Last night I was reading a book to my daughter at bedtime. It was all about a kid who had chickenpox. I looked at my wife and said, “this is a bit outdated.”

“So what, it’s cute,” she accurately replied.

Wow. I hadn’t thought about it much lately, but chickenpox in the U.S. is disappearing rapidly. “Pox parties” are gone. Kids aren’t missing weeks of school. Pediatric ICUs aren’t seeing much varicella pneumonia. Now that I think about it, a number of important lessons I learned in medical school are becoming historical oddities. On my pediatric rotation, we learned to watch for the ominous “thumb print sign” on lateral neck x-rays, along with the stridor and drooling that accompanies epiglottitis. Thanks to the Hib vaccine, this entity is now very rare.

Of course, these childhood diseases still exist. Mumps is still with us. Measles waxes and wanes. And pertussis (whooping cough) is alive and well.

In my work as an internist, I see a lot of coughs and colds. They are very common, and a lot of my time is spent dispensing grandmotherly advice and helping people understand why antibiotics are not going to cure a virus. But not every cough is completely benign, and much of the teaching I do is helping young doctors to distinguish the difference.

Over the last year, I’ve diagnosed around 4 cases of pertussis. Ideally this shouldn’t have happened. Pertussis is relatively harmless in adults, but it is very dangerous to young children. Pertussis used to be a widespread disease. It is fairly benign in adults, causing a bronchitis-like illness. But children are at high risk of becoming very ill. The greatest risk is for children under 6 months old. If they get pertussis, they almost always need to be hospitalized. Pneumonia occurs in about a quarter of them, seizures and brain damage in about 3-5%. Death rates are about 1-2 in 1000. Serious allergic reactions to the vaccine occur in less than one in 100,000 cases.

If you are unvaccinated and live with someone who has the disease, you will catch it (80-100% transmission rate). Vaccination prevents disease, and when it does not, it lessens the severity. Most importantly, vaccination prevents transmission to those most vulnerable…babies. They are too young to have developed proper immunity. So getting vaccinated is not just for personal protection; it is for the protection of others.

Vaccination is safe and effective…we already have a way to fight this. The problem is, the vaccine’s effects do not last forever, and if an adult catches it, it looks a lot like a common cold; there is no way to identify and isolate the infected to prevent transmission. Vaccinating everyone protects our most vulnerable, and failure to vaccinate everyone puts our infants at risk.

Since pertussis immunity wanes with time, a new adult vaccine containing acellular pertussis is now available bundled with tetanus and diphtheria (if you’re under 65). When you go for your next tetanus shot (every 10 years), ask about it. By vaccinating yourself and your family, you can help prevent a child from getting ill. You might even save a life.

CDC Pertussis Information

More pertussis information


6 responses to “Whoopie!”

  1. angrynight

    It is something we take for granted. Both my brother and I caught it together. More accurately I caught at kindergarten and brought it home. Our sister however, has never had it, and never will.

    On the other hand, my brother got shingles later at age 12, and it was one of the most painful experiences of his life. Though I suppose chicken pox was a fabrication, a cover-up for an environmental toxin that lead to allergic reaction. The kooks always have an answer.

  2. I think I may have had whooping cough about 10 years ago (age 47).
    Data point: Back in 2003 a coworker (53 at the time) caught chicken pox. He had never had it as a child.

  3. It’s funny, people remember chicken pox as being completely benign. I got it before a vaccine was available, and I remember people being upset about the vaccine as if chickenpox were a right of passage.

    Now, having acquired ITP after getting chickenpox, which for you non-medical types is bad, bad, bad, I have a different view about this right of passage. With ITP you basically run out of platelets due to an autoimmune reaction the infection sets off against them. I had bruises all over, even on my toes. I couldn’t go to school for months, play sports, etc and the only plus side was my brothers had a serious proscription against beating up their little brother for a time. A family member also got ITP after the same strain of chicken pox was hospitalized from bleeding.

    If I ever have kids they’re not getting to enjoy that right of passage.

  4. PKIDS is a national nonprofit whose mission is to educate the public about infectious diseases.

    Last year, they launched a campaign for teen and adult re-vaccination against pertussis: “Silence the Sounds of Pertussis.”

    The site is:

    I’d make my recommendation even stronger: If you have contact with infants and young children, don’t delay–ask your physician for a Tetanus-diphtheria-acellular pertussis (Tdap) booster shot. If you or your spouse are planning to have a baby, get yourselves the booster shot before the pregnancy begins.

  5. Old diseases fade away, but new ones shall replace them.

    The anti-vaccination campaigns are annoying. Here in the UK we have outbreaks of measles and mumps, two diseases we thought we would never see again, because concerned parents are refusing to have their children vaccinated due to that stupid autism scare. And elsewhere, a conspiricy theory about the vaccine being part of a western plot to sterilise muslim women is the only thing preventing the complete eradication of polio.

  6. I agree you should ask about new adult vaccine bundled with tetanus. I just got a tetanus booster and was going to be given the new acellular pertussis bundle but I declined for the following reason. As far as I know, it is unknown how long immunity to this pertussis booster lasts. This isn’t an issue in and of itself, but I am under the impression that you can currently only get this vaccine once. Again not a problem, however I may have more children in the future, so if in 6 years I have another child I want to have the opportunity to get the vaccine at that point. Thus, reducing the risk of me bringing pertussis into the house before this hypothetical infant is properly vaccinated. I would have taken the package deal if I was in frequent contact with young infants, but Im not so I begged off this particular bundle.

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