Prudence, Prevention and the Real-World Perils of Pertussis

It’s back-to-school time, so it’s back to wellness basics for our children.  One of the most effective ways we can keep our children healthy is to keep them up-to-date with immunizations. And one of the most important immunizations a child (and parents and grandparents) can get protects against pertussis, also known as whooping cough.

We’ve talked about this before, but it’s well worth discussing again.

Pertussis is a highly contagious bacterial disease that causes a severe and prolonged cough, so much so that it has been called “the 100-day cough.” It’s an illness that’s especially difficult – and even life-threatening – for infants who are less than six months of age. Infants with pertussis can get so exhausted from the steady coughing that feeding becomes too hard for them. When older children or adults contract pertussis, they can develop a cough that, while not life-threatening, can be severe and may persist for three long months.  A persisting cough may prevent adolescents from participating in sports for many weeks and the elderly have even been known to break a rib in a severe bout of coughing.

The need for booster shots

Antibiotics do not help reduce the severity of the illness or make the cough go away sooner, but do make the patient less contagious.

Pertussis vaccine is the best way to prevent pertussis. It is very effective in preventing severe disease, but somewhat less effective in preventing mild disease. Protection from the vaccine – or the disease itself – lasts no more than 10 years; that’s why we recommend booster shots.

The U.S. schedule for immunization recommends the following:

  • Three doses (DTaP) in the first six months of life
  • A booster at 15-18 months
  • A booster at 4-6 years of age
  • A booster (adult Tdap) in early adolescence between the ages of 11 and 12
  • Finally, a single dose of Tdap is also recommended for all adults and is particularly important during an epidemic.

Why is there an epidemic?

There’s been a lot of commentary about whether there’s an epidemic of pertussis. Across the U.S., there’s been a huge increase in pertussis, and public health authorties believe the size of the outbreak in Washington state deserves being called an epidemic.  We don’t know why this happening now, but do have some clues:

  • First, there is a cyclical nature to this disease. For some reason, it increases every few years.
  • Second, the vaccines we use today protect for a shorter period than did older vaccines. Since 1996, we’ve used what’s called an “acellular vaccine” that’s highly purified and causes fewer and milder side effects, but has shorter-lived immunity. Before then, we used a “whole-cell vaccine” that caused more severe side effects such as fever and seizures. We made the switch to acellular vaccines to avoid such reactions.
  • Third, despite the benefits of the vaccine and the dangers of the disease, there are a substantial number of people who hesitate to get their pertussis shots. Reasons why include: some people aren’t aware of the risk or the severity of the illness; others are fearful of needles and vaccines; and still others don’t know where to get the vaccine. The bottom line is that people may not have enough science-based information to objectively balance the benefits and risks of pertussis immunization against the risks of the disease.

Not just a child’s disease

It’s important to remember that pertussis isn’t just a child’s disease. It occurs all over the world – in both developed and undeveloped nations. Morbidity is highest where there are fewer resources to care for seriously ill small infants, but studies done over the past 70 years show us that pertussis affects people of all ages. Adults can get it at their work place, be it a factory, a restaurant, or a college.  Students can get it in school or at church. Here in Washington state, the peak attack rate has been among adolescents.

When someone has a long-lasting cough, we tend to think it is the flu, or walking pneumonia, or sinusitis – not pertussis. In mild cases, pertussis is indistinguishable from any other prolonged cough illness. In the past, confirming pertussis by swabbing the patient’s nasopharynx and growing the pertussis bacteria was difficult. But today, we can confirm  pertussis more easily than in years past without having to actually grow the bacteria.

This best way to protect against pertussis is to be up-to-date on your immunization, and to practice and urge those around you to practice good cough hygiene.

Immunization expert available for interviews

Edgar K. Marcuse, MD, MPH: Dr Marcuse is Professor of Pediatrics and Adjunct Professor of Epidemiology at the University of Washington and Associate Medical Director, Quality Improvement at Seattle Children’s. He is an academic general pediatrician with special interest in immunization (policy, practice, ethics, economics, and vaccinology) and quality improvement (application of lean principles, implementation of evidence-based medicine, and the impact of culture on quality).

Nationally, Dr. Marcuse has served as a member and Chair of the United States Department of Health and Human Services National Vaccine Advisory Committee, a member of the American Academy of Pediatrics Committee on Infectious Diseases (Red Book), Associate Editor of the Red Book, Chair of the American Academy of Pediatrics Immunization Advisory Team, a member of the CDCs Advisory Committee on Immunization Practice, a member of the Institute of Medicines Committee on the National Vaccine Plan and currently serves on the FDAs Vaccines and Related Biologics Advisory Committee. He has authored over 100 publications relating to immunization, general pediatrics, and public health.


  • For a Q and A on what parents need to know about pertussis, visit:
  • For more information about whole-cell vs. acellular pertussis vaccines, visit:
  • For more information about Washington’s pertussis epidemic, visit:
  • For more information about pertussis rates throughout the U.S., visit:


If you’d like to arrange an interview with Dr. Marcuse, please contact Seattle Children’s PR team at 206-987-4500 or [email protected].