Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults

Dennis A. Brooks, MD; Richard Clover, MD


J Am Board Fam Med. 2006;19(6):603-611. 

In This Article

Abstract and Introduction


Pertussis is the only vaccine-preventable disease on the rise in the United States, with increasing incidence in adolescents and adults related to waning immunity. Although often considered a relatively mild infection in these populations, pertussis can be a serious, potentially deadly illness, particularly in children <12 months old. Infected adolescents and adults serve as a reservoir for disease transmission to young children and infants, who are most vulnerable to severe pertussis and its life-threatening complications. In 2005, the US Food and Drug Administration licensed two vaccines that contain tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis vaccine (Tdap), one for use in adolescents and the other for use in adolescents and adults. In light of these licensures, the CDC's Advisory Committee on Immunization Practices (ACIP) revised its recommendations for pertussis vaccination to include a Tdap booster dose for all adolescents aged 11 to 12 years as well as catch-up vaccination of those aged 13 to 18 years who did not receive the Td booster. The Committee also recommended a Tdap booster dose for all adults aged 19 to 64 years to replace the next Td booster dose, particularly for those who have close contact with infants <12 months old. In February 2006, the ACIP recommended a Tdap booster dose for health care personnel as soon as feasible. If widely administered, Tdap vaccination should have a substantial impact on pertussis.


Pertussis is a highly contagious, respiratory disease marked by severe and protracted coughing. Its common name, whooping cough, comes from the "whoop" sound often made when affected persons try to inhale during or after a severe coughing spell. Pertussis is caused by Bordetella pertussis, a small aerobic Gram-negative rod first isolated at the beginning of the 20th century. The organism produces multiple antigenic and biologically active substances that play a role in the clinical illness and elicit an immune response conferring immunity. Recent evidence suggests that immunity from B. pertussis infection, whether vaccine acquired or natural, is not lifelong. In fact, immunity may wane rather quickly, with protection minimal after 10 years.[1]

Pertussis is associated with substantial morbidity and mortality, especially among the very young and the very old, and imposes an economic burden. About 90% of pertussis-related deaths are in infants <6 months old.[2] Increased rates of pertussis-related hospitalizations in persons >50 years may be due to increased risk of pneumonia.[3] Mean medical and nonmedical costs per case in 2002 were $242 and $155, respectively, for adolescents and $326 and $447, respectively, for adults.[4] More than 60% of affected adults miss a mean of 9.8 days from work and over 80% of affected adolescents miss a mean of 5.5 days from school because of pertussis.[4]

Pertussis remains a public health concern despite availability of an effective diphtheria-tetanus-acellular pertussis (DTaP) vaccine for infants and children. Two pertussis booster vaccines were recently licensed in the United States for use in adolescents; one of the two is also licensed for use in adults. These vaccines may provide an effective method for reducing pertussis incidence, which has been on the rise for decades. The new vaccines combine the tetanus and diphtheria (Td) booster, long recommended for adolescents at 11 to 12 years of age, with acellular pertussis. The resulting booster vaccine (Tdap), therefore, adds no injections to the immunization schedule, while providing much needed protection against this disease. The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) has issued recommendations for Tdap vaccination of adolescents and adults.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.