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Protect your Baby from Whooping Cough


You've probably seen a lot of talk in the news recently about the increase in pertussis (also known as whooping cough). It's a bacterial infection that usually starts with a runny nose, fever, and cough. The cough develops into a raspy cough that sounds more like a loud bark than an actual cough.

It's a highly-contagious disease. People with pertussis usually spread it by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria, according to the U.S. Centers for Disease Control and Prevention (CDC). Many infants who get pertussis are infected by older siblings, parents, or caregivers who might not even know they have the disease. The symptoms usually develop within 7 to 10 days after exposure, but sometimes it takes as long as 6 weeks.

"If you've ever seen a child with pertussis you, won't forget it," says the American Academy of Pediatrics (AAP). "The child coughs violently and rapidly, over and over, until the air is gone from his/her lungs and he/she is forced to inhale with the loud 'whooping' sound that gives the disease its nickname. Then, the coughing begins again."

These severe coughing spells can go on for weeks, says the AAP. The child might turn blue from lack of air or vomit after a coughing spell. A child with pertussis can have difficulty eating, drinking, or even breathing. Most commonly, pertussis effects children. Infants with pertussis are often hospitalized to assist their breathing.

Young infants are at the highest risk for pertussis-related complications, including pneumonia, seizures, brain swelling, and even death, according to experts at Brenner Children's Hospital which is a part of Wake Forest University in Winston-Salem North Carolina. In the U.S., the incidence of pertussis peaks at one month of age and progressively decreases over the next year. Pneumonia is the most common cause of infant pertussis-related deaths. Most deaths occur among unvaccinated children or infants too young to be vaccinated.

RECENT OUTBREAKS

Recently, there have been pertussis outbreaks in various areas of the U.S. At least six babies have died during these outbreaks. Visit the CDC's Pertussis page for information on current areas where there have been outbreaks: www.cdc.gov/vaccines/vpd-vac/pertussis/default.htm.

The AAP recommends "cocooning," a strategy that protects infants who are too young to be immunized, by having parents, siblings, and caretakers vaccinated against this disease. People over age 11 (and those over age 7 in some states with outbreaks) should receive 1 dose of Tdap vaccine, if they have not already. (Of course, all infants and children should already be receiving the vaccine on the recommended schedule.)

Even with the success of pertussis vaccines, the disease is still common in the U.S., says the CDC. Many cases are not diagnosed and so are not reported. Yet over the past 5 years, between 8,000 and 25,000 cases have been reported annually. Institutional outbreaks of whooping cough such as those in a daycare centers, schools, or hospitals are common and occur each year in many states.

Whooping cough cases vary each year, and the CDC says they tend to peak every 3 to 5 years. The most recent peak: in 2005, when more than 25,000 cases were reported in the U.S.

RECOMMENDED VACCINATION SCHEDULE

You may have seen TV public-service announcements encouraging adults to get vaccinated to help protect infants from pertussis. There are two types of pertussis vaccines: DTaP for infants and children and Tdap for adolescents and adults. Getting vaccinated with Tdap is especially important for family members with, and caregivers of, new infants. (Also, if caring for an infant, keep him or her away from anyone with cough or cold symptoms.)

The CDC recommends the following vaccination schedule:

 Infants and children are recommended to receive 5 doses of the DTaP vaccine at 2, 4, and 6 months, at 15 through 18 months, and at 4 through 6 years. All 5 doses are needed for maximum protection.

 Adolescents are recommended to receive the Tdap vaccine at their regular check-up at age 11 or 12. If teenagers (13 through 18 years) missed getting the Tdap vaccine, parents should ask the doctor about getting it for them now.

 Adults who are 19 through 64 years old are recommended to get a one-time dose of Tdap in place of the Td booster they're recommended to receive every 10 years. No need to wait until you are due for your Td booster. The dose of Tdap can be given earlier than the 10-year mark since the last Td booster. It's a good idea for adults to talk to their healthcare provider about what's best for their specific situation.

 Pregnant women should, ideally, receive Tdap before pregnancy. Otherwise, it is recommended that Tdap be given after delivery, before leaving the hospital or birthing center. If a pregnant woman is at increased risk for getting pertussis, such as during a community outbreak, her doctor may consider giving Tdap during pregnancy. Although pregnancy is not a contraindication for receiving Tdap, a pregnant woman and her doctor should discuss the risks and benefits before choosing to receive Tdap during pregnancy.

 People 65 years and older do not currently have a whooping cough booster vaccine licensed for their age group. However, people in this age group can talk to their healthcare provider to see if getting Tdap is a good decision for them. This discussion can include weighing the risks and benefits of receiving Tdap. Receiving Tdap may be especially important during a community outbreak and/or if the person is caring for an infant.

PROTECTING THE MOST VULNERABLE

Yes, we just talked about the CDC's recommended timing for infant vaccination. But protecting very young infants from pertussis may be as easy as administering a routine vaccine two weeks earlier than it is typically given, according to a just-released study by researchers at Wake Forest University School of Medicine and Vanderbilt University.

This two-week shift has the potential to prevent at least 1,236 cases of pertussis, 898 hospitalizations, and seven deaths each year in the U.S., says Timothy R. Peters, M.D., co-lead author and an assistant professor of pediatrics at Brenner Children's Hospital.

"Rates of pertussis, which can be life-threatening in young infants, are increasing," Peters says. "Pertussis vaccine has been highly effective in defending children against this disease, and we find that modest adjustments in the timing of vaccine administration may offer enhanced protection to very young infants, who are especially susceptible to severe disease."

While there's no lifelong protection against pertussis, immunization is the best preventive measure. The 2004 National Immunization Survey (the most recent statistics available) estimated that only 88 percent of infants had received one dose of DTaP vaccine by three months of age, 76 percent had received two doses of DTaP vaccine by five months of age, and only 66 percent had received the first three vital doses of DTaP vaccine by seven months of age.

In the study, researchers sought to estimate the potential benefit of accelerating first-dose administration from two months to six weeks of age. "While two weeks may seem negligible, this change would reduce the time that a two-month-old infant is completely without pertussis vaccine protection by 25 percent," Peters notes.

Although administration of the first dose at six weeks is a change from the current routine practice of administration at two months, moving it up this much still falls within the current recommendations of the CDC's Advisory Committee on Immunization Practices and the American Academy of Pediatrics for the childhood vaccination schedule, and should have little impact on medical providers or on the number of doctor visits for vaccines, the researchers report.

The bottom line: Talk with your child's doctor about when to give this important vaccine to your infant. And make sure that you, your other children, and any caregivers are vaccinated as well.

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