Another fitful night. A mom lies awake, listening helplessly as her child coughs and coughs. This mom knows tomorrow will be another day of school missed. Soccer practice missed. And for her, another day of work missed. She wonders wearily when it will end.

This cough is whooping cough, also called the “100-day cough” because of its long duration. And the child? Not an infant, as one might expect, but a preteen, 11 years old.

Whooping cough—or pertussis—is a serious and very contagious respiratory disease that can cause long, violent coughing fits and the characteristic “whooping” sound that follows when a person gasps for air.

Whooping cough has been on the rise in preteens and teens. In 2009, a quarter of the 16,858 cases of pertussis reported in the United States were among 10- through 19-year-olds.

Most children get vaccinated against whooping cough as babies and get a booster shot before starting kindergarten or first grade. But protection from these vaccines wears off, leaving preteens at risk for infection that can cause prolonged illness, disruptions in school and activities, and even hospitalization.

To boost immunity, the Centers for Disease Control and Prevention (CDC) recommends the Tdap vaccine for all 11- and 12-year-olds.

“It’s important for preteens to get a one-time dose of Tdap to protect themselves and those around them from whooping cough,” says Anne Schuchat, MD, director of CDC’s National Center for Immunization and Respiratory Diseases. “Young infants are most vulnerable to serious complications from pertussis and can be infected by older siblings, parents, or other caretakers.” For infants, whooping cough can be deadly.

“Unfortunately, the most recent survey shows that only a little more than half of teens have received the Tdap vaccine,” says Dr. Schuchat. “By taking their preteen to get Tdap, parents can protect their child and help stop this disease from spreading.”

Tdap is one of three vaccines CDC specifically recommends for preteens. The others are the meningococcal vaccine, which protects against meningococcal disease, including bacterial meningitis, and, for girls, the HPV vaccine, which prevents cervical cancer. Boys and young men can get HPV vaccine to prevent genital warts. Of course, the flu vaccine is recommended for everyone six months and older.

Preteens should also be up-to-date on so-called childhood vaccines to prevent hepatitis B, chickenpox, polio, measles, mumps, and rubella.

These recommendations are supported by the American Academy of Pediatrics, the American Academy of Family Physicians, and the Society for Adolescent Health and Medicine.

To learn more, visit CDC’s adolescent vaccine website or call 800-CDC-INFO.

It’s also Hepatitis Awareness month, although World Hepatitis Day is in July. We can’t explain why.

The important part is that we can use this month to remind moms and dads that hepatitis is around and some of it can be prevented by vaccination.

Hepatitis C is a bloodborne virus that attacks the liver. It is not vaccine-preventable. If babies are infected it’s usually from their hepatitis C+ mothers or, and this is unlikely these days, from a blood transfusion. It’s unlikely because the screening process of donated blood is pretty darn thorough. But, germs have slipped through that screening process.

Teens and young adults may become infected, primarily through sharing of needles, sex with an HCV+ person, or sharing personal items such as razors or toothbrushes that may be contaminated with HCV.

There are effective treatments that work on a good portion of hepatitis C-infected children. But not on all infected children. Work is ongoing in this area.

Hepatitis C is frequently a chronic infection, meaning that if treatment is not effective, you will be infected for your lifetime.

Hepatitis A is vaccine-preventable. Normally, it’s passed person-to-person through the fecal-oral route, which is when something you eat or drink has been contaminated with hepatitis A+ poop. If you haven’t been vaccinated, chances are you will become infected.

This virus makes you feel lousy and can, rarely, do serious damage to the body. It does not become a chronic infection. It infects you and then goes away, like a cold virus.

Hepatitis B is vaccine-preventable. It’s transmitted in a lot of ways—mom to newborn, sharing needles or personal items, sex with an infected person, even household (nonsexual) contact. If a mom is aware of her infection prior to giving birth, shots can be given to the baby within 12 hours of birth that are effective at stopping tranmission of the virus from mom to baby. However, when babies are infected, almost half of them in the US will become chronically infected. In developing countries, that figure shoots up to 90 percent.

