Pertussis: the other vaccine-preventable respiratory disease that we can’t get rid of.

This illustration depicted a three-dimensional (3D), computer-generated image, of a group of aerobic, Gram-negative, Bordetella pertussis bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery. (Source: CDC/Sarah Bailey Cutchin PHIL ID# 22874)

Let me tell you about how I got whooping cough. Actually, I don’t know how I got it. I just started feeling unwell one day, almost unnoticeably. I had a very low-grade fever and general malaise, but it lasted for a few weeks, so I made an appointment with a doctor. I had moved to Washington State six months before, and I didn’t yet have a GP. By the time my appointment came around, I had been coughing sometimes in the evening, coughing fits that were uncomfortable but not alarming. I was seen by a woman who took my temperature and looked at my throat, listened to my symptoms, and said “You have a virus. What do you want me to do? It will pass.” I was sent home.

In spite of widespread vaccination programs, which are effective in reducing serious disease in those most at risk for serious complications (children under one year of age), the currently-used vaccine is possibly not effective in reducing transmission, and vaccine exemptions given in some states means that herd immunity is now lower than it was after the initial vaccination drives. Some studies have cited the increased use of acellular vaccines, rather than the inactivated whole-cell vaccines previously used, as a possible cause of increasing infection rates. While it has more adverse side effects, the inactivated whole-cell vaccine has been shown to have a higher efficacy in preventing infection than acellular vaccines. In addition, immunity to the bacteria that causes pertussis wanes in the years following vaccination, and some countries have added booster shots to their vaccination schedules to counter this effect. As of 2015, the US recommends pertussis inoculation three times in the first year of life, once in the second year of life, and once more between the ages of 4 and 6, one in early adolescence, and one for women in the third trimester of pregnancy.

As predicted, my PCR test came up negative, meaning that my case would never show up in the data as a positive case, just as a suspected case. In 2002, the year I had whooping cough, 575 people were diagnosed with pertussis in Washington State, a three-fold increase from the previous year. Actual numbers are likely much higher. In 2012, there were over 900 diagnosed cases. In 2018, the most recently reported year, there were 630 cases of pertussis diagnosed. The numbers wax and wane as herd immunity varies. My case is not represented in the numbers. I was still given erythromycin, at the time the antibiotic of choice for pertussis, just in case there were any bacteria still in my system. Every time I took it, I had stomach aches and spiked a fever. Once my doctor changed me to azythromycin, which has since displaced erythromycin as the choice antibiotic to treat pertussis, the medicine-induced fevers stopped, but my condition didn’t show any rapid improvement. Of course, by the time my diagnosis had come, the bacteria had left my body and I was just left with the aftermath; the damage had already been done. After a few more months, my cough had faded, only to be replaced with asthma. My fatigue lasted for months, and the painful ribs for years, only to be re-injured in each of my pregnancies years later.

My husband never got pertussis. Or did he? Was he the asymptomatic carrier who gave it to me? Women are significantly more likely than men to be diagnosed with pertussis, but it is not entirely clear whether this is caused by increased exposure, higher diagnosis rates, chromosomal or hormonal differences, or some other factor. Pertussis is so contagious that up to 90% of susceptible household contacts acquire it from an infected person. Did I contract it from one of my students? Or one of my co-workers? Or somebody I passed by at the grocery store? I’ll never know. Studies have shown that immunity from vaccines provides greater immunity to the disease than infection itself. What I do know is that I’ll be getting my booster shots regularly.

Sources:

• Annual Communical Disease Report 2002, Washington State Department of Health

• Cherry, James D., et al. “Epidemic Pertussis in 2012 — The Resurgence of a Vaccine-Preventable Disease: NEJM.” New England Journal of Medicine, 30 Aug. 2012, www.nejm.org/doi/full/10.1056/nejmp1209051.

• 􏰚􏰝De Greeff, Sabine C., et al. “Estimation of Household Transmission Rates of Pertussis and the Effect of Cocooning Vaccination Strategies on Infant Pertussis.” Epidemiology, vol. 23, no. 6, 2012, pp. 852–860., www.jstor.org/stable/41739684. Accessed 11 Apr. 2021.

• 􏰞􏰎􏰚􏰟􏰖􏰏􏰠Epidemiological Alerts and Updates 2012. Annual Report 2012. Pan American Health Organization First Edition: May 2013. https://iris.paho.org/bitstream/handle/10665.2/50525/Reportepialert2012_eng.pdf?sequence=2&isAllowed=y. Accessed 10 Apr. 2021.

• Giovanni Gabutti, Chiara Azzari, Paolo Bonanni, Rosa Prato, Alberto E Tozzi, Alessandro Zanetti & Gianvincenzo Zuccotti (2015) Pertussis, Human Vaccines & Immunotherapeutics, 11:1, 108–117, DOI: 10.4161/hv.34364

• Kathryn M. Edwards, Michael D. Decker, 44 — Pertussis Vaccines, Editor(s): Stanley A. Plotkin, Walter A. Orenstein, Paul A. Offit, Kathryn M. Edwards, Plotkin’s Vaccines (Seventh Edition), Elsevier, 2018, Pages 711–761.e16, https://doi.org/10.1016/B978-0-323-35761-6.00043-2., (https://www.sciencedirect.com/science/article/pii/B9780323357616000432)

• “Signs and Symptoms of Whooping Cough (Pertussis) | CDC.” Centers for Disease Control, www.cdc.gov/pertussis/about/signs-symptoms.html. Accessed 13 Mar. 2021.

Fiction and Science Writer — just not science fiction.

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