Whooping Cough Booster Shot – Gotta Have It!

14 05 2012

(Welcome to the CDC folks again! Today they’re talking about whooping cough and the booster shot kids need.)

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.





When to Seek Help for a Cough

3 05 2012

As a parent, you may wonder whether you or your child with a cough has pertussis, but when you go to the doctor, he or she may not agree or even suggest testing.

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





Brady’s Life

16 04 2012

Kathryn shares the story of her son Brady’s life, and his ferocious battle with pertussis.

Listen now!

Right-click here to download podcast (14 mins/7mb)





Pre-teens Need Vaccines Too

21 07 2010

(courtesy of guest blogger Amelia Burke, MA)

There are serious diseases that kids are at increased risk for as they approach the teen years, such as meningitis, whooping cough, and human papillomavirus (also known as HPV, the virus that can lead to cervical cancer in women).

And the statistics speak for themselves:

  • 13,000 cases of pertussis (whooping cough) were reported in 2008.  Although deaths from pertussis are usually in the youngest infants, adolescents and adults can develop complications such as pneumonia, rib fracture, difficulty sleeping and urinary incontinence.  Infants often catch pertussis from family members, including adolescents;
  • An estimated 1,000 – 1,200 cases of meningococcal disease (including meningitis) occur in the United States annually, with 10-15% of those people dying from it and an additional 15% having a long-term disability, such as hearing loss, loss of a limb, nervous system damage, or brain damage as a result;
  • And every year in the U.S., about 6.2 million people get a new HPV infection, about 12,000 women are diagnosed with cervical cancer, and about 4,000 women die from the disease.

CDC recommends that pre-teens should receive the following:

  • Tdap vaccine – combined protection against tetanus, diphtheria and pertussis
  • Meningococcal  vaccine  – protection against meningitis and its complications
  • Seasonal and H1N1 flu vaccines – protection against seasonal and H1N1 influenza viruses
  • For girls, HPV vaccines to protect against the two types of human papillomavirus that cause up to 70% of cervical cancers.

As well, one of two available HPV vaccines also protects against warts in the genital area, and boys and men ages nine through 26 can get this vaccine.

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

Most health insurance plans cover these vaccines, and for families without insurance, there are options for cost coverage through the Vaccines for Children program (VFC). You can find a VFC provider by contacting your local health department, visiting CDC’s website, or calling 1800-CDC-INFO.

CDC’s Pre-teen Vaccine Campaign has educational materials tailored for various audiences, including Caucasian, African-American, Hispanic, Asian American, and Native American parents, available in English, Spanish, Korean, and Vietnamese.  Learn more and download / order these materials at NO COST.





Whooping Cough Spreads Too Easily, So Vaccinate!

26 05 2009

silence the soundsWhooping cough sounds like something a pioneer child would catch.  Maybe from trudging through the dust behind her Conestoga wagon. 

No doubt there were plenty of cases back then, and not a darn thing they could do about it.  Now, there is something we can do, and if you’ve ever had pertussis (whooping cough), or watched a loved one go through it, you would get vaccinated as fast as the wheels of your car could take you to the nearest immunization clinic.

Pertussis is a highly contagious and potentially deadly bacterial infection that makes life absolutely miserable at any age, but is particularly dangerous for babies. 

The sounds of pertussis are like no other, marked by a “whoop” made when babies are gasping for breath after a severe coughing attack.

More than half of babies with pertussis are hospitalized.  Coughing can be so severe that it’s hard for babies to eat, drink or breathe and they can suffer from these complications:

• Babies may bleed behind the eyes and in the brain from coughing.
• The most common complication is bacterial pneumonia.  About 1 child in 10 with pertussis also gets pneumonia, and about 1 in every 50 will have convulsions.
• Brain damage occurs in 1 out of every 250 people who get pertussis.
• Pertussis causes about 10-15 deaths a year in the United States.

Pertussis spreads through droplets from the mouth and nose when an infected person coughs, sneezes or talks.

Because it’s most contagious during the first two weeks of infection when symptoms resemble a cold, pertussis just zips through a household.  A parent, grandparent or babysitter suffering from what seems like a cold can actually have pertussis and spread the disease to the baby. 

Babies don’t start the series of vaccines that include pertussis until they’re two months of age, and they don’t get the final dose until they’re at least four years of age, although they’re fairly protected by the time they’re one year old.  But until then and particular when they’re under six months of age, no one should be around them who’s not received the booster shot as an adolescent or adult.

Half of babies with pertussis are infected by their parents.  Most unvaccinated children living with someone who has pertussis will get the disease, and 90 percent of pertussis-associated deaths have been among babies less than a year old.

This is why it’s so important for parents and other family members to get the pertussis vaccine themselves to help “cocoon” babies and young children when they are most vulnerable to the dangers of pertussis.