Latest / Culture Positive: An Infection Prevention Podcast / Case Files: The Kissing Cough
Transcript
- Ally: Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each week, We'll dive into healthcare stories, public health conversations, workplace realities, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. I came across an interesting article the other day from the Washington Post. Fighting measles is expensive. See what it costs to contain 10 cases. This particular measles outbreak involved just 10 cases, but state and local public health agencies in Colorado spent nearly half a million dollars responding to it. Investigators logged thousands of hours tracking exposures, reviewing records, identifying possible exposures, coordinating testing and monitoring people who needed to quarantine. Ten measles cases led to 91 people quarantined, 68 tests ordered, and 512 days of school missed by infected students and those who needed to quarantine. This article gave a nice glimpse into the behind-the-scenes work that goes into an investigation and the steps taken to try and contain an outbreak. And it got me thinking: I've worked on my fair share of investigations over the years. So I thought, why not take you behind the scenes? Welcome to Case Files, a new series where I'll walk through an investigation, outbreak. Or interesting infectious disease case that I've encountered during my time as an infectious disease epidemiologist and infection preventionist. And for our very first case file, I'm taking you back to when I was working as an infectious disease epidemiologist. What started as an increase in cases turned into a pretty interesting investigation. Join me in being a detective. We're opening the first case file, the kissing cough Let's get into it. Pertussis, also known as whooping cough, Is a respiratory illness caused by Borditella protussis bacteria. Symptoms usually appear about 7 to 10 days after exposure, but symptoms can appear from 4 to 21 days after a person is infected. It is rare, but it can take up to six weeks to develop symptoms. Some people have milder symptoms, which can lead to individuals spreading pertussis without even realizing. We can typically batch symptoms for protussis into three different stages. Stage one lasts around one to two weeks, with symptoms reported to be runny nose, sneezing, low grade fever, mild cough. a lot of times it appears like a common cold. But when the cough changes, is when protesses should come to mind. Stage two can last for one to two months. The cough becomes more severe and can cause coughing fits, which can lead to a high-pitch whoop. The whoop noise is from someone trying to catch their breath. This is where we get the nickname whooping cough for protesses. You might have noticed that I called the episode the kissing cough. That will make more sense later. The final stage of symptoms can last weeks to months. This is the recovery phase when a person slowly gets better. This could be recovering from intense coughing fits. Some people even experience bruised ribs from all the coughing. A population we are very worried about in regards to protussis are infants, especially those under six months old. Reported outcomes from protussis infections for infants. Can include pneumonia, ear infection, slowed or stopped breathing, dehydration, seizures, and brain damage. Oftentimes, if teens or adults get protesses, they are able to recover without issues. How does pertussis spread? This pathogen spreads person to person via particles in the air. If someone who is infectious coughs or sneeze, particles float in the air, and if you are close enough in vicinity, you can breathe in the bacteria. Think close shared spaces. It can also pass through direct contact with infectious mucus, like kissing or shared items like drinking cups. The tough part about protussis is the period of time an individual is infectious for. A person with whooping cough can pass it to others as soon as they get cold like symptoms. an individual with protussis can also be infectious for up to three weeks after they have started coughing. If the infected person takes an appropriate antibiotic, however, they will not spread protussis after five full days of treatment. We are coming up on respiratory season, so just a friendly reminder about respiratory etiquette. Firstly, please cover your mouth and nose anytime you sneeze or cough. Even working in a hospital, I see grown adults not covering their mouth or nose. Please, please, please cover your mouth and nose. If you do not have access to a tissue, use your elbow and cough or sneeze into your inner elbow. Wear a mask if you are out in public and not feeling well. And finally, I'm sure no surprise to anyone, wash your hands. Okay, I'll get off my soapbox about respiratory etiquette, but please don't be a part of spreading respiratory diseases. Luckily, we do have a vaccine for protussis. This is the best way to prevent getting that dreaded whooping cough. This particular vaccine is what we consider a series, meaning multiple shots are given at different times. The vaccine for protussis is known as TDAP. TDAP not only protects you from protussis, but also diphtheria and tetanus. This is a childhood vaccine and the typical schedule for kids to receive TTAP is the following. At two months, four months, six months, fifteen to eighteen months, And 4 to 6 years old. For TDAP, booster shots are also recommended. I think booster vaccines have become more socialized with COVID-19, but booster shots essentially help strengthen your body's immune system to help fight off the pathogen. In this case with TDAP, booster shots are recommended to the following populations. Protection for protussis vaccine tends to fade by age 11. So, healthcare experts recommend a shot of TDAP at 11 or 12 years old. It is also recommended that pregnant women between 27 and 36 weeks of each pregnancy receive TDAP. This may also give some protection to an infant during their first few months of life. A TDAP or TD booster every 10 years for adults is also recommended. If you receive TDAP once as a teen or adult, Subsequent ten year boosters can either be TDAP or DT, DT covering tetanus and diphtheria. Since we have a vaccine for protussis, there aren't a lot of cases nationwide, right? Well, that was true