Today, despite the vaccine, approximately 1,000 babies become chronically infected with hepatitis B each year in the US. Many of the moms-to-be who are infected are unaware of their infection. Every pregnant woman should be tested for hepatitis B so that action can be taken at birth to prevent infection of the newborn.

Hepatitis D is an odd virus. You have to be infected with hepatitis B before you can get hepatitis D. It’s vaccine-preventable in that, if you get immunized against hepatitis B, you won’t be able to get hepatitis D.

Hepatitis E is similar to hepatitis A in the way it is transmitted—the fecal-oral route. It’s rarely a chronic infection. For most people, they get it, get sick, and get over it. It can however be dangerous for pregnant women, with a 10% – 30% fatality rate for this group. It’s not often found in the US but can be easily picked up in some other parts of the world.

That’s about it for hepatitis in the US. To prevent a hepatitis infection (and lots of other infections), wash your hands throughout the day, put barriers between yourself and another person’s blood or body fluid, and use the available vaccines. The trick is to do these things with everyone. It’s impossible to tell who is infected with what, most of the time, so the safest course of action is to assume everyone is infected with something and then act accordingly.

Got any tips? Hope you share them will us in the comments.

By Trish Parnell

Image courtesy of Johns Hopkins

In 2011, we had 222 cases of measles in the U.S.—a 15-year high.

Most of the 222 infected individuals were either unvaccinated or their vaccination status was unknown.

How did this happen? The answer is, almost all of the infections were imported. They came from U.S. residents returning from trips outside the country, or from visitors from foreign lands. The travelers carried the germ and, in some cases, infected others once they arrived.

Almost half of these cases came from countries with easy access to vaccines; the WHO European Region. The rub is, there are some Europeans who choose not to vaccinate themselves or their children, and the same is true in this country.

When a disease is floating around a community, it finds those who are unprotected and boom, we have disease outbreaks.

Most of the time, most of the diseases that are vaccine-preventable are not going to kill a child. They might not hospitalize him, or even make him feel really bad.

But, no one can say which disease will harm which child, and how much harm it will cause.

Kids do die from measles and chickenpox and other vaccine-preventable diseases. Or they don’t die and they only lose a limb, or their hearing, or they just need a liver transplant. Or any number of other health problems may occur that are still better than dying.

But like I said, no one can say how one child will be affected by one disease. So when I answer the phone here at PKIDs, and a parent on the other end asks if they really need to vaccinate their child against XYZ disease, I don’t have a problem telling them: you really do.

By Trish Parnell

Image courtesy of Vox efx

The truth of the matter is that the accurate diagnosis of pertussis is challenging. Classic symptoms such as severe coughing spells and the inspiratory whoop are striking and strongly suggest pertussis, but they are not always present, especially in previously vaccinated or previously infected adolescents and adults. Additionally, as described in Dr. Cherry’s recent post, available tests are most sensitive early in disease when the bacteria is present in the nose, but this is often before pertussis is suspected. Accurate diagnosis also depends upon the likelihood of having been exposed to someone with pertussis. Communities across the U.S. are experiencing pertussis outbreaks and many children and adults present to their health care provider with a cough.

So, how do doctors know what to look for?

Background
Pertussis occurs in ALL age groups but is most severe in young infants. While pertussis-containing vaccines have been available since the 1940s, pertussis outbreaks continue to occur every year in the U.S. The number of reported cases has been increasing steadily since the 1980s, especially among young infants and adolescents. According to the Centers for Disease Control and Prevention (CDC), more than 27,000 people were diagnosed with pertussis in 2010.

Pertussis is most severe in young infants who are too young to have received any or all doses of vaccine; in fact, about 3 of every 4 infants less than 6 months old develop complications like pneumonia or seizures and about 1 of every 100  infants less than 2 months old die. Unfortunately, many infants get pertussis from adolescents and adults who don’t realize that they have it.

