Pertussis (whooping cough)

The Secretary of Health of the state of Washington declared a pertussis epidemic on April 3, 2012, after the number of reported cases reached 640, compared to 94 cases reported in the same time period in 2011. Pertussis, or “whooping cough,” is a respiratory disease caused by the Bordetella pertussis bacteria. After a person becomes infected, it can take from 7 days to a month for pertussis symptoms to develop. The bacteria cause the disease by releasing toxins that lower the lungs’ ability to clear out respiratory secretions (mucus). After an initial period of a low-grade fever and mild cough, the cough becomes severe and occurs in episodes that prevent the patient from breathing properly, so much so that some patients turn blue during the coughing bouts and for a short time after.[1] According to the Centers for Disease Control and Prevention (CDC), 27,550 cases of pertussis were reported to public health authorities in 2010. More

In October 2010, the Advisory Committee on Immunization Practices (ACIP) issued a new recommendation for Tdap vaccination -- the booster vaccine that provides protection against tetanus, diphtheria, and pertussis (whooping cough). While the vaccine had previously been recommended as a one-time booster for adults up to age 64, replacing an individual tetanus booster, the committee voted to expand that recommendation: anyone older than 65 who had not received a prior dose of Tdap should receive one if they expected to have close contact with an infant younger than 12 months old.

This recommendation was made partially in light of the California whooping cough epidemic. While whooping cough is typically less severe in adults, the infection can still be passed to infants, for whom infections are much more severe. Study data has indicated that grandparents, for example, are the ultimate source of the infection in 6-8% of cases. However, the committee noted that there was a direct benefit to the individual as well, since whooping cough tends to be more severe in adults older than 65 than in younger adults. (For more details, see "Advisory Committee Votes for Expanded Pertussis Vaccine Recommendations" from the History of Vaccines blog.)

Although this recommendation was issued last October, some adults older than 65 who wanted to receive a Tdap booster had difficulties obtaining one due to confusion between the ACIP's recommendation and the FDA's approved label usage for the vaccine at the time. Neither of the two Tdap vaccines (Sanofi Pasteur's Adacel and GlaxoSmithKline's Boostrix) was approved by the FDA for use in adults older than 65. More

National Infant Immunization Week is April 23-30 this year. This week, the History of Vaccines blog features posts about several diseases that can be prevented by vaccination of infants.

Although its name is not as well known as those of diseases like chickenpox or measles, rotavirus is the most common cause of severe diarrhea in children and infants worldwide. Before a vaccine was introduced in the United States, the disease caused more than 400,000 doctor's visits and 200,000 emergency room visits each year, causing as many as 60 deaths annually in U.S. children younger than five.

The virus spreads easily among children, and can also be passed from children to those with whom they're in close contact. Rotavirus spreads via the fecal-oral route -- that is, from the waste of an infected person to the mouth of another individual. This can occur via contamination on hands or objects like toys.

Rotavirus can be prevented by vaccination. The first dose of the vaccine series is recommended at two months of age. More

The U.S. Supreme Court ruled on February 22 on Bruesewitz vs. Wyeth, upholding a federal law that established protection for vaccine makers from lawsuits and that provides compensation for certain vaccine injuries.

The Bruesewitz suit claimed that a vaccine Hannah Bruesewitz received in 1992 (her third dose of the diphtheria-whole cell pertussis-tetanus vaccine) was defective in its composition and thus resulted in the girl’s seizures and developmental delays. The Bruesewitz family earlier had been denied compensation from the National Vaccine Injury Compensation Program.

Antonin Scalia wrote the majority opinion, stating that "Vaccine manufacturers fund from their sales an informal, efficient compensation program for vaccine injuries; in exchange they avoid costly tort litigation and the occasional disproportionate jury verdict."  He asserted that the intention of the National Childhood Vaccine Injury Act of 1986 (which established NVICP) to exclude drug design defects from liability claims is evident in its “lack of guidance for design defects combined with the expansive guidance for the grounds of liability specifically mentioned.” More

Meeting in Atlanta, the Advisory Committee on Immunization Practices voted on October 27 for new recommendations regarding Tdap vaccination.

Tdap, the booster vaccine for tetanus, diphtheria, and pertussis (whooping cough) has been a source of confusion in recent months. In light of the pertussis outbreak that began in California, health authorities had issued reminders about the adult Tdap recommendation: adults aged 19-64 should substitute one Td booster (recommended every ten years to protect against tetanus and diphtheria) with a single Tdap booster, which also offers protection against pertussis. This is recommended to limit the disease's ability to spread; while adult pertussis cases are generally milder than those in children, adult patients can still spread the disease to young children, including those too young to be vaccinated. The adult vaccination schedule did not include a recommendation about Tdap for adults aged 65 and older, however, which includes many grandparents concerned about passing pertussis on to their grandchildren. More

A post on the History of Vaccines blog earlier this month mentioned an outbreak of whooping cough in California, noting that at the time, four infants had already died from the disease. The death count has now reached five, all children less than three months of age, and the total number of confirmed cases reached 910 as of June 15th. The director of the California Department of Public Health declared in a statement that the outbreak is now an epidemic.

The most recent major outbreak of whooping cough was in 2005, when 3,182 cases were recorded in California. This year’s epidemic is on pace to surpass the number of cases from 2005. An outbreak has also been reported in Ohio, and Oregon public health officials have reportedly noted an unusually high number of cases there as well.

Whooping cough can be prevented by vaccination, but the first dose of the vaccine is not given until two months of age. Prior to that infants are highly susceptible to the disease, which is often spread by adults. A booster vaccine against whooping cough is available for adults as part of the Tdap (tetanus, diphtheria, pertussis) immunization, which can be substituted for one tetanus or Td vaccination between the ages of 19 and 64. The Advisory Committee on Immunization Practices (ACIP) recommends Tdap vaccination for adults who have contact with infants younger than 12 years of age. More

*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 StaffGuest 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. More