Whooping Cough: Low Adult Vaccination Rates Makes Infants More Vulnerable

NAM Executive Director Sandy Close . The panelists include experts from the CDC and Dr. Gilberto Chávez, Chief, Center for Infectious Disease, California Department of Public Health and California State Epidemiologist.

July 23 , 2010

LOS ANGELES— The low whooping cough vaccination rate among U.S. adults—less than 6 percent nationally—is endangering the lives of infants too young to be immunized, federal and state health officials warned this week .Diagnosing the disease in infants is difficult because early symptoms are generally no different from the common cold, so vaccinating adults “is the first line of defense,” Stacey Martin, an epidemiologist with the Centers for Disease Control and Prevention, said at a packed ethnic media briefing here at Mercado La Paloma on July 15. The CDC-sponsored briefing, supported by the California Public Health Department and organized by New America Media, drew some 25 ethnic media journalists, as well as a few from the mainstream media, from across Southern California. After the deaths of five infants in California this year, and 1,300 more confirmed cases of the disease statewide, officials last month declared a whooping cough epidemic, calling it the worst outbreak in 50 years.

Another 700 cases are suspected but not confirmed. California is the only state to report such a dramatic surge in pertussis, the scientific name for whooping cough, this year, according to the CDC. South Carolina has also seen a fairly large uptick .A highly contagious bacterial disease that affects the respiratory system, pertussis is characterized by severe spasms of coughing that can last for weeks or even months. The coughing ends in a whooping sound, hence its name. The cyclical disease, which officials say is easier to prevent than to treat, seems to surge in the United States every five years or so. The last spike occurred in 2005, when California registered 18 deaths. Last week, California health officials said cases of whooping cough have quadrupled this year, compared to the same period in 2009. In Los Angeles County, there have been 88 confirmed cases this year, with 160 more under investigation, said Dr. Alvin Nelson El Amin, medical director for LA County’s Department of Public Health.

The county, he said, has pulled out all stops in alerting health care providers to tell their patients about the importance of getting vaccinated and of “[staying] away from infants when you are coughing.” Providers have also been told to encourage pregnant women to get vaccinated in the third trimester, to boost their immunity before delivery. New mothers and fathers are also being encouraged to get booster vaccines. All five infants who have died this year were Latino. A high percentage of whooping cough cases occurs among that community, noted Dr. Juan D. Ruiz, chief of the CDPH’s Preparedness and Response section. That could be because Hispanics tend to live in extended families. “We’re targeting the Hispanic community in our outreach efforts,” Ruiz said, “by providing them easy-toread messages in Spanish. For those who cannot read, the messages are going out over radio and TV.” Infants receive a series of three vaccinations at 2, 4, and 6 months.

The CDC recommends an additional dose from 15 to 18 months, and again at 4 to 6 years. At most, a child may experience mild reactions to the vaccine, including swelling at the injection site, itching, lowgrade fever or restlessness, officials said. In 2005, a booster shot called TdaP was introduced for adolescents and adults to inoculate against tetanus, diphtheria and pertussis. TdaP is recommended for 11- and 12-year-olds going to their regular check-up. The CDC recommends reinoculation every five years among adults. Only about 41 percent of adolescents nationally and 43 percent in California are reimmunized against whooping cough. California is only one of 11 states that don’t require a booster shot for middle-schoolers, a situation the legislature is trying to change. Marin County has been disproportionately affected by the pertussis epidemic, most likely because of a widespread fear among parents that vaccines may be linked to autism, with the bulk of those cases diagnosed among 5- to 17-year-olds. That link between vaccines and autism has been studied and rejected by scientists, health officials added. Infants under two months old are too young to be vaccinated, and the disease progresses most quickly among that age group.

So prevention of infection involves vaccinating people around them, said Martin, a strategy called “cocooning.” “People who are in close contact with infants should get vaccinated,” reiterated Dr. Robert Schecheter, section chief of CDPH’s immunization branch. The disease is often misdiagnosed, which is why it spreads so quickly, he said. What happened to Mariah Bianchi, a Bay Area mother and nurse who passed the infection to her newborn son, Dylan, five years ago, bears this out. Bianchi shared her poignant story with the media at the Los Angeles briefing, as well as at another NAM-sponsored ethnic media briefing in San Francisco the day before. Following “violent fits of coughing” and a runny nose in the weeks prior to giving birth to Dylan, Bianchi, who had not gotten the booster, said she was casually told by her ob-gyn that she might have contracted whooping cough. But neither that doctor, nor others she consulted, warned her about its seriousness. Bianchi washed her hands frequently, thinking that that was enough to keep the infection from spreading. But both her 3-year-old son and her newborn caught the infection. The older son, whose symptoms were severe, was treated and recovered, but Dylan, who showed very little symptoms of the infection aside from a perpetual lethargy, died in her arms when he was just 17 days old. “As a critical care nurse, I should have known better,” Bianchi said, her voice breaking. “This guilt will haunt me for the rest of my life.” “We have to work together on this,” Bianchi told the journalists, noting that pertussis “is not limited by borders, race or ethnicity. “And it you have any concerns about the safety of the vaccines, talk to your provider,” she added.

More information on pertussis can be found on the CDC website at http://www.cdc.gov. Information on which clinics in California are offering the vaccination can be found at http:// www.cdph.ca.gov.

-Staff Reports

 

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