Pertussis is transmitted in respiratory droplets by coughing and sneezing, and people with pertussis can be contagious for up to 3 weeks after developing symptoms. Pertussis is so contagious that when someone in the house has it, virtually everyone else in the house that is not immune will also get it. In fact, studies have shown that if ten unimmunized people are in a room with someone who is infected, 8 or 9 of them will also develop pertussis.

Vaccination is the most effective way to prevent pertussis, but protection is not lifelong. Vaccination is highly effective, however, it does not prevent all disease and immunity decreases over time. This is also the case after natural infection and is why even people who have had pertussis before should still get a booster dose. This decreased immunity through time is also why we have seen an increase in pertussis among adolescents and adults.

What Parents Should Look For
The official set of symptoms used to identify cases of pertussis is:

A cough that lasts for at least 14 days and either episodes of multiple, rapid coughs without any break, whooping when breathing in or a cough so severe that vomiting occurs.

However, it is important to realize that symptoms are not always typical, especially in previously vaccinated older children, adolescents and adults. The way that pertussis presents depends upon your age and vaccination status:

Infants and young children
The most ‘typical’ presentation occurs in young children:

• Stage 1 -   Pertussis starts with mild cold symptoms like runny nose, mild cough and watery eyes  This stage typically lasts for about 1 to 2 weeks.
• Stage 2 -  Despite resolution of other symptoms, severe cough develops.  ‘Whooping cough’ refers to episodes of multiple, rapid coughs without any break.  The episodes can be so severe that the lungs run out of air resulting in a forced inhalation that sounds like a ‘whoop.’  The cough can also be accompanied by vomiting.    Infants and children can look quite ill when coughing but appear well in between episodes.  This stage can last for 1 to several weeks.
• Stage 3 –  The coughing episodes begin to resolve and become less common over several weeks  to months.
• All Stages – Fever is not a major symptom of pertussis.

Babies are less likely to show these classic symptoms. They tend to have coughing associated with gagging or gasping and ”apneic’ episodes, during  which they briefly stop  breathing.  Infants and young children may also turn blue during coughing spells because they can’t get enough oxygen due to the severe, repeated coughing. Young infants may also show no interest in eating and might experience seizures. 

If parents notice any of these signs or symptoms, they should have their child seen by a health care provider right away for testing and antibiotics—this is especially important for young infants since they are at the greatest risk for severe disease. Antibiotic treatment can decrease the duration of symptoms and make them less severe, but it is most effective when given early in the infection.  Antibiotics also help decrease the likelihood of spreading pertussis to others.

Adolescents and adults
Older children, adolescents and adults with pertussis are more likely to have milder symptoms that can mimic other cough illnesses, especially if they have been immunized or previously infected, however, they can still develop severe disease:

• The primary symptom is often a persistent cough lasting at least 7 days, usually without a fever.
• Severe coughing episodes and whooping may occur, but is more common in unimmunized individuals.
• Coughing episodes can be severe enough to cause rib fractures, difficulty sleeping, poor bladder control, damage to the lung cavity and even bleeding in the brain.  Vomiting with cough can also occur and is considered to be highly suggestive of pertussis in adults.
• The average duration of cough in adults is 1 to 1 1/2 months.
• Adolescents and adult who recently had pertussis may experience a return of symptoms if they get another respiratory infection shortly after recovering.

Because older children, adolescents and adults are less likely to have typical symptoms, they often are not tested or treated, and unknowingly spread pertussis to others. Pertussis should therefore be considered in anyone with a coughing illness with no fever or a mild fever, especially if they have been around someone with pertussis or a cough illness or they have regular contact with infants and young children who are at risk for severe disease.

