You may have heard about the increase in pertussis (also known as whooping cough). It’s a bacterial infection that usually starts with a runny nose, fever, and cough. It develops into a raspy cough that actually sounds like a loud bark.
Pertussis is a highly contagious disease. People with pertussis usually spread it by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria, according to the U.S. Centers for Disease Control and Prevention (CDC). Many infants who get pertussis are infected by older siblings, parents, or caregivers who might not even know they have the disease. The symptoms usually develop within seven to 10 days after exposure, but sometimes incubation may take as long as six weeks.
Most commonly, pertussis affects children. “If you’ve ever seen a child with pertussis, you won’t forget it,” according to the American Academy of Pediatrics (AAP). “The child coughs violently and rapidly, over and over, until the air is gone from his/her lungs and he/she is forced to inhale with the loud ‘whooping’ sound that gives the disease its nickname. Then the coughing begins again.” These severe coughing spells can persist for weeks, says the AAP. The child might turn blue from lack of air, or vomit. A child with pertussis can have difficulty eating, drinking, or breathing. Infants with pertussis are often hospitalized to monitor their breathing.
Young infants are at the highest risk for complications. These can include pneumonia, seizures, brain swelling, and even death, according to experts at Brenner Children’s Hospital, at Wake Forest University in Winston-Salem, NC. In the U.S., the incidence of whooping cough peaks at 1 month of age and progressively decreases over the next year. Pneumonia is the most common cause of infant pertussis-related deaths. Most deaths occur among unvaccinated children or infants too young to be vaccinated.
Recent Outbreaks of Pertussis
Recently, at least six babies have died during pertussis outbreaks around the U.S. Visit the CDC’s Pertussis web page for information on currently affected areas.
The AAP recommends “cocooning,” a strategy that protects infants too young to be immunized, by having parents, siblings, and caretakers vaccinated against this disease. People over age 11 (and those over 7 in some states with outbreaks) who haven’t been vaccinated should receive one dose of Tdap vaccine. (Of course, all infants and children should already be receiving the vaccine on the recommended schedule.) And isolate infants from anyone with cough or cold symptoms.
Even with the success of pertussis vaccines, the disease is common, says the CDC. Many cases aren’t diagnosed and so aren’t reported. During 2010, several states have reported an increase in cases, and in the past five years, between 8,000 and 25,000 cases have been reported annually in the U.S. The CDC says cases tend to peak every three to five years, most recently in 2005.
Vaccines on Schedule
There are two types of pertussis vaccines: DTaP for infants and children, and Tdap for adolescents and adults. Getting vaccinated with Tdap is crucial for family members with, and caregivers of, new infants. The CDC recommends this schedule:
- Infants and children should receive five doses of DTaP: at 2, 4, and 6 months; at 15 through 18 months; and then at 4 through 6 years. Youngsters need all five doses for maximum protection.
- Adolescents should receive Tdap at their regular check-up at age 11 or 12. If teenagers (13 through 18 years) missed getting Tdap, parents should ask their doctor about when teens should get it.
- Adults 19 through 64 years old are recommended to get a one-time dose of Tdap in place of the Td booster they’re recommended to receive every 10 years. No need to wait until you’re due for your Td booster. The Tdap can be administered earlier than the 10-year mark since the last Td booster. Adults should talk to their healthcare provider about what’s best for their specific situation.
- Pregnant women should, ideally, receive Tdap before getting pregnant. Otherwise, it’s recommended that Tdap be given after delivery, before leaving the hospital or birthing center. If a pregnant woman is at increased risk for getting pertussis, such as during a community outbreak, her doctor may consider giving Tdap. Pregnancy isn’t a contraindication for receiving it, but a pregnant woman and her doctor should discuss the pros and cons of the vaccine.
- There’s currently no booster for those over 65. However, people in this age group can ask their healthcare provider if they should receive Tdap. Doing so may be important during a community outbreak and/or if the person is caring for an infant.
A New Vaccine Schedule
Despite the CDC’s recommended timing for infant vaccination, protecting very young infants from pertussis may be as easy as administering a routine vaccine two weeks earlier than usual, according to a new study by researchers at Wake Forest University School of Medicine and Vanderbilt University.
This two-week shift has the potential to prevent at least 1,236 cases of pertussis, 898 hospitalizations, and seven deaths each year in the U.S., says Timothy R. Peters, M.D., co-lead author and an assistant professor of pediatrics at Brenner Children’s Hospital.
“Rates of pertussis, which can be life-threatening in young infants, are increasing,” Peters says. “Pertussis vaccine has been highly effective in defending children against this disease, and we find that modest adjustments in the timing of vaccine administration may offer enhanced protection to very young infants, who are especially susceptible to severe disease.”
While there’s no lifelong protection against pertussis, immunization is the best preventive measure. The 2004 National Immunization Survey (the most recent statistics available) estimated that only 88 percent of infants had received one dose of DTaP by 3 months of age, 76 percent had received two doses of DTaP by 5 months, and only 66 percent had received the first three vital doses of DTaP by 7 months.
In the study, researchers estimated the potential benefit of moving first-dose administration from 2 months to 6 weeks of age. “While two weeks may seem negligible, this change would reduce the time that a 2-month-old infant is completely without pertussis vaccine protection by 25 percent,” Peters notes.
Although administration of the first dose at 6 weeks is a change from the current routine practice of administration at 2 months, accelerating it this much still falls within the current recommendations of the CDC’s Advisory Committee on Immunization Practices and the American Academy of Pediatrics for the childhood vaccination schedule, and should have little impact on medical providers or on the number of doctor visits for vaccines, the researchers report.
The Bottom Line
Talk with your child’s doctor about when to give this important vaccine to your infant. And ensure that you, your other children, and any caregivers are vaccinated as well.
Kathy Sena is an award-winning freelance journalist who specializes in writing about children’s health. Visit her blog at Bad Ballet.