several years ago, but not anymore. In 2025, there were nearly 29,000 cases of whooping cough in the United States. The highest number of cases since 2012. Why, you may ask? Part of this is due to vaccine hesitancy. Of the children under six years who contracted whooping cough in 2025, only one in five had completed their primary series, three or more doses of the vaccine. Recently released data from Centers for Disease Control indicates that vaccination coverage among infants and young children is below targets in many states. Among children who were two years old at the time of the 2024 National Immunization Survey. National level coverage for four doses of vaccination were estimated to be 80.9%. For herd immunity for protussis, we need about 92 to 94% of a population vaccinated. Herd immunity being when the majority are immune in this case. via vaccines, the infection is not able to spread. Having such a low vaccination coverage, especially for little kiddos, is troubling. It might be helpful if I can try to communicate how infectious pertussis is. Us science nerds utilize an R naught. R naught is the average number of people infected by one sick individual. For example, the seasonal flu has an R naught of around two. So one sick person with the seasonal flu typically infects two other people. For protussis, it's a very different story. If we have one sick person with protussis, it is estimated that one person will infect twelve to seventeen other people. That is a very high R naught. And as you can imagine, one case of pretussis can easily lead to an outbreak in no time. so now that we know a little more about protussis, let's get into what actually happened when we started seeing those cases increase. Let's dive into our first case file, the kissing cough. Protussis is a reportable communical disease, meaning cases are reported to health departments and the CDC. Every health department is set up a little differently, but where I worked, we would be notified when someone had a positive lab result. From there we would try to reach out to the person who was sick or their caretaker to ask a few questions. It's Nancy Drew time. During surveillance and investigations conducted by epidemiologists at both the city and state health departments, we started noticing a trend. Protussis cases were increasing. When we took a deeper dive into the data, it became clear that we were seeing an increase among young adults. Think college students and recent college graduates. During a protussis investigation, It's important to gather as much information as possible. When did you first start feeling sick? Have you been around anyone else who was sick? Do you have any roommates? Have you traveled recently? The goal is to pull all of these pieces together to try to figure out what might be happening and ideally how the disease is spreading. So, how was Protussis spreading among the young adult population? After conducting multiple interviews and comparing the information we collected, we started to see a pattern. Not everyone we interviewed went to the same school. Not everyone had a history of travel. Some people couldn't remember exactly when their symptoms started, but a lot could remember one thing. They had recently been out in South E. If you're not from Boston or never lived there, let me set the scene for you. Southie is one of those Boston neighborhoods where you can still sometimes hear that beautiful old school Boston accent. Not a lot of things make me happier than hearing that. Southie is also home to a large population of young professionals. And college students. It's also famous for hosting one of the best St. Patrick's Day parades. So people were having a great time in Southie, going out, going to bars, and unfortunately spreading protesses. For an epidemiologist, being able to identify a common location or activity among cases can be a very exciting moment in an investigation. it gives you a potential clue about where transmission may be occurring and importantly where you can focus your public health response. and in this investigation, Southie became that focus. Part of working in public health and healthcare is educating people. So they have the information they need to protect themselves and others. In this case, we needed to reach a population that probably wasn't going to be sitting around waiting for the latest public health announcement on the local news channel. So, we went to them. Information about protussis, including how to protect yourself, how it spreads, and what to do if you become sick, was posted throughout Southie neighborhood. Public health education made it to the local bar scene in Southie. And after the education and outreach efforts, the number of protussis cases decreased. Protussis became known as the kissing cough in this investigation. And as we close the file on this case, there is an important lesson to take away. Understand the population you are working with and meet people where they are. For our huddle corner, a section for some takeaways before signing off. Pertussis, aka whooping cough, can be a really tough infection to get. From infants to adults, it can be a virus that has symptoms for weeks to months and can cause more severe outcomes for our most vulnerable. Luckily, we do have a vaccine. TDAP might be a good time to check in on your own vaccine history as we are headed into the respiratory season. This is also the first of hopefully many episodes in Case File series. Marianne, I heard you wanted an episode like this. Let me know what you think. You never know where an investigation might lead you. You could end up posting education. on Protussis in a local bar. If you have any interesting investigations to share, I would love to hear them. Email me at culturepositivepod at gmail.com or message me on Instagram at culturepositive pod. Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at CulturePositive Pod at gmail.com. You can also Thank you for listening to Culture Positive. If you have any questi Nope. find me on Instagram at CulturePositive Pod. Please like, share, and review the podcast wherever you listen. References for the episode can be found in the notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious, stay compassionate, and keep building a culture that's truly positive.