A Final Word about Testing
Testing for pertussis is most sensitive in the first 3 to 4 weeks of infection. Bacteria that cause pertussis can usually be detected from the very beginning of the illness through the first two weeks of the cough stage; however,  in people who have been vaccinated, like adolescents and adults, the bacteria may not be detectable for even that long. Since adolescents and adults often do not go to the doctor until late in their illness, there may no longer be any bacteria present. Therefore, choice of test is important:

• Bacterial culture is the gold standard but it is difficult to perform, takes a long time (up to 2 weeks) and is less likely to be positive later during the disease or  in previously immunized individuals.   It is most sensitive when performed within 2 weeks of cough onset.
• Pertussis PCR is now widely available, very sensitive and provides results quickly.   Bacteria can be detected even 7 days after taking antibiotics, but false positives can also occur.  PCR tests should NOT be done on anyone without symptoms, even close contacts of confirmed cases.  PCR tests are most sensitive when done within 4 weeks of cough onset.
• Serology is a test that is performed on blood samples and detects antibodies to pertussis.  This test is usually positive by the time a patient decides to see the doctor about a cough. However, because young infants don’t make antibodies to the protein that the test measures, it is not useful in infants.  In people who were previously immunized, false positives may occur, so doctors need to look at relative levels of antibodies.  This test is most useful in adults and adolescents because testing is usually done too late for culture or PCR tests.  Serology testing can be performed within 2-8 weeks of cough onset.  If the test is done too early in the infection, it may be falsely negative.

Parents who suspect pertussis in themselves or their children should discuss their concerns with their healthcare providers. Providers should be able to help in determining the best approach for making a diagnosis and managing treatment. 

Kristen A. Feemster, MD MPH MSHP
Assistant Professor of Pediatrics
Pereleman School of Medicine at the University of Pennsylvania
Attending Physician, Division of Infectious Diseases
Physician-Scientist at the Vaccine Education Center
The Children’s Hospital of Philadelphia

When it comes to their kids, parents are always planning. Healthy dinners. Safe activities.

One plan that’s easy to make could have a tremendous benefit, even saving a life. That’s planning to have preteens vaccinated against HPV, the leading cause of cervical and anal cancers.

“There are about 12,000 new cervical cancer cases each year in the United States,” says Dr. Melinda Wharton, deputy director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC). “Cervical cancer causes about 4,000 deaths in U.S. women each year. But vaccinating boys and girls against HPV greatly reduces the chances that today’s girls will ever have to face this devastating disease.”

CDC recommends HPV vaccination for 11- and 12-year-old girls and boys, as well as for young women ages 13 through 26 and young men ages 13 through 21 who have not yet been vaccinated.

Two HPV vaccines—Cervarix and Gardasil—are available for girls to protect against the HPV types that cause most cervical and anal cancers. Gardasil also protects against the HPV types that cause most genital warts. Gardasil is the only vaccine approved for boys.

Both brands of HPV vaccine are given in three doses (shots) over six months, and protection requires all three doses. “Completing the three-dose HPV vaccine series is very important to ensure protection against HPV-related disease,” adds Dr. Wharton.

While vaccinating against a sexually transmitted virus at age 11 or 12 might seem unnecessary, the preteen years are the best time to vaccinate. “The HPV vaccine only provides protection if it is given before exposure to HPV,” says Dr. Wharton. “Someone can be infected with HPV the very first time they have sexual contact with another person.”

To get the most benefit from HPV vaccination, all three doses must be received before any kind of sexual activity with another person begins.

Atlanta mom Amber Zirkle recognizes the importance of vaccinating her children now for protection they’ll need in the future. Her 11-year-old daughter will get an HPV vaccine this year at her regular check-up. As for getting HPV vaccine for her 16-year-old son, Amber says, “I didn’t know it was available for boys. I’ll talk with the pediatrician about it.” She adds, “Genital warts aren’t something I want my son to deal with.”

Other vaccines recommended specifically for preteens include meningococcal conjugate, which protects against bacterial meningitis, and Tdap, which boosts immunity against pertussis (whooping cough). Everyone age six months and older should get an annual flu vaccine.

To learn more, visit CDC’s teen website or call 800-CDC-INFO.

The answer to this question is more complex than simply counting up numbers of people who die from infection. For example, diseases like measles and smallpox have proved to be far deadlier in some populations—such as Native Americans—than in others, because of population differences in disease resistance.

Another variable is intensity of the illness a pathogen causes. Influenza comes in many forms of virulence, and as the Spanish flu pandemic of the early 20th century made clear, even that virulence can vary depending on specific population features; the Spanish flu, which took an estimated 50 million lives, killed the young most relentlessly.

