I had planned to write a followup post on personality psychology, but got sidetracked by a severe sore throat and a peculiar cough. I barked in a double rhythm over and over again. Three months ago I had an episode with a similar cough, was eventually diagnosed as having bronchitis and was treated with a short course of antibiotics. This felt more like a viral upper respiratory infection (URI), but I had problems swallowing (the med-speak term is dysphagia). I ate hard boiled egg whites and apple sauce and yogurt for the first two days of this illness. That was four days ago and I'm much better now; the sore throat is gone and last night I got eight plus hours of sleep, uninterrupted by any coughing spells. I have a virus, but there's been a lot of concern at the national level about several diagnostic possibilities that I turned out not to have.
The first issue to mention is pertussis, AKA whooping cough. When I had my similar episode months ago, the friends we were visiting in Washington asked if I might have whooping cough. They said their state was in the midst of a pertussis epidemic. Now I had thought of it as a). a disease affecting the very young and b). a thing of the past because of vaccinations.
It turns out I was wrong on both counts. The National Library of Medicine's website outlines the entity: it's bacterial, not viral, in origin, is a URI, lasts ~ 6 weeks, and is most dangerous to infants. But it can affect us at any age and with most youngsters being vaccinated it's more commonly seen in adolescents and adults (2012 estimates were 100 cases per 100,00). Its hallmark is a peculiar cough that starts when the infected person tries to take a breath and ends in a "whoop." That paradigmatic sound is rare in those under six months of age and in adults.
Whooping cough doesn't just affect Botswana
And, in contrast to my thought that pertussis was something that I studied in the 1960s, but of little consequence today, the CDC has a webpage on pertussis outbreaks that classify it as an endemic disease (i.e., one that's always around) that has moderate peaks every 3-5 years and some severe outbreaks.
I found an article online from the Huffington Post from July of 2012 that said yearly whooping cough cases, prior to the development of an effective vaccine in the 1940s, used to number in the hundreds of thousands . Then case reports fell markedly to less than 5,000 per year. That lasted about twenty-five years with a distinct climb in the 1990s. In 2004, 2005 and especially in 2010, case numbers soared to greater than 25,000.
The CDC's provisional figures for 2012 were much higher, over 41,000 cases with 18 deaths, mostly in infants younger than 3 months.
I remembered that the American Medical Association had recently urged that all adults 65 and older get an update on their vaccination for pertussis. The easiest way appeared to get a Tdap shot, a booster vaccination against tetanus (lockjaw), diphtheria and pertussis. My problem was I had a tetanus vaccination in April, 2012, after cutting myself on a piece of metal, but I'm pretty sure they used Td (i.e., a vaccine for tetanus and diphtheria, but not pertussis). That apparently had been the recommendation in past years for those of us over 65. I've asked my physician to track down which I received and will ask, if I did get Td, if it's safe to get Tdap now, nine months later.
Diphtheria, formerly a major killer of children, is now extinct or nearly so in the United States, with no confirmed cases here since 2003 (That's not the case elsewhere in the world!). So why don't they give adults a booster with "Tap," a tetanus and pertussis vaccine? Perhaps it's because adults often travel overseas and could conceivably be exposed to diphtheria.
This person may need a tetanus booster; how about Tdap?
A March 2012 American geriatric panel suggested it would be relatively simple to give older adults Tdap. It's also relatively difficult to diagnose whooping cough from other cough-causing diseases in older adults and pertussis can be dangerous in those over 65 according to a Duke University geriatrics professor.
Many of us in the 65+ age range have young grandchildren (or even great grandchildren) and should avoid infecting them with a serious disease. The Advisory Committee on Immunization Practices has advised we get Tdap when we need a tetanus booster and is looking into the possibility of giving it to those who've had a similar shot once before.