Is pertussis a frequent cause of cough in adolescents and adults? Should routine pertussis immunization be recommended?

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Abstract
For many years, it was believed that pertussis only affected infants and children. The diagnosis was never considered in adolescents and adults. Recently it has been reported as a cause of persistent cough in adolescents and adults, but actual disease rates have been extremely difficult to determine. Why has such a seemingly simple task been so difficult to accomplish? The major reason lies with the biology of the Bordetella pertussis organism itself. Most respiratory bacterial pathogens have short incubation periods, cause illness for a relatively short period of time, and are rapidly eliminated. Pertussis is much different. It has an incubation period measured in days to weeks, is extremely fastidious, frequently cannot be cultured, and causes a prolonged “one-hundred-day cough.” How the organism can produce such prolonged symptoms when it cannot be cultured remains an unanswered question, which highlights our poor understanding of its pathogenesis. These difficulties are further compounded in previously immunized adolescents and adults, from whom the organism can rarely be isolated, even early in the course of disease.

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