Tag Archives: pertussis

Have You Had Your Pertussis Vaccine?

As the North Pacific Pediatric Society’s annual meeting got underway recently, organizers invited Dr. Maxine Hayes of the Washington State Department of Health to the podium to deliver a special – and urgent – message.

Dr. Maxine Hayes (Sherry Boschert/IMNG Medical Media)

Her plea to pediatricians: Make sure that you, all of your staff, and your patients have been immunized against pertussis. Not only was the Society meeting during National Infant Immunization Week, but Washington State had just recorded its 1,000th case of pertussis in 2012, with 61% of cases in school-age children, she reported.

“It’s the worst we’ve seen in six decades,” Dr. Hayes said. “If infections continue at this rate, we’ll have more than 3,000 cases by the end of the year.”

Washington State had 1,008 reported cases of pertussis by April 21, 2012 – nearly 10 times more than the 110 cases reported during the same period in 2011, according to the U.S. Centers for Disease Control and Prevention. There are more pertussis cases in the state already for 2012 than there were in all of 2011 (965 cases) or all of 2010 (608 cases).

The Washington epidemic follows on the heals of a 2010 outbreak of 9,143 cases in California – the most in 63 years – that killed at least 10 infants.

My colleagues at IMNG Medical Media have been following the story, with multiple reports. The California epidemic probably was due to the waning immunity of the tetanus-diphtheria-acellular pertussis (Tdap) vaccine. Tdap vaccine is recommended for all health care workers.

And it’s not just for kids, health care workers, and medical office staff. If you’re a physician who treats adults, you should know that older adults need the Tdap vaccine too. Even pregnant women should be vaccinated.

When Dr. Michael E. Pichichero randomly asked 10 pediatricians if they’d had the Tdap vaccine, 8 of them said no, with some pretty weak excuses, if you ask me.

“I know that there are people in this room who have not had their Tdaps,” Dr. Hayes said with an accusing smile. “I also know that in busy practices, you have people in and out every day that have not had their Tdap. I’m calling on you to really get on it.” Make sure that your emergency rooms have Tdap in stock, too, she added.

“And if you’re not in Washington, don’t be smug about this, because you could be next,” Dr. Hayes said. Her public health colleagues in Oregon State are taking this so seriously that they’re planning to open pertussis booster clinics, she noted.

–Sherry Boschert (@sherryboschert on Twitter)


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A Call for Timely Diagnosis of Pertussis

Image via Flickr user Pink Sherbet by Creative Commons License.

The pertussis outbreak in California shows no signs of slowing.

According to the California Department of Public Health, as of Sept. 7, 2010, there have been 3,834 confirmed, probable, and suspect cases of the illness reported in 2010, for a state rate of 9.8 cases per 100,000. That translates into a sevenfold increase in the number of reported cases during the same time period in 2009.

This marks the most cases reported since 1958, when Dwight D. Eisenhower was president. 

The situation is so shaky that, on Aug. 19, the state’s immunization branch chief, Dr. John Talarico, sent a letter to physicians and hospitals statewide, urging them to treat anyone under the age of 6 years who presents with trouble breathing as whooping cough until proven otherwise. To date, 8 infants have died from the disease. 

“A common theme among the infant deaths is that pertussis was not typically diagnosed until after multiple visits to outpatient clinics, emergency departments, or other health care facilities,” Dr. Talarico wrote. “In several cases, the infant’s symptoms at the time of examination were not highly suggestive of pertussis and the infants were treated only for nasal congestion or mild upper respiratory infection. By the time these infants developed severe respiratory distress, it was usually too late for any intervention to prevent their tragic deaths.” 

For a reminder of what whooping cough sounds like, give this file a listen.

— Doug Brunk (on Twitter@dougbrunk)

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Whipping Whooping

1945 ad for Parke Davis and Company Pharmaceuticals. By Flickr Creative Commons user Stuff About Minneapolis

Whooping cough is on the rise.

