The highly contagious infection was once primarily a childhood illness–but it's on the rise in teens and adults.

By Amanda Gardner
November 28, 2018

Whooping cough used to be primarily a childhood disease–and one that was becoming less and less common. In 1976, there were only 1,000 cases of whooping cough in the entire United States. But today, there are close to 50,000 documented cases of whooping cough (also called pertussis) in the U.S. each year, and half of those are among adults and adolescents.

“Pertussis has become increasingly common in adolescents and younger adults,” confirms William Schaffner, MD, an infectious diseases specialist at Vanderbilt University Medical Center in Nashville.

There are different explanations for the trend. One is that the newer vaccine is less effective than the older one. “The old vaccine provided robust protection that went on for years and years [but] had many, many side effects,” says Dr. Schaffner. The newer vaccine has fewer side effects, but its protection starts waning as soon as five years after getting vaccinated.

A second explanation is that parents in some communities are also forgoing pertussis vaccination for their kids. Incomplete vaccine coverage means more adults and more kids can get sick, especially babies who are too young to get the vaccine and who are more likely to die of whooping cough.

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Whooping cough symptoms

While whooping cough in children and adults do share some similarities, signs of whooping cough can look different in adults.

“What might distinguish it from children is the severity and type of symptoms,” says Afaaq Siddiqui, MD, a family physician at Henry Ford Medical Center in Michigan. In general, adult pertussis is milder than in children, because an adult's immune system "is better equipped to handle infection due to the prior vaccine,” he says. In other words, the vaccine’s efficacy may fade, but it doesn’t disappear; it still confers some protection.

Whooping cough­–caused by the Bordetella pertussis bacterium–is so named because of the distinctive “whooping” sound patients make when trying to catch their breath after a long coughing spell. Adults are less likely to produce the actual “whoop,” especially if they have a mild case of the disease. (Some children also do not have this symptom). If adults do have this symptom, it’s–understandably–much easier to diagnose them with whooping cough, says Dr. Schaffner.

The early symptoms of whooping cough in both adults and children can look a lot like a cold or bronchitis: sneezing, runny nose, some coughing. But the cough soon takes over.

“The main symptom that can be seen in adults may be nothing more than a prolonged cough for a long duration of time,” says Dr. Siddiqui. “Long,” in this case, means at least two weeks–though a pertussis cough can linger for months. An estimated 10% to 30% of long-lasting coughs in adults are due to pertussis.

The coughs also usually happen several at a time, and they can be rough. “The cough can come during a meal, while you’re working, while you’re asleep, so they can be very intrusive,” says Dr. Schaffner. “They can interrupt your activities of daily living. They can make you very tired. These can be very debilitating.” In some cases, the coughing is so severe, people can even break a rib, he adds. Whooping cough can also lead to pneumonia, hospitalization, or, if you’re not getting enough oxygen due to a coughing fit, fainting.

Another classic feature of pertussis, vomiting after coughing, is less common in adults than in children, though it can happen at any age.

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Whooping cough treatment

There is treatment for pertussis–but a lot of the options just make you feel better while the infection runs its course. “Treatment is largely symptomatic,” says Dr. Schaffner. “We can give antibiotics, but they usually do not have a major impact.” Antibiotics can, however, prevent family members and other close contacts from getting pertussis themselves.

The pertussis vaccine is still the best prevention, especially because whooping cough can be contagious before any actual coughing starts. “Pertussis can be prevented by vaccination even though the vaccination is not perfect,” says Dr. Schaffner.

Children are protected through a series of five injections given between the ages of two months and 4 to 6 years. Doctors typically recommend adolescents get a booster shot at age 11 or 12 with the Tdap vaccine, which protects against pertussis, tetanus, and diphtheria. Adults 19 and older who did not get an earlier booster should also get Tdap.

After that, adults should get boosters with the tetanus and diphtheria (Td) vaccine every 10 years; some forms may also protect against whooping cough. Talk with your health care provider about the best vaccination schedule for you if you’re pregnant or you have contact with babies under the age of 12 months.

“Prevention is especially important in adults,” says Dr. Siddiqui, “as the symptoms are often less clear-cut.”

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