Whooping cough making a comeback in Delco
Published: Monday, September 20, 2010
By ALEX ROSE
arose@delcotimes.comWith incidents of whooping cough on the rise, one Boothwyn woman is hoping medical personnel will keep an eye out for symptoms in an unlikely age group: Adults.
According to Jane Doe, whose name was changed for this story, her husband “John” started presenting cold-like symptoms in the last week of July.
John was coughing “nonstop, night and day,” but thought it was just allergies, said Jane.
By the time he got back from a business trip in California Aug. 11, Jane had to take her husband to the emergency room. He had called her during the trip gasping, struggling to breathe.
“It was a violent, choking cough where he actually would stand there trying to get a breath,” she said.
The emergency room doctor diagnosed John with bronchitis. But when he was later admitted to Riddle Memorial Hospital, Jane said his chest X-ray looked great. A pulmonologist agreed, she said.
“So they sent him home with inhalers, antibiotics, cough medicines, steroids,” said Jane. “I mean, all these hundreds of dollars of medicine that (were) doing absolutely nothing.”
John was still coughing, sometimes so bad he stayed up nights pacing for fear that if he fell asleep he might never wake up again.
So they went back to Riddle, where John was admitted, again, and had more tests performed. At one point, they thought it was acid reflux, said Jane, so John simply stopped eating. He lost 20 pounds, but he never got better.
The thing is, John felt absolutely fine throughout the whole ordeal, as long as he didn’t cough.
Last week, he went back to his pulmonologist, who did some blood work and sent it off to the labs at the Pennsylvania Department of Health.
A nurse there called Jane Thursday and confirmed what she had long suspected: John had pertussis, better known as whooping cough.
“That phone call I got from the Department of Health was the best news, because we finally got a diagnosis,” said Jane. “It was so good just having a diagnosis, and to know that he’s not contagious to anybody with this because he’s had so much antibiotics (treatment) … There’s nothing that can be done to help him at this point, it’s got to run its course.”
Jane said her husband is happy with the diagnosis and the couple doesn’t plan to try to recoup any money spent on doctors or treatment.
She just hopes his story will open some eyes to the possibility of adult pertussis when patients present respiratory problems, which can often go overlooked.
“Physicians, hospitals, emergency rooms — I want them to be more aware of the possibility of whooping cough,” said Jane. “It has to start with these doctor’s offices where people go first for help.”
Dr. Steven Ostroff, the acting physician general for the Pennsylvania Department of Health and director of the Bureau of Epidemiology, said misdiagnosis in adults is not uncommon.
“I think that many people have the impression that this is only an issue for kids and that’s not true, and the fact that it’s not true has implications in a couple of different ways,” said Ostroff. “One of them is that when adults become ill, it’s very uncommon for your health care provider to consider a diagnosis like pertussis in an adult, and the second is that … the signs and symptoms of pertussis in adults are not the same as they are in children.”
In adults, whooping cough can look like a cold or any of a wide variety of other respiratory infections, said Ostroff, and is very likely to be treated as such.
The Centers for Disease Control and Prevention in Atlanta said between 8,000 and 25,000 cases have been reported each year for the past five years, but most cases are likely unreported due to misdiagnosis.
And symptoms can linger long after the bacteria has been flushed from the system, said Ostroff, making it even harder to spot.
Jane said she was told John might have the cough for 100 days or more. Ostroff said that will vary by patient, depending on factors like underlying lung health.
“Usually, it doesn’t hang around very long, but the damage that it causes does, so you may be very symptomatic even though your body’s immune system has, for the most part, gotten rid of the bug,” he said. “The problem is that not getting diagnosed and not getting proper treatment increases the likelihood that that ill person spreads pertussis to others, some of which are kids and who will get the bad disease.”
Luckily, pertussis is bacterial, so a dose of antibiotics like the one John received isn’t the worst thing for it.
Department of Health spokeswoman Holli Senior said there have been 59 identified cases of pertussis in Delaware County this year, 31 of which occurred since June 30.
That spike prompted two recent public vaccination clinics at the county State Health Center in Chester and at Penn State Brandywine.
“The issue with whooping cough is once you begin to see it, it spreads so easily and so quickly,” said Senior.
Infants and children are recommended to receive five doses of the DTaP vaccine — which covers diphtheria, tetanus and acellular pertussis — at 2, 4, and 6 months, between 15-18 months, at 4-6 years and at age 11 or 12.
Senior said the effectiveness of the immunity tends to wane over time, which is why most cases appear in children ages 8 to 12.
But the danger in misdiagnosis comes when someone isn’t aware they have whooping cough and don’t know to stay away from children. Contracting pertussis can be fatal, usually due to complications from a secondary infection, like bacterial pneumonia.
At the very least, Jane said her husband certainly wouldn’t have gotten on a flight to California had he known what he was carrying.
“Even though they can’t do anything, you’ll stay away from little kids and old people,” she said. “You’ll stay away from people period, at least until you’re not contagious any more.”
The department is recommending adults receive an extra booster shot at least once in their adult lives in conjunction with regular tetanus and diphtheria inoculations.
Ostroff said the department has also put out alerts to health care providers and public health agencies to raise awareness about the uptick of pertussis activity in different parts of the state, including Delaware County.
“We’re hoping that we don’t continue to see an upward climb in the number of identified cases,” he said. “It’s floating around, so if you’re not up to date on your vaccinations, get vaccinated. It doesn’t occur just in kids.”
