by Kim Wilschek, RN, CCE
Prevalence of pertussis, or whooping cough, has been increasing since the 1980's, especially in infants and young adolescents. In 2008, there were more than 13,000 reported cases including 18 deaths nationally. Currently, it has reached epidemic proportions in the state of California. Pertussis can be especially dangerous for young infants, leading to extreme leukocytosis, pneumonia, and pulmonary hypertension. Maternity nurses and educators are in a unique position to educate families by taking advantage of the conversation you have when offering new moms the TDaP vaccine.
Let's start with a quick review of pertussis. Whooping cough is caused by Bordetella pertussis bacteria. It is spread via coughing or sneezing. Many infants who get pertussis are infected by parents, older siblings, or other caregivers who might not even know they have the disease. Diagnosis is made via nasal swab and standard treatment is azithromycin. This bacterium affects the linings of the airways, causing swelling and narrowing. The infection initially presents by resembling a common cold. In fact, it is often misdiagnosed in the adult population as asthma, allergies, or bronchitis. Patients typically appear well when not coughing and may have normal physical findings initially. Pertussis is most contagious during the early stages, before the patient exhibits a cough.
After 1-2 weeks of the "cold-like" symptoms, patients develop severe coughing. Infants and children can cough violently until all the air is gone from their lungs, causing them to inhale with a loud “whooping’ sound. Pertussis is most severe for infants resulting in hospitalization (more than 50%), pneumonia (20% ), convulsions (1%) and death (1%). Because the disease progresses so rapidly in infants, the CDC recommended that ‘suspected’ cases are treated before lab confirmation.
The best protection against pertussis is through vaccination. The childhood vaccine is called DTaP and the booster for adolescents and adults is called TDaP. Both of these vaccines protect against Tetanus, Diphtheria,and Pertussis. The booster, only available since 2008, is critically important because experts know that the childhood vaccine does not provide lifetime immunity. The CDC recommends that adults (age 19-64) have a one-time booster of TDaP in place of the Td booster they’re recommended to receive every 10 years. However, certain populations should receive the TDaP booster now, regardless of the timing of their last Td booster:
• Healthcare workers
• Those working around young children
• Families and caregivers of newborns and infants
• Postpartum women prior to hospital discharge
Per the AAP vaccination schedule, infants 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. So here lays the ‘danger zone’ for today’s parents of newborns - most adults have not received the TDaP booster since it has only been available for 2 years AND infants are too young to be fully vaccinated. This is why establishing a ‘circle of protection’ around young infants becomes critical. Fortifying this ‘circle’ involves the below three steps:
• Vaccination of all household members and those providing care to the newborn (note that a vaccine for those over the age of 65 has not been approved. However, people in this age group can talk to their healthcare provider to see if getting TDaP is a good decision for their family)
• Avoidance of high risk exposure situations– avoid/limit the newborn’s exposure to crowds, large gatherings, and anyone who is sick or has a “cold”.
• Routine vaccination of infants/children per the AAP vaccination schedule
The CDC and the AAP have lots of valuable information for healthcare providers and parents on pertussis. Many of us in healthcare have never cared for a child with whooping cough. Click here to hear what pertussis sounds like.
Handouts have been included in the left hand column to educate parents and grandparents of newborns about the dangers of whooping cough and the importance of vaccinating themselves.