*Update* — Note that the Advisory Committee on Immunization Practices voted on October 27, 2010, for new recommendations regarding Tdap vaccination. For more information see our blog post, “Advisory Committee Votes for Expanded Pertussis Vaccine Recommendations.” — HOV Staff
Guest Post by
Andreas Bollmann, MD, PhD, FAAP
Pediatric Associates Inc.
Since December 2006, the Advisory Committee on Immunization Practices (ACIP) has recommended the use of Tdap (tetanus and diphtheria toxoids, acellular pertussis vaccine) instead of Td (tetanus and diphtheria toxoid immunization) during adolescence and at least once during adulthood.
Most adults don’t worry about whooping cough (also known as pertussis). Once a patient has moved on from a pediatrician’s care, this disease usually falls off everybody’s radar.
In fact, vaccination rates among adults in the United States against pertussis are estimated to be very low.
Studies show that about 75% of pertussis infections among babies are contracted from household members. Pertussis cases reported from 2000 to 2003 have risen (and it is likely they are even higher, since only a small percentage of cases are actually reported). From 2000-2004, 92 deaths occurred in infants (12 month of age and younger) in the United States. From 2004-2005, 66 deaths occurred. And just recently, California health officials reported that pertussis cases so far in 2010 have more than doubled from the same period in 2009. Already this year in California, four infants have died from the disease.
Typically, pertussis symptoms start 7-10 days after exposure. This makes detecting the disease in time to begin effective antibiotic treatment virtually impossible.
In children, the disease usually begins with symptoms similar to those of the common cold. But a dry cough may linger, and children may have coughing fits that last as long as several minutes. The coughing can be so severe that babies vomit, pass out, or even have seizures. In infants, the coughing spell often ends in a “whoop” sound. The cough may last six weeks or more. Adolescents and adults do not have these classic symptoms, yet they still can transmit the germs.
Therefore the following recommendations are in force:
- Adults aged 19 to 64 years should receive a single dose of Tdap to replace tetanus and diphtheria toxoids (Td) for booster immunization against tetanus, diphtheria, and pertussis if they received their last dose of Td >10 years earlier and they have not previously received Tdap. Intervals shorter than 10 years since the last Td may be used for booster protection against pertussis.
- Adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, child-care providers, and health-care personnel) should receive a single dose of Tdap to reduce the risk for transmitting pertussis. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used.
- When possible, women should receive Tdap before becoming pregnant. Women who have not previously received Tdap should receive a dose of Tdap in the immediate postpartum period.
- Health-care personnel who work in hospitals or ambulatory care settings and have direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap. An interval as short as 2 years from the last dose of Td is recommended; shorter intervals may be used.
Pertussis is an example where vaccinating the people who might otherwise be transmitting the bacteria will afford protection to infants and toddlers like an umbrella. This is the principle of herd immunity.
Resources and additional reading
Typical Sound of Whooping Cough
AAP Policy Statement on Prevention of Pertussis Among Adolescents http://pediatrics.aappublications.org/content/117/3/965
AAP Pertussis Immunization Information
AAP Pertussis Quickfacts
CDC’s DTaP Vaccine Information Sheet
ACIP’s Recommendations for Adults on Tdap Vaccination
Immunization Action Coalition Pertussis
Los Angeles Times: Cases of Whooping Cough More Than Double in California, 5/27/2010