What You Should Know About Pertussis Protection: Q&A with Pediatrician & Author Dr. Ari Brown
Ari Brown, M.D., FAAP, is a pediatrician, author, child health advocate and mom. Dr. Brown completed a bachelor’s degree in child development from the University of Texas at Austin, earned her M.D. from Baylor and completed her general pediatric residency at Harvard Medical School/Boston Children’s Hospital. Dr. Brown is Board Certified and is a Fellow of the American Academy of Pediatrics. She works full-time in private practice. Her passion to educate families about children’s health led Dr. Brown to co-author the books Baby 411: Clear Answers and Smart Advice for Your Baby’s First Year (4th Ed, Windsor Peak, 2009), Toddler 411 (3rd Ed., Windsor Peak, 2010), and Expecting 411 (1st Ed., Windsor Peak, 2010). She has appeared on NBC’s Today Show, CNN, Dr. Phil, Rachael Ray, and ABC News. She serves on the advisory board for Parents Magazine and hosts a message board at their website, Parents.com. She is a spokeswoman for the American Academy of Pediatrics and the Texas Medical Association.
Q. What is pertussis?
A. Pertussis, also known as “whooping cough,” is a highly contagious disease marked by irritation and inflammation of the throat, caused by the Bordatella pertussis bacteria. The bacteria attaches to the tiny hairlike structures (cilia) in the respiratory tract, causing inflammation. The swelling prevents mucus from being coughed up and creates a blocked airway, particularly for those with the smallest airways – infants.
Q. What are the symptoms?
A. Pertussis infection has three stages. It initially looks like the common cold. Stage one includes symptoms like runny nose, coughing and sneezing for a couple of weeks. In stage two, coughing fits or spasms begin, with trouble catching the breath at the end of each coughing spell. As a person tries to get a breath in, she makes a characteristic “whoop.” Infants, who have smaller airways, are unable to breathe at all. Instead of whooping, they stop breathing, and their faces may turn red or purple. Children often vomit during a coughing episode. Stage two may last six weeks. The third stage of pertussis is a period of gradual recovery and persistent cough for another 6-12 weeks. The length of the illness is why this illness is known as the “100 Day Cough” in Asia.
Q. How does pertussis spread?
A. This disease is easily spread through cough droplets and runny nose droplets. It is contagious for three to four weeks after infection.
Q. How common is it?
A. In the 1900s, before the vaccine for pertussis was developed, there were roughly 200,000 cases per year in the US, and 10,000 deaths annually – mostly infants. Post-vaccine, in 2006, confirmed pertussis cases numbered about 15,000 per year. However, pertussis today is much more common than the numbers show. That’s because many cases are treated without lab confirmation of the infection. Some people get treated for “bronchitis,” when it is really whooping cough. In addition, some physicians treat a patient without doing the test, because their location may require sending that lab test off to the state health department. Some people are walking around with pertussis without being treated at all. So the true infection rate may actually be in the range of one to three million cases per year.
We also continue to experience outbreaks of pertussis in particular parts of the country that are of great concern. This disease is so contagious and may not be readily recognized as pertussis, so raising public awareness about immunization, as well as signs and symptoms, is critical.
Q. Who is most at risk?
A. The younger the child, the more severe the illness. Pertussis is most serious in babies under one year of age – and particularly dangerous for infants under six moths of age. For that age group, 50 percent of babies with pertussis are hospitalized and 10 percent develop pneumonia. Their airways are smaller and they have more difficulty handling the inflammation and clearing of secretions. As a result, younger children are more likely to have “apnea” spells where they cannot breathe. Younger children are also more likely to develop pneumonia, which can be deadly.
Q. How can we prevent pertussis?
A. Vaccination is the number one way to prevent the disease. Anyone over two months of age and under 64 years of age is eligible to receive the vaccine, barring certain health conditions. Infants are not fully protected by the vaccine until they receive their third dose at age six months, so they rely on others around them to keep them safe from exposure.
However, immunity through the vaccine is not forever. Teens and adults need to get the Tdap booster (tetanus, diptheria and pertussis). This vaccine is the TD booster that teens and adults need to get every 10 years, but with pertussis protection added. The Tdap booster has been available since 2005. Any teen or adult who has not had a tetanus shot since the year 2005 probably needs to get the Tdap.
Q. Why is it important for teens and adults to get pertussis booster shots?
A. Immunity fades over time, making booster shots crucial. Also, older kids and adults tend to be the ones who get the infection and then pass it on to infants, who are too young to have been fully vaccinated. The same babies who haven’t yet been fully protected by all the doses they need of the vaccine are the most vulnerable to suffering from complications if they become sick. That’s why everyone in the household needs to be up-to-date on their immunizations. All moms, dads, grandparents, siblings, babysitters and other adult caregivers should get the Tdap vaccine four weeks before spending time around a baby. It takes four weeks for the vaccine to be fully effective.
Q. What should women who are planning a pregnancy (or are already pregnant) know about pertussis vaccination?
A. The recommendation and the ideal is to get the pertussis vaccine before becoming pregnant, or routinely after delivery as part of postpartum care. But pregnant women may be vaccinated against pertussis, if there is a known risk of being exposed or a significant risk of exposure. The pertussis vaccine is safe to receive while breastfeeding.
Q. What are the biggest myths and challenges around this issue?
A. There is a false perception that no one carries the Tdap shot. While not all doctors’ offices carry it, many outpatient pharmacies do. It is widely available, but patients need to know to ask for it. There is also a myth that a teen or adult cannot receive the Tdap booster if they received a tetanus shot less than 10 years ago. In fact, as long as it has been two years, you can get the Tdap. We also need to let the public know that even if you have had pertussis, you can get the infection again – the Tdap booster is still needed.
Q. What can partners in public health do to help?
A. Improving public awareness is key. Since it is not “standard” to offer this vaccine to parents and parents-to-be (and certainly not to grandparents and grandparents-to-be), we need to speak up and let the public know about this issue. The message to parents is, “Remember, your baby can only be protected against pertussis if everyone around him is vaccinated.” From a public health standpoint, we need to make vaccination the standard. The CDC recommends it. Finally, we need to make sure insurance companies routinely cover it and that providers offer it.
To learn more about pertussis from the US Centers for Disease Control and Prevention (CDC), go to www.cdc.gov/vaccines/vpd-vac/pertussis/default.htm.