Can pertussis affect older people and how does it manifest?
Pertussis is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. Though vaccination has dramatically reduced cases, the disease is still a significant threat, particularly to vulnerable populations. Among these are older adults, whose immunity from childhood vaccinations and past infections wanes over time, a process known as immunosenescence. This makes them susceptible to reinfection and subsequent severe illness.
Symptoms in older adults often differ significantly from those seen in infants and young children. Instead of the classic inspiratory "whoop," older adults may experience a prolonged, severe, and persistent cough that can last for weeks or even months. This atypical presentation often leads to misdiagnosis, as the illness can easily be mistaken for a common cold, bronchitis, or asthma. The persistent, violent coughing fits can be profoundly debilitating, interrupting sleep, and leading to considerable exhaustion.
The unique health risks of pertussis for older adults
For older individuals, the danger of pertussis extends beyond a simple, annoying cough. The forceful and frequent coughing can lead to serious physical and systemic complications, which are heightened for those with underlying chronic conditions such as asthma or COPD. Complications for older adults can include bruised or fractured ribs, pneumonia, dehydration, weight loss, loss of bladder control, and fainting.
Comparing pertussis in older adults vs. infants
| Feature | Infants (especially under 6 months) | Older Adults |
|---|---|---|
| Key Symptom | Apnea (life-threatening pauses in breathing), minimal or absent cough. | Prolonged, persistent hacking cough lasting weeks or months; "whoop" is less common. |
| Severity | Often severe, potentially fatal; hospitalization is frequently required. | Can be severe, leading to serious complications and prolonged illness; hospitalization can occur. |
| Risk Factors | Unvaccinated status, immature immune system. | Waning immunity from childhood vaccines, immunosenescence, and pre-existing health conditions (e.g., asthma, COPD). |
| Diagnosis | Often diagnosed based on clear symptoms and age, but can be difficult due to atypical presentation. | Frequently delayed or misdiagnosed due to atypical symptoms resembling other respiratory illnesses. |
| Complications | Pneumonia, brain damage, seizures, heart failure, death. | Rib fractures, pneumonia, dehydration, urinary incontinence, fainting. |
Diagnosis and treatment for older adults
Accurate diagnosis can be challenging and delayed in older adults because the symptoms are often not recognized as pertussis. When a healthcare provider suspects pertussis, they will likely use laboratory tests to confirm the diagnosis. The preferred method is a polymerase chain reaction (PCR) test using a nasal swab. Serology may also be used later in the illness.
Treatment primarily involves antibiotics, which are most effective when administered early. If treatment is delayed until the persistent cough phase, antibiotics may not alleviate the symptoms as the damage to the respiratory tract has occurred. In this later stage, supportive care is key, including rest, hydration, using a clean, cool-mist humidifier, and avoiding irritants.
Prevention strategies: The role of the Tdap vaccine
The best defense against pertussis for older adults is vaccination. The CDC recommends that adults who have not received a Tdap vaccine should get a single dose. After this initial dose, a Td or Tdap booster is recommended every 10 years. Vaccination is also important to protect vulnerable infants.
Conclusion
Can pertussis affect older people? Yes, and the consequences can be significant. Pertussis is not just a childhood disease; it presents a substantial health risk to older adults, particularly those with underlying health conditions. The illness can cause prolonged and debilitating coughing fits, leading to serious complications like pneumonia and rib fractures. Early diagnosis is often challenging due to atypical symptoms, emphasizing the importance of awareness and vigilance. The most effective preventative strategy is vaccination with the Tdap vaccine, which can significantly reduce the risk of severe illness and help protect vulnerable infants from infection. Older adults should discuss their vaccination status with their healthcare provider to ensure they have the best protection possible. For more information on adult immunizations, visit the {Link: CDC's adult vaccination page https://www.cdc.gov/vaccines/adults/rec-vacs/index.html}.
