Can Adults Get Whooping Cough?
Yes, adults absolutely can and do get whooping cough (pertussis), and it is more common than typically recognized—accounting for approximately 21% of adults with persistent cough lasting 2 weeks or longer 1, 2.
Why This Matters
Pertussis in adults represents a significant public health concern because:
- Adults serve as the primary reservoir for transmission to vulnerable infants, who face the highest risk of severe complications and death 1, 3
- The disease is frequently underdiagnosed in adults because they present with atypical symptoms, often lacking the classic "whooping" sound that gives the disease its name 4, 5
- Recent epidemiologic shifts show pertussis is increasingly affecting older age groups, with a post-COVID-19 trend toward cases in older persons rather than just infants 6
Clinical Presentation in Adults
The 2019 CHEST guidelines provide clear diagnostic criteria for adults 1:
Key Clinical Features to Assess:
High sensitivity features (rule OUT pertussis if absent):
- Paroxysmal cough (93.2% sensitive): Recurrent prolonged coughing episodes with multiple bursts of outflow and inability to breathe during spells
- Absence of fever (81.8% sensitive): Temperature ≤98.6°F (37°C)
High specificity features (rule IN pertussis if present):
- Inspiratory whooping (77.7% specific): Continuous inspiratory airway sound with whooping quality
- Post-tussive vomiting (79.5% specific): Vomiting induced by coughing
Critical Diagnostic Algorithm:
Consider pertussis LIKELY if:
- Post-tussive vomiting present, OR
- Inspiratory whooping present
Consider pertussis UNLIKELY if:
- Fever present, OR
- Cough is NOT paroxysmal
Important Clinical Pitfalls
Atypical Presentations Are Common
Adults frequently present without classic symptoms 4, 5:
- May mimic refractory community-acquired pneumonia
- Can present with severe complications including hemoptysis (40%), cardiac arrhythmia (40%), and syncope (60%)
- Clinical symptoms and lymphocyte counts do NOT reliably differentiate pertussis from other causes of cough 2
Diagnostic Challenges
- Culture and direct fluorescent antibody testing have poor sensitivity in adults 2
- Serologic testing is most useful: A single elevated antibody titer to pertussis toxin (PT) or filamentous hemagglutinin (FHA) at initial presentation identifies 81% of cases 2
- Metagenomic next-generation sequencing may be valuable when conventional methods fail 4
Treatment Considerations
- Macrolide resistance is emerging: 98% of strains in China show resistance, now spreading globally 6
- Alternative antibiotics may be necessary: Trimethoprim-sulfamethoxazole should be considered if macrolide failure occurs 4
- Early treatment is critical to prevent transmission, though it does not alter the clinical course once symptoms are established 1
Prevention Implications
Adults need booster vaccination, particularly:
- Healthcare workers exposed to vulnerable populations
- Adults in close contact with infants
- Pregnant women (during each pregnancy to protect newborns) 5, 7, 8
The resurgence of pertussis despite high vaccination coverage (84% globally) underscores that waning immunity in adults is a major contributor to ongoing transmission 6, 8.