Thursday, February 23, 2012

Pertussis: The Preventable Epidemic


Pertussis, also known as whooping cough is the only vaccine-preventable disease that is on the rise. After 1940 when Pertussis vaccine became available till 1980, there was a steady decline of this deadly childhood disease in the United States. If you thought pertussis was history, think again. Since 1980 the number of cases in the U.S. has risen to more than 3 million a year. More cases are being reported among adults and adolescents who experience a milder but just as stubborn form of the disease as infants. Since pertussis initially resembles other common colds the disease is probably under reported.

Babies under the age of one year get the infection from those who are closest to them. Family members, friends, caregivers are usually the source. We have only recognized in recent years, the role of adults around the infant to be a potentially dangerous reservoir of the disease. Adults are susceptible to pertussis, because the vaccine you received as a child wanes over five to ten years. If one member of a household has it, there's a 90% to 100% chance that other susceptible household members will catch it.

The vaccine is administered at 2, 4 and 6 months of age. A fourth dose is administered between 12 and 18 months, and a fifth after age 4. Teens need another booster shot between 11 and 18 years of age. All adults should have a single adult booster of Tdap (tetanus, diphtheria, and acellular pertussis) vaccine. Even when your baby is vaccinated, he or she may not be fully protected until they have received at least 3 doses of the infant pertussis vaccine. In order to create a “cocoon of safety” around your infant, those in close contact with the baby should receive a single dose of Tdap.  

The infection is spread easily through mucus droplets broadcast by profound coughing and sneezing. It can take 3 weeks or more to develop symptoms after exposure to the infection. You can give it to others until you've been treated with antibiotics for five days, or until you've been coughing for 21 days. The swelling and inflammation to airways is actually caused by toxins secreted by the bacteria. After 21 days of the infection the bacteria will die off but have already released their damaging toxins. Early recognition and treatment is important to minimizing the effects and preventing spread of the acute infection to others. Pertussis (whooping cough) causes spells of coughing that make it hard for a child to eat, drink, or breathe. The cough is often followed by a "whooping" sound as the person gasps for air, which is how the condition got its name. Some historians referred to the disease as the “100 day cough”. Serious side effects from the coughing fits are common in children. The choking and gasping can be fatal in children under one year of age. The disease is most serious in infants, especially those too young to get the vaccine or not fully protected. Babies with whooping cough are often hospitalized. With older kids and adults, the disease is milder and can cause several weeks of exhausting coughs. Although rarely fatal in adults and older children, time loss from school and work is substantial.

Early detection is important in limiting the spread of the disease. Appropriate antibiotic therapy for the person suffering with the condition and their close contacts needs to be started as soon as possible. Late recognition and treatment fails to change the course of the disease. Many weeks of coughing in the affected individual will continue even if the spread is limited. Testing specimens from a nasal swab can be helpful in identifying pertussis only in the first couple weeks. Many patients do not seek medical evaluation till later. The results of testing also causes further delay. Precise recognition can be difficult. Treatment is often started in the context of clinical symptoms and known outbreak in the community.

This punctuates the importance of prevention and a proactive approach to immunizations of both children and adults in our community. The best way to help protect babies against pertussis is to get infant vaccinations in a timely fashion. Adolescents and adults should have a single dose of Tdap booster. 

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