Who's afraid of whooping cough? Tdap booster offers protection against the disease

By Michaela Gibson Morris/NEMS Daily Journal

Most vaccine-preventable diseases – polio, small pox, measles – have largely been consigned to the history books.
But pertussis, most commonly known as whooping cough, has been making a troubling comeback.
In 2012, Mississippi has seen 59 cases of the disease. Nationally, more than 29,000 cases – including 14 deaths – have been reported.
“It’s more than last year, but nothing to the magnitude that some states have seen,” said Mississippi State Epidemiologist Dr. Thomas Dobbs.
Tupelo pediatrician Dr. Ed Ivancic said his practice sees a few handfuls of cases each year.
“Thankfully, we haven’t seen any cases in small babies in quite some time,” Ivancic said.
Babies under a year, particularly in the first three months, are at greatest risk for hospitalization and death from the disease.
“Approximately 50 percent of the children under 1 (diagnosed with pertussis) will be hospitalized,” Dobbs said. “Two percent will die.”
To protect those babies, it’s vital the people around them get a Tdap booster, which also protects against tetanus and diphtheria. Infants start the Tdap series when they are 3 months old, but they don’t develop maximum immunity until they receive the last shot at a year old, Dobbs said.
“It’s important for pregnant women and all family members and caregivers of newborns to get a booster,” Dobbs said. “It’s kind of like a cocooning effect.”
Pregnant women can get the vaccine at any time. Ideally, it should be given at least two weeks before giving birth.
The NMMC Women’s Hospital also is offering it to new moms if they haven’t been vaccinated prior to leaving the hospital after delivery, Ivancic said.
Boosters recommended
But the immunization efforts to corral pertussis extend beyond families with babies. This year Mississippi joined 43 other states in requiring 7th-graders get a Tdap booster.
“We seem to have had a really good response,” Dobbs said. “We had very busy immunization clinics.”
Although it’s not required, the vaccine is recommended for other teens and adults, even those without babies in the house
“Older kids need it, too,” Ivancic said.
Teens and adults can also develop whooping cough, and while it’s generally not life-threatening, it isn’t much fun.
“It’s not as deadly, but the clinical course can be very vexing,” Dobbs said, although not everyone with pertussis develops the signature cough.
Antibiotics can clear the infection, but they do nothing for the signature cough, which can continue for weeks and months. Teens and adults can cough so hard they vomit, pass out and even break a rib.
“It’s horrible,” Dobbs said.
Expanding protection
Wider use of booster immunizations are likely the key to getting whooping cough under control.
“The outbreaks this year seem to be connected to waning immunity,” Dobbs said, as opposed to the outbreaks in California a decade ago that were linked to unimmunized children.
The immunity from the new Tdap vaccine doesn’t seem to last as long. Part of that may be that changes to make the vaccine less irritating may have made it less powerful. It also may be due to fewer pertussis germs in the environment, giving the body fewer opportunities to fight off the disease, Ivancic said.
“We’re not getting that natural boost,” he said.
Currently the CDC recommends adults between 19 and 64 get a single dose Tdap booster and then tetanus shots every 10 years.
Ivancic said he wouldn’t be surprised if the recommendation changes to a Tdap booster every 10 years.
“It looks like the immunity lasts about 10 years,” Ivancic said.
michaela.morris@journalinc.com