Even an individual disease vector can wax and wane in terms of how virulent it is or which tissues it invades. For example, Yersinia pestis, the bacterium responsible for the infamous Black Death that swept through Europe in the 14th century, may vary over time in its virulence and is far more deadly when transmitted as an aerosol to lung tissues than when it invades the lymph and causes the bubos that characterize it.

Another issue is, how do we calculate “deadliest?” Is it in terms of sheer overall numbers, or do we calculate it in terms of how many people it kills among the number infected? For the sake of addressing this question, let’s talk about both.

Historically, in terms of sheer numbers, the deadliest diseases were smallpox, measles, tuberculosis, plague (e.g., the Black Plague), and malaria. According to a handy Website, the Book of Odds, which calculates odds for us, measles has killed about 200 million people worldwide in the last 150 years and still kills hundreds of thousands in the developing world. Thanks to vaccines, the odds of contracting measles in the United States today are very low unless you are an unvaccinated person living in areas where vaccine uptake is low.

The story on smallpox is similar—it may have killed more people by percent or sheer numbers than any other infectious disease in history, including 300 million in the 20th century alone by some estimates. Yet smallpox as an infectious disease no longer exists thanks to its total elimination through vaccine campaigns.

Thus, along with the plague, smallpox and measles have, for millennia, been the historical killers of humans and would still be among the deadliest infectious diseases today were it not for vaccines. What we have left are some old killers on the list—tuberculosis and malaria—and a newer entity, HIV, the virus that causes AIDS.

We have yet to develop efficient vaccines against any of them. According to USAID, in terms of absolute numbers of deaths, AIDS kills the most people each year, with 2.8 million AIDS-related deaths in 2004, followed by tuberculosis and malaria.

Indeed, AIDS and tuberculosis are often co-conspirators in death, as infection with the HIV virus makes people 20 to 30 times more likely to develop active TB with TB infection. Research for vaccines against HIV and malaria has been feverish but as-yet incompletely successful, one reason these diseases remain the top global killers.

But what about the deadliest disease in terms of how many of infected people die? In the absence of effective treatment, HIV might be one candidate. But the ones that come first to mind are the viruses that cause fast-moving hemorrhagic fevers, such as the Marburg or Ebola viruses.

The Marburg virus, named for the location of the first outbreak and a virus that may reside without symptoms in fruit bats, has caused death rates as high as 90% in some areas, although the average is 23–25%. It is a filovirus, in the same viral family as the five Ebola viruses. One of the Ebola viruses, Ebola-Reston, is perhaps the most notorious of the hemorrhagic fever viruses, having led to death rates as high as 89% in outbreaks.

A near-100% mortality rate is about as deadly as an infectious agent can be if that’s the measure of “deadly” we’re using.

By Emily Willingham

Image courtesy of Wikimedia Commons

The world is enormous, but nowadays it’s also quite small.

Long ago, when people were mostly nomadic in nature, diseases were not easily spread, at least not outside of one’s group or tribe.

Then we formed societies, lived closer together, traded wheat and pelts, and passed germs like nobody’s business. But it still took months and sometimes years for diseases to become widespread.

Today, with air travel, diseases can spread from country to country in a matter of days, and sometimes, within a few hours.

These diseases are not all new; many are vaccine-preventable. But, when the immunity in a community is low due to reluctance to vaccinate or lack of access to vaccines, these diseases which science has bested scatter anew, bringing illness and sometimes death.

The United Nations Foundation’s Shot@Life campaign targets Americans with the hope that we will be inspired to advocate for those with little or no access to vaccines.

That inspiration isn’t too hard to find, if you’re a mom or dad. Once you’re a parent, you acquire a faint and nagging voice that compels you to “parent” all kids, anyone’s kids, every kid.

There are numerous self-serving reasons to ensure everyone is vaccinated, and that’s OK. Who wants to get sick? There are some of us for whom this or that vaccine simply doesn’t work, or we can’t use a vaccine due to allergies or for other reasons. We’re unprotected and we depend on those around us to not get sick and, so, not infect us.

