The Update:
Pertussis out breaks(i.e. whooping cough) have been occuring more frequently over the past few years prompting changes in our immunization booster recommendations for pertussies. Because this is a major publich health issue, it is important to have an understanding about why pertussis is on the rise and why it is so important we all get immunized against pertussis – as kids and adults.
Understanding Pertussis Recommendations Based on History
Pertussis is one of the vaccine preventable illnesses. Before the wide-spread vaccination against pertussis, the illness claimed the lives of 5000-10,000 people annually. Vaccination reduced that number to 30! However, in recent years, we’ve begun to see a rise in Pertussis cases reaching 25,000 in 2005. This is thought to be the result of waning immunity to the primary series of Pertussis immunizations given in infancy and early childhood and due to the rising number of people not opting to immunize their children. Another factor is that because immunity wanes over time, adults once vaccinated are becoming unprotected and contracting Pertussis if exposed.
To avoid a public health disaster, the CDC altered the Pertussis immunization recommendations to add a booster in the form of TdaP for teens instead of the traditional Td and to do the same for adults when their next Td would be due. The hope would be to re-booster vulnerable people and get everyone protected again thereby haulting this rise we are seeing.
Pertussis Information:
Technical Names: Pertussis
Nicknames: Whooping Cough
What it is: respiratory illness caused by Bordetella Pertussis
Typical Ages for Illness: Any!! Most severe in infants less than 1 year of age
Typical Symptoms:
Starts as a cold then quickly progresses to the “whoops” which come is spurts or spasms.
Seasonal Issues: none
How’s It Spread? Person to Person by respiratory droplets
Contagiousness: People are contagious for the first 2 weeks of the cough without antibiotics or until on antibiotics for a full 5 days.
Incubation Period: usually 7-10 days from exposure but can be up to 3 weeks
Diagnosis: nasal swab for culture
Symptom Duration:
Cold symptoms for 1-2 weeks then 2-4 weeks of cough followed by a recovery phase that can last for months.
Treatment:
Antibiotics shorten the “whoop” phase as well as stop the spread to other people.
Supportive care with fluids and respiratory treatments if needed
Some kids do need to be cared for in the hospital
Complications: pneumonia (1 in 10), seizures (1 in 50), encephalopathy (1 in 250), fatal in 10-20 cases a year
Call Your Pediatrician if your child has: High fever, difficulty breathing, not eating or drinking, not acting right, seizures, productive cough
Prevention: VACCINATION
Primary DTaP series at 2, 4 and 6 and 15-18 mo of age with a booster going into Kindergarten (4-6 years of age)
TdaP for at the 11-12 year old well child visit, and for adults when their next Td would be due for one dose.
Return to School and Activities:
This is a tough call as each child’s case of Pertussis is unique. Like with other illnesses, children need to be fever free for 24 hours. In the case of Pertussis, they need to be on antibiotics for 5 full days before returning to school, as opposed to the standard 24 hours for other illnesses requiring antibiotic treatment.
To return to school, children should also be able to move well without coughing too much and be able to eat and drink normally.
So, the optimal time to return to school will be determined not just by when a child starts the antibiotics but when other symptoms are controlled enough so that the child can attend school comfortably. Your pediatrician will be able to guide you best for this.
Internet Resources For Parents
CDC: why vaccinate for pertussis
CDC: Pertussis Vaccine Information
American Academy of Pediatrics: Pertussis Information
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