperin was invited by the Connecticut Thoracic Society to give the keynote at its annual meeting Wednesday night: entitled "Pertussis: An Infection for the Entire Family."

While usually not deadly in older children and adults, pertussis can, in a small percentage of cases, cause lifelong lung problems.

The illness is caused by a highly contagious bacteria called Bordetella pertussis, which infects the upper respiratory tract, mostly the windpipe or trachea and the bronchi.

The bacteria produce toxins that interfere with the respiratory tract, causing uncontrollable coughing and the narrowing of breathing tubes. The characteristic whoop is a gasp for air through narrowed breathing passages at the end of a long stretch of coughing.

This is particularly dangerous in infants because their airways are so tiny.

Dr. John Shanley, director of infectious diseases at the University of Connecticut Health Center, said that in 1945 there were more childhood deaths due to whooping cough than to diphtheria, scarlet fever, polio or measles combined.

The disease can be "very frightening for parents," said Dr. Brian Cooper, director of infectious disease at Hartford Hospital. "Kids turn blue and cough and cough and can't seem to catch their breath ... The kids who die basically suffocate."

Halperin said that in older children and adults the disease isn't always recognized partly because they may get it without the whoop. The cough can last six weeks or longer; it was often called "the 100-day cough."

As is often the case, by the time Alderman was diagnosed with the ailment, she had passed the worst of it. If the illness is caught extremely early, doctors can prescribe antibiotics for whooping cough, but rarely is it ever caught that soon because the early symptoms mimic a mild cold with a runny nose or low fever.

Once severe coughing has begun, antibiotics can stop the spread of the bacteria but cannot help the victim recover any more quickly.

The U.S. Centers for Disease Control and Prevention shows a steady climb in the cases of diagnosed whooping cough through the nineties. In 2000, 7,867 cases were diagnosed, but by 2004 that number had reached a 40-year-high of 25,827.

However, CDC experts say that many more adults - they estimate 600,000 between the ages of 20 and 64 - contract the disease every year but are never diagnosed.

In Connecticut, the annual numbers of cases diagnosed hovered in the 20 to 50 range, but in recent years have risen with 77 cases in 2003 and 86 in 2005.

Most recently whooping cough made headlines when more than two dozen medical workers at St. Vincent Hospital in Worcester were diagnosed with it.

Why does the diagnosis appear to be on the increase? Experts suspect it's a combination of an increase in recognition of the disease, fading immunity among adolescents and adults, and a pool of infants and children who are not immunized or are under-immunized.

As with any vaccination, the effectiveness of vaccines against pertussis wanes over time. According to the CDC, the vaccination against pertussis wanes five to 10 years after the last childhood immunization.

What to do about it? Because the disease is so rarely diagnosed early, experts say that prevention is the best way to go.

The CDC's advisory committee on immunization has recommended that adolescents and adults receive periodic shots to boost their immunity.

In 2005, the Food and Drug Administration licensed two new vaccines for pertussis. One is called Boostrix, manufactured by GlaxoSmithKline Biologicals for use in children ages 10 through 18. The other is called ADACEL, made by sanofi pasteur pharmaceutical company, for ages 11 through 64.

Shanley said the suggestion is that when adults receive a tetanus shot - about every 10 years - they receive a booster protecting them from diphtheria, tetanus and pertussis.

"I'm a strong advocate for adult vaccination," said Shanley. Unfortunately, he said, the adult health care system - unlike that for children - doesn't keep good track of adult vaccinations.