There are also simple, human reasons for wanting everyone vaccinated. There are boys and girls in need who should grow up laughing and being naughty sometimes, who should go to school and raise families. This one will clean toilets for 30 years and then retire to enjoy his grandchildren. That one will discover life on another planet. Another will be the teacher who changes the lives of hundreds of students, who in turn go on to do wondrous deeds.

It’s a really small world, when you think about it. Protecting other children will protect our own children. And, it’s what we do for neighbors.

Check out Shot@Life. Do something this week to help your neighbors in Nigeria, Laos, Bangladesh, and elsewhere.

By Trish Parnell

Image courtesy of Shot@Life

BACKGROUND:

In pertussis the site of infections is on ciliated epithelial cells in the nasopharynx (NP).  In primary infections (infants and young child not previously vaccinated) the bacterial load is high and is present in the nasopharynx from the onset of illness (coryza) the second week of the paroxysmal stage and often longer.  In children who are vaccine failures the bacterial load in the NP is less than in primary infections and the bacteria are present for a shorter period of time (ie onset of coryza through the second week of cough).

In adults (all of whom have had previous infections unknown to them) the bacterial load is less than in previously vaccinated children and the duration of presence of bacteria is also less.  Also, adolescents and adults rarely seek care for their pertussis cough illness until the third or fourth week from illness onset.  Nevertheless adults with unrecognized pertussis are the most common source of infection in infants who are unimmunized or only partially immunized.

LABORATORY:

Culture:

Culture is 100% specific whereas all other tests are not.  Culture in children is a much more sensitive test than generally believed.  However, today in the U.S., for the most part, culture is a lost art in most diagnostic laboratories because of lack of fresh media and technicians with little experience.  With a good laboratory the main reason for failure to isolate Bordetella pertussis is that the specimen was not collected properly or that it was collected too late in the illness.

To obtain an adequate sample the ciliated cells in the NP must be touched by the dacron tip of the NP swab or the catheter used in a NP aspirate must touch the ciliated cells.  Nasal wash is frequently done but this is much less sensitive than either NP swab or NP aspirate.  For PCR the same facts apply regarding specimen collection.

PCR:

For children (during the first 3 weeks of illness) and adults (during the first week of illness) PCR is the method of choice because it is much more sensitive than culture.  Unfortunately, there has been much misinformation disseminated about PCR results.  PCR is readily available in the U.S. in hospital labs and several commercial labs.

The test that is universally available in the U.S. uses primers that identify insertion sequence (IS) 481 for B. pertussis and IS1001 for B. parapertussis.  Because B. pertussis contains ~238 copies of IS481 this test is exceedingly sensitive.  It is so sensitive that it can pick up examination room contamination because of a previous patient with pertussis or the immunization with DTaP of a previous patient in the room.  Therefore NP specimens should not be collected in rooms where DTaP immunization is being carried out or in rooms that have been occupied by previous patients with pertussis.

Today in the U.S. real time PCR is the method most often used and the number of cycles necessary to obtain a positive result reflects the concentration of B. pertussis in the sample.  The lower the cycle the greater the number of bacteria.  With high cycle detection the possibility of contamination at the collection site is a likely possibility.  However positives are positives regardless of the cycle.  It has been suggested that labs not report high cycle positives as positive results.  This is wrong; these results represent infections or contamination and the physician who obtained the specimen must decide if the findings are consistent with the patient’s illness.  The lab should not call high cycle positives as negative or indeterminate because this relays false information to the physician.

In situations in which both IS481 and IS1001 are positive this may be due to infection with B. holmesii (also a cause of clinical pertussis) or a mixed infection with B. pertussis and B. parapertussis.

PCR should only be performed on patients with cough illnesses.  During pertussis outbreaks asymptomatic infections are very common in previous vaccinees so that you will get positive PCR results from people who are well and these results just confuse the picture (except in planned surveillance studies).

