Long term effects of whooping cough in adults

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Children who survive a severe case of pertussis can suffer from long-term health and developmental problems, researchers reported in September.

In a study published in Public Health Reports, researchers in Oregon followed a girl who experienced a severe pertussis infection and hospitalization when she was three weeks old.

More than five years later, the girl lagged on developmental milestones and required substantial medical care, experiencing chronic lung problems, stroke, epilepsy, impaired neurodevelopment and vision problems.

“It’s been a while since anyone looked at all the impacts from severe pertussis,” said study co-author Paul Cieslak, MD, medical director for communicable diseases and immunizations at the Oregon Health Authority. “There’s some skepticism about how bad this disease can be, but a severe case of pertussis has consequences that last well beyond the coughing.”

Thanks to vaccines, U.S. pertussis rates have plummeted, down more than 80% since before a vaccine was available, according to the Centers for Disease Control and Prevention. In the pre-vaccine era, pertussis, also known as whooping cough, was a common childhood disease, with more than 200,000 cases every year. As of 2017, CDC reported about 19,000 cases of pertussis, though the agency warns that cases have been rising over the last few decades.

Babies are at greatest risk of infection and serious complications from pertussis, as they cannot be vaccinated against the disease until they are 2 months old.

Oregon continues to experience periodic pertussis outbreaks, according to the Public Health Reports study, with the last one in 2012 topping 900 cases. The Oregon child described in the study was born that year. She was admitted to the hospital with a pertussis infection three weeks after birth, staying there for 90 days, 75 of which were in a pediatric intensive care unit. In the years following her discharge, researchers chronicled a long list of ongoing care and complications.

Two months after discharge, for example, her medical records reported substantial lung scarring, likely related to a prolonged need for mechanical ventilation during her hospitalization. She later began treatment for ongoing respiratory problems at age 31 months.

At age 4 months, after neurological exams, she was enrolled in an early intervention program for children with developmental delays and disabilities. At age 1, records reported poor muscle tone and some difficulty with gross motor skills, including crawling and walking. She did not begin walking until after her third birthday.

At 4 years old, she began having seizures again, which had not happened since her hospitalization in 2012. At age 5, she began experiencing a series of vision problems and underwent two corrective surgeries. A neurodevelopmental evaluation at age 5 showed that she was functioning at the same level as a typical 1- to 3-year-old. By the end of the follow-up period — five years after being hospitalized with severe pertussis — she continued to need physical, occupational and speech therapy.

“The intensity of her care is an indicator of the severity of the (consequences of severe pertussis) and their high cost, both in dollars and in burden on her family,” the study stated.

Researchers said the child’s story underscores the importance of vaccinating women against pertussis during pregnancy, which allows antibodies to reach fetuses in the womb.

“It provides the baby with immunity right out of the gate,” Cieslak said.

The study cited prior research showing that vaccinating pregnant women with the tetanus-diphtheria and pertussis vaccine is highly effective at preventing pertussis and related hospitalizations among newborns.

CDC currently recommends that all women receive the Tdap vaccine during the 27th through 36th week of pregnancy.

Ceislak said he hopes fellow public health workers can use the Oregon study to help persuade obstetricians in their communities to add Tdap vaccination to their routine recommendations.

If a pregnant woman is trying to decide whether to be vaccinated, “this is another piece of data we hope will persuade her,” he told The Nation’s Health.

People born during whooping cough outbreaks are more likely to die prematurely even if they survive into adulthood, research at Lund University in Sweden has found. Women had a 20% higher risk of an early death, and men a staggering 40%. Women also suffered more complications during and after pregnancy, with an increased risk of miscarriage as well as infant death within the first month of life.

"The results show the importance of following up patients with exposure to whooping cough in childhood, particularly pregnant women," says Luciana Quaranta, the PhD candidate at Lund University behind the findings.

The landmark study used a globally unique database, the Scanian Economic Demographic Database, based on data from Sweden's extensive population registers. Quaranta mapped five communities between 1813 and 1968, in an effort to understand how conditions at birth, such as socioeconomic status and exposure to infectious diseases, affect us later in life.

Whooping cough, or pertussis, was widely considered to have been all but eradicated in many developed countries until recently. The UK, the US and Australia have all seen outbreaks of the disease in the past two years.

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