Parents need pertussis vaccination

The Pediatric Insider

© 2010 Roy Benaroch, MD

Sheri wrote, “A friend sent me a link to information regarding the pertussis vaccine for adults. I have a 6 month old. What are your thoughts?”

I wrote about vaccines for parents of newborns last year, but recent news about several outbreaks of pertussis make this question especially important. It’s time for an update.

Pertussis, also called “whooping cough,” is bad news. For children and adults it causes literally months of coughing, at times so severe that it causes vomiting and broken ribs. But for infants and especially newborns, pertussis is much worse: they can’t tolerate the respiratory infection, and sometimes just stop breathing. Pertussis can also lead to seizures and encephalopathy (brain inflammation) in the young. There is no effective therapy for the severe cough and other symptoms of pertussis short of intensive care and mechanical ventilation on a machine. Though antibiotics are prescribed, those do not help the victim recover faster—they only prevent further spread of the infection.

Worldwide, about 300,000 deaths occur from pertussis each year, 90% in developing countries. (That’s second only to influenza in vaccine-preventable deaths.) The rate of pertussis had been as high as 160 per 100,000 person-years in the USA prior to the introduction of the vaccine; it then dropped to probably 1 per 100,000 years.

Pertussis is now making a comeback. California has declared an epidemic, and local health authorities near my home in Georgia are also posting warnings about outbreaks. In my own practice, we’ve seen at least half a dozen kids with pertussis in the last 12 months, far more than I’ve ever seen before.

Why is pertussis sneaking back?

  • The vaccine isn’t 100% effective. Getting fully immunized provides good protection probably 80% of the time. That’s why it’s especially important for everyone to stay vaccinated—if you or your child is one of the unlucky ones who didn’t get good protection from the vaccine, you’ll still be relatively protected if all of your neighbors are vaccinated.
  • We are more aware of pertussis and looking out for more cases. Nowadays if I see a child who coughs until he vomits, or has a cough longer than three or four weeks, I’m thinking about pertussis. More awareness leads to more testing and more diagnosing.
  • Some parents are choosing to skip, delay, or somehow split vaccines. It’s considered the hip thing to do in certain neighborhoods, and has the support of playboy bunny starlets (lots of good vaccine info links underneath the video.) Remember it’s the youngest babies who will suffer most from vaccine-preventable illnesses. You wouldn’t dream of driving around without a car safety seat; don’t delay or skip the protection your child needs from vaccines.

Until recently, only children were vaccinated against pertussis, using the “DTaP” immunization. Though children are affected more seriously and account for most of the mortality, adults also get quite ill with pertussis and are a source of contagion in the community—so an adult version, abbreviated “Tdap” or “TdaP,” was introduced a few years ago for use from age 10-65. (Both the children’s DTaP and adult Tdap includes tetanus, diphtheria, and pertussis protection. There is no “single-agent” vaccine against pertussis alone in the United States.)

All adults up through age 65 should receive a dose of Tdap, especially those with children, and absolutely especially those with babies and newborns.

Tdap is recommended as long as it has been 5 years or more since your last tetanus shot. In some situations, even 2 years is a sufficient gap, depending on the likelihood of exposures and other household risk factors. You’ll want to review these specifics and other information about risks, benefits, and possible side effects with whomever will be administering the vaccine.

Where can you get it? Here in Atlanta hospital maternity wards offer it to moms after birth (though not to dads, which I find odd.) We also offer this and other vaccines to parents and grandparents of kids in my practice, so you might want to ask you own child’s pediatrician if you and your husband can be vaccinated there. You can also ask your own physician and obstetrician (though admittedly adult-oriented docs have not been as keen to stock vaccines as pediatricians and family physicians.) County health departments should also be able to administer this vaccine.

Got it? Good! Haven’t gotten it? Get it, before it gets you!

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5 Comments on “Parents need pertussis vaccination”

  1. Sheri Flink Says:

    Dr. Roy,

    After reading your post I realized I did get it when I had my baby 6 months ago. Since my kids are patients of yours I will send my husband in for a vaccine. What about my nanny? She’s 19. Can she get it at your office as well? I’m also wondering if its part of the routine vaccines for older boys as I have 3 stepchildren that go to a different doctor but are around my 6 month old regularly.

    Thanks for your response.

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  2. Dr. Roy Says:

    Sheri, your 19 y/o nanny can get the imm with us as long as insurance isn’t an issue. If she doesn’t have insurance to cover immunizations she should go to the county health department instead of us, they’re far less expensive.

    Children should get a tetanus-diphtheria-pertussis booster at age 11 or 12, the same Tdap that’s used in adults.

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  3. Michelle Says:

    Are there any other vaccines that you recommend parents of newborns getting? My inlaws are flying over from England for the birth of our second child and I want to make sure they are vaccinated against anything that they might get there or on the plane ride over. Thanks!

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  4. Dr. Roy Says:

    Michelle, the UK has experienced a dramatic rise in measles- certainly MMR vaccination is a good idea, as measles is very contagious at every age. Travelers ought to also consider Hep A vaccination.

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