Serology:

All persons who have been previously vaccinated or who have had previous infection will have a rapid rise in antibody to various B. pertussis antigens so that pertussis illness can be diagnosed by single serum serology.  The most useful antibody to determine if a cough illness is pertussis is that to pertussis toxin (PT) because this antigen is exclusive of B. pertussis.  Some tests also determine antibody to filamentous hemagglutinin (FHA) but since this antigen is not exclusive to B. pertussis high titers could be due to B. pertussis infection, other Bordetella spp and M. pneumoniae and perhaps other microorganisms.

Single serum serologic Dx has been used successfully in Massachusetts for over 20 years.  Commercial laboratories also perform single serum serology but unfortunately many of these tests are poor.  Specifically any test that uses the whole B. pertussis bacterium is virtually useless as are tests that don’t express results in units.  Tests that say they are measuring IgM antibody are also useless.  To my knowledge the only commercial test available in the U.S. that is acceptable is that offered by Focus Laboratories.  This test has specificity of ~95%.

Serologic diagnosis will be affected by recent immunization with either DTaP and Tdap so it should not be attempted if the patient has been vaccinated within the previous year.  In general single serum serology should be used for the diagnosis of pertussis in adolescents and adults who have not been recently vaccinated.

White Blood Cell (WBC) Count

Primary infections of pertussis universally have high WBC counts with absolute lymphocytosis.  This is seen in all infants who have not been immunized and who have not received antibody to PT from the mother transplacentally.  Therefore in young infants with afebrile cough illnesses the WBC count with differential can be diagnostic.  Because the WBC count has prognostic implications it should be performed on all infants who might have pertussis at the time of first physician encounter.  A WBC count of  > 20,000 cells/mm3 with a lymphocyte count of  > 10,000 cells/mm3 should be diagnosed as pertussis and immediately treated with azithromycin.

SUMMARY POINTS

• The onset of cough illnesses in afebrile or minimal febrile persons of all ages should be suspected of having pertussis.
• Lab confirmation tests should be performed and specific tests employed relate to patient age, vaccine history and duration of cough.
• For infants and children PCR is the most sensitive and specific test.
• Whenever possible cultures should also be performed so that epidemic trends can be followed (ie antibiotic resistance, genetic changes in the organism)
• For adolescents and adults single serum serology to determine antibody to PT is the most sensitive and specific test (unless the patient is seen during the first week of cough).
• For young infants the WBC count with differential is often diagnostic.

James D. Cherry, MD, MSc

Distinguished Professor of Pediatrics

David Geffen School of Medicine at UCLA

Attending Physician

Pediatric Infectious Diseases

Mattel Children’s Hospital UCLA

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I was something to look at.

The pimples turned out to be chickenpox. On hearing the news, my shiny new husband smirked, explaining he’d been infected as a child; as if I was somehow lame to get such a disease at my age.

The source of my infection turned out to be my sweet, sick young nephew.

The varicella vaccine was not yet routinely recommended for kids at that time, so I couldn’t blame anyone for not vaccinating the boy. I did try, though.

All this is to say that adults get sick, and sometimes their infections are preventable. It’s now recommended that adults get vaccinated against chickenpox if they have never been infected. And there are a host of other vaccines available to us, although if you are like me, you rarely think about getting immunized against anything other than influenza. We think about the kids, and we worry about our parents, but for ourselves, no.

It’s time to think about us. The National Foundation for Infectious Diseases (NFID) revamped their adult vaccination website and it’s worth a look. On the site you’ll find specifics about the vaccines you may need and details about the diseases those vaccines prevent.

Healthcare professionals weren’t forgotten. There’s a toolkit of ready-to-use resources and listings of more such items, should they be needed.

Bonus: much of the site’s information is presented in English and Spanish.

Take a few minutes this week to email or call your healthcare provider. Find out which vaccines you need and then go in, get vaccinated. Vaccines don’t work 100% of the time on 100% of those who are vaccinated. If we as adults get vaccinated, we will stop many of the incidents of parent-to-child infection. So, if you don’t want to take time for yourselves, take time to get vaccinated for your family.

By Trish Parnell

Image courtesy of sheknows.com