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Vital Signs

Fall 2010

Vaccine Recommended in Wake of Statewide Whooping Cough Epidemic

VS-Fall10-Whooping CoughIn June, the California Department of Public Health declared an epidemic of pertussis, also known as whooping cough, amid indications that the state was experiencing its worst outbreak of the illness in 50 years. Through the end of July, approximately 1,500 children had been diagnosed and at least seven infants had died from pertussis, an illness caused by the Bordetella pertussis bacterium that infects the respiratory system. The number of cases more than quadrupled what had been reported in California at the same point last year. UCLA pediatric infectious-disease specialist James Cherry, M.D., explains what is contributing to the epidemic, and discusses the need for more vigilance in detecting pertussis cases and increasing the vaccination rate for adolescents and adults — especially those in close contact with newborns.

Why is California experiencing such an upswing in pertussis cases?
Pertussis was once extremely common — approximately 200,000 cases a year were reported in the United States in the 1940s, and it was a major cause of childhood illness and death, particularly among infants. A vaccine began to be widely used in the late 1940s, and since then the number of cases each year has been much lower. But we still experience up-cycles every two-to-five years, and the reason is a buildup of susceptible individuals: unvaccinated or partially vaccinated children. That’s what’s happening in California now.

Why are infants particularly vulnerable?
For one thing, infants can’t get their first vaccination until they are at least 6 weeks old, and they do not have adequate protection until about 7 months of age after they have received three doses of vaccine. But beyond that, pertussis in the first three months of life tends to be particularly severe. Because it often starts as a mild illness with little or no fever, it’s easy for parents to have a false sense of security. Too often, physicians don’t recognize pertussis until it has progressed, by which time it escalates rapidly, almost always requiring hospitalization for babies, and sometimes proving fatal.

How is it most commonly transmitted to infants?
It’s usually from contact in the household with a family member — most often the mother — who has a cough illness that has not been recognized as pertussis. This is why it’s so important that physicians do a better job of recognizing and treating pertussis, and that all appropriate people are vaccinated — particularly those who have contact with young babies.

What are the symptoms of pertussis?
Pertussis doesn’t typically involve a fever. The illness starts somewhat mildly and then frequently becomes a paroxysmal cough, in which you cough all of the air out and take a breath — the whoop of whooping cough. In adolescents and adults, it is always worse at night. And unlike bronchitis or other coughing illnesses, the cough isn’t productive. Adults will sometimes also have fainting spells and although they aren’t likely to die from it, the illness can be severe, including causing broken ribs in some persons.

VS-Fall10-Dr. CherryWho should be vaccinated?
Children receive the DTaP (diphtheria, tetanus and pertussis) vaccine as part of their routine immunizations. But since 2005, we have also had a booster shot (Tdap) for adolescents and adults with a special vaccine prepared for older persons. This is important because even if you have had the vaccinations in childhood, immunity wanes after about five years. The big push now is to get more people to use these adolescent and adult Tdap booster vaccines — in particular, women who are pregnant or have just given birth, along with the infant’s father, siblings and grandparents. This is known as a cocoon strategy and can prevent a good deal of early infant pertussis. Hospitals such as Ronald Reagan UCLA Medical Center, Mattel Children’s Hospital UCLA and Santa Monica- UCLA Medical Center and Orthopaedic Hospital have programs to provide routine vaccinations for postpartum women, and children born at these hospitals are much less likely to get pertussis as a result. Unfortunately, although the Centers for Disease Control and Prevention recommends the booster for adolescents at age 11 or 12, as of 2008 only 44 percent of California adolescents were getting it.

To what do you attribute the lower-thandesirable vaccination rates?
Certainly there are people who have misconceptions about vaccines, such as the concern that they might cause autism — a charge that has been completely disproven. Prior to 1995, there were some negative reactions to the whole-cell DTP vaccine, but the present vaccines have had the reaction-causing components of the old DTP vaccine removed, so that reaction — fever and redness, pain at the vaccination site — is generally mild and less common. Moreover, the preservative thimerosal, which is falsely linked to autism, is now not even in the vaccine. But fear of vaccines is probably only a minor player, especially since we are doing a very good job of immunizing young children — close to 90 percent. Certainly, if that rate begins to decline, we will have a major epidemic on our hands.

When to vaccinate
Six weeks old, but infants are not adequately protected until the initial series of three shots is complete. In addition, the series of shots that most children receive wears off by the time they finish middle school.

Who else should be vaccinated?
New mothers and family members who have close contact with infants should receive the Tdap booster vaccine. The California Department of Public Health also recommends that the adolescent-adult Tdap booster vaccine be given to:

  • Anyone 7 years and older who is not fully immunized, including those who are older than 64.
  • Women of childbearing age, before, during or immediately after pregnancy.
  • Other people who have contact with pregnant women or infants.

Where to receive the vaccine
The Tdap booster vaccine is being provided at birthing hospitals, including Ronald Reagan UCLA Medical Center, Mattel Children’s Hospital UCLA and UCLA Medical Center, Santa Monica, community health centers, Native American health centers and local health departments.

Source: California Department of Public Health

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