Saturday, December 8, 2012

Pertussis on the Upswing in the United States: What Can Be Done?

Here are the most recent numbers from the CDC on pertussis infections in the United States.

Bordetella pertussis (
Pertussis, a respiratory illness also known as "whooping cough," is caused by the bacteria Bordetella pertussis and is a highly contagious disease. The disease is spread from person to person by coughing and sneezing. In adults, the disease usually begins with cold-like symptoms, with the disease later characterized by fits of severe coughing; disease can go on for months and is sometimes referred to as the "100 day cough." Violent coughing episodes lead to a paucity of air in the lungs, with the "whooping" sound thereafter generated by rapid inhalation; listen here for what this sounds like.

Pertussis is associated with significant morbidity in children, adolescents and adults, but can be fatal to younger children, especially infants. Infants can develop apnea (long periods of not breathing) and die from this illness; over 50% of infants less than 1 year of age who develop pertussis need to be hospitalized.

Pertussis is common in the United States, and periodic spikes in cases are seen every 3-5 years. The last spike was in 2010 where there were 27,550 cases reported; we thereafter saw a decline in cases in 2011. We have seen a spike in cases in 2012, with over 36,000 cases reported to the CDC by November 17th with 16 deaths. Some states (such as Washington, Minnesota, Vermont and Wisconsin) have been hit particularly hard; see the table below.
Although good vaccines are available for pertussis (and are included in the standard childhood vaccination program in the United States), by late childhood immunity from these can wane thereby leaving older children, adolescents and adults at risk for developing the disease. This waning immunity is partly responsible for why the disease is still common. Additionally, as the initial symptoms are non-specific, the disease is often not recognized until late (if at all), with an infected person transmitting the infection on to others.

So what can be done? The most important thing is for people to be immunized against pertussis; if people don't contract the disease then they won't spread it to others, especially the population most at risk for disease complications: infants.

A booster of pertussis is recommended for children at 11 to 12 years of age and for all adults (this is the "Tdap" vaccine). Adults should receive a one-time Tetanus-Diphtheria-Pertussis vaccine ("Tdap") and can do so regardless of when they received their last tetanus shot. As infants are at particularly high risk for having severe disease with pertussis, families of young infants (including pregnant women) should make sure they have received the Tdap vaccine. More information about pertussis vaccination can be found here.

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