CDC: Whooping Cough Is Back

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

From the WebMD Archives

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

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

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

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

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

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

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

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

A Nasty Disease

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

While deaths are rare, infants, particularly those who get the illness before their first vaccination at age 2 months, are more susceptible. Despite the 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 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. The new shot should be given at age 11-15 if it has been five years since the last booster.

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

WebMD Health News Reviewed by Michael W. Smith, MD on December 22, 2005


SOURCES: CDC, MMWR: Morbidity and Mortality Weekly Report, Dec. 23, 2005; vol 54: pp 1283-1286. Recommended Childhood and Adolescent Immunization Schedule, United States 2005, CDC National Immunization Program. WebMD Medical News: "Adult Whooping Cough Cases May Hit 1 Million."

© 2005 WebMD, Inc. All rights reserved.