California, Texas, South Carolina, and other states are seeing significant increases in the disease this year. The situation is especially grave in California, where six children have died of the fully preventable respiratory illness, and nearly 1,500 more have been sickened by it.

So what’s going on? According to Dr. Gil Chavez, deputy director of the California Department of Public Health’s Center for Infectious Diseases, decreasing immunization rates are the biggest factor. Families who refuse to vaccinate their little ones – either for religious reasons or fear of disastrous side effects – punch tiny holes in the herd immunity that protects us all. The funny thing is that a Bordatella bacillus only needs a tiny hole to get in and do its dirty work.

At a July 19 press conference, Dr. Chavez laid it on the line. “Before whooping cough vaccine became available in the 1940s, California had upwards of 20,000 cases year. By the 1960s-1980s, we had nearly eliminated this disease. But at the beginning of the 1990s, we saw steady increases and in 2005, there was a pertussis epidemic in California.”

The 1,500 cases reported so far this year represent a 5-fold increase from the same time in 2009, he said. “If we continue at this pace, we expect by the end of this year to have the largest number of cases we have seen for 50 years.”

Barbara Loe Fisher, co-founder of the National Vaccine Information Center, has a different take on the issue. In her world, it’s a big evolutionary roll of the dice. A July 14 video posted on the site explains the reasoning of this group, which purports that vaccines are more dangerous than the disease they are meant to prevent.

Officials shouldn’t be pointing the finger of blame at families who choose not to vaccinate, Ms. Fisher said. The real cause of the outbreaks is more likely the cyclical nature of the disease, which runs regular peaks and nadirs; infections caused by a subspecies of Bordatella (B. parapertussis), which is not affected by the current vaccine; and Bordatella’s mutation into vaccine-resistant forms.

The center also claims that the pertussis vaccine is notoriously dangerous, citing data from the National Vaccine Injury Compensation Program

Since 1988, the NVIC program has compensated 1,386 claims for injury or death associated with a pertussis-containing vaccine. It’s hard to know what to make of that, since all but two of the claims were made for combination vaccines.

Still, said Ms. Fisher, the proof is in her own pudding.

“My precocious 2-year-old son suffered a convulsion, collapse/shock and brain inflammation following his fourth DPT shot in 1980 and was left with multiple learning disabilities and attention deficit disorder. In 1993, my two youngest children, then 5 and 10 years old, came down with whooping cough. They coughed violently and spit up huge amounts of thick mucus for 8 weeks before fully recovering and going on to become honor roll students. There are no guarantees”  in pertussis—or in life—she said.

No truer words were ever spoken. But when we have proven methods of disease prevention, should we be willing to take that gamble with our health, the health of our children, and the health of others—including immunocompromised folks who might be showered with our enterprising little bugs?

Reams of data support over and over the safety and efficacy of immunization. And yet many illnesses once considered virtually extinct in the U.S. are staging a comeback, and vaccine refusal is a major reason for this. A 2009 case-control study published in Pediatrics looked at vaccination rates among 156 laboratory-confirmed pertussis cases and 595 matched controls. The rate of vaccine refusers was 12% among cases and 0.5% among the controls.

A page from the Texas Department of State Health Services gives a 60-year perspective on the issue, listing cases and fatalities from 1947-2009. From more than 21,000 cases in the first year, the rate fell steadily to a nadir of just 36 in 1976. Since then the disease has been on a fairly steady incline, with rates tripling from 2007-2009 (1,051-3,358)

The South Carolina Department of Health and Environmental Control has a similar recent history. So far in 2010, the state has seen 168 reports of pertussis. During the same time periods in 2009, 2008, 2007 and 2006, there were 114, 62, 42, and 78 reports of pertussis, respectively.

My parents—90 and 87 years old—tell of childhood friends lost to measles, rubella, polio, whooping cough. But society has a short memory. No young parents—and now few grandparents—have ever seen their ravages, so these killer diseases are fading in our collective consciousness.

But their perpetrators are still among us, waiting to strike again as soon as our defenses erode.

—Michele G. Sullivan (@MGSullivan on Twitter)
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