CDC: Whooping Cough Is Back

Cases Rising -- but Often Not Recognized -- in Teens, Preteens

Medically Reviewed by Michael W. Smith, MD on December 22, 2005
From the WebMD Archives

Dec. 22, 2005 -- Whooping cough is making a big comeback, especially amongteens and preteens.

That's the word from the CDC -- and the disease-tracking agency says statesare woefully undercounting whooping-cough cases.

Even so, a report in the Dec. 23 issue of the CDC's MMWR shows thatcases are on the rise. Whooping cough -- pertussis, to doctors -- hit ahistoric low of about 1,000 cases in 1976. Since then, the numbers have beengetting much worse. In 2003, there were 11,647 cases.

But these numbers almost certainly are too low. For example, Massachusettstries much harder than other states to count cases. That state has only 2% ofthe U.S. population. But it reported 19% of all cases in kids aged 11-19.

"Awareness of pertussis in adolescents … is still low in manyplaces," notes a CDC editorial. "Massachusetts data are believed tomore closely reflect the pertussis burden in the United States."

In fact, a report earlier this year in The New England Journal ofMedicine predicted that about 1 million cases of whoopingcough occur among teens and adults in the U.S. each year. In olderchildren and adults, whooping cough may be mistaken for bronchitis.

Recently doctors realized that the childhood whooping cough vaccine wearsoff by adolescence. That leaves preteens and teens vulnerable to the disease --and able to spread the infection to their far more vulnerable infantsiblings.

Last summer, the U.S. recommended a whooping cough/tetanus/diphtheriabooster shot for everyone aged 11-18. It's hoped that this will reverse therising tide of cases.

A Nasty Disease

Whooping cough isn't pretty. The symptoms include violent attacks ofcoughing, often followed by vomiting. The "whoop" part comes when thecoughing attack subsides, and the patient finally takes a huge, whoopingbreath.

While deaths are rare, infants, particularly those who get the illnessbefore their first vaccination at age 2 months, are more susceptible. Despitethe rise in cases among teens, infants still bear the brunt of the disease.More than 90% of whooping cough deaths are in infants younger than 6 months.Three-fourths of whooping-cough deaths are in babies younger than 2 months.

Kids get a combination pertussis/tetanus/diphtheria vaccine at ages 2months, 4 months, 6 months, 15-18 months, and 4-6 years. The new shot should begiven at age 11-15 if it has been five years since the last booster.

"Ensuring high coverage with [tetanus/diphtheria/pertussis vaccine] inadolescents is an important step to better control pertussis in the UnitedStates," the CDC says.