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Whooping cough worries
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Whooping cough is back. Caused by pertussis bacteria, this disease was responsible for countless thousands of deaths, mostly among children, before a vaccine was developed in the 1940s. Whooping cough was almost eliminated by childhood immunization in the intervening years, but since 1976 it's made a steady comeback. Recently, the reported cases have skyrocketed to epidemic proportions.
<!-- ARTICLE SIDEBAR --> <table align="left" border="0" cellpadding="0" cellspacing="0" width="210"> <tbody><tr> <td colspan="2" height="5"></td> </tr> <tr> <td> <!--MAIN PHOTO--> <!--MAIN FACTS BOX--> </td> <td width="10"></td> </tr> </tbody></table> A 40-year high in the incidence of pertussis was recorded in 2004, and it is believed that there are now up to 3 million cases yearly in America. While the infection rate has increased in all age groups, the largest increases have been among adolescents and young adults. Experts believe many children are still incompletely immunized, and that there is a longstanding lack of natural immune boosting that previously occurred before the first pertussis vaccine was developed and the disease was commonplace. The disease also has been under-diagnosed in adolescents and adults and their close contacts have not received prophylactic antibiotics to prevent further spread.
But the biggest reason for the prevalence is that pertussis immunity is not life long, whether conferred by childhood vaccination (diphtheria-tetanus-pertussis) or by natural disease. Immunity wanes and the illness resurfaces beginning in the adolescent years.
Whooping cough is a serious life-threatening infection, especially in infants younger than 6 months. They can smother in their own bronchial secretions too thick to clear, develop seizures, encephalopathy, pneumonia, sudden respiratory failure and death. Illness in adolescents and adults is much milder only sometimes leading to the classic fits of severe coughing and post-tussive vomiting that may last for weeks and even months. And unlike young children, they may not manifest the characteristic inspiratory whoop after coughing.
Antibiotic treatment of suspected whooping cough cases is important, because it will interrupt further transmission to others, especially family members and other close contacts. In fact, adolescents and adults, especially young mothers, are the primary source of infection to infants who are not old enough to begin immunizations or who are only partially through the immunization schedule. The infant mortality rate from pertussis has doubled in the last 20 years.
Pertussis can be a difficult clinical diagnosis to make, particularly early in the disease process. Culturing or otherwise testing for the bacteria is problematic and the procedure to obtain specimens from the patient is uncomfortable. The best way to address this resurgent infection is through prevention.
Fortunately, new pertussis vaccines for adolescents and adults are now available for the first time. The Centers for Disease Control and Prevention has issued recommendations for routinely vaccinating 11- to 12-year-olds and catch-up vaccinations through age 18 with the new "adult" tetanus-diphtheria-pertussis vaccine replacing the old tetanus-diphtheria booster. The recommendations also include boosting all adults 10 years after their last "tetanus booster" was received. However, new parents, health-care workers, and caregivers of infants should receive the new immunization at a much shorter interval since their last tetanus shot.
We can now virtually eliminate this scourge from out of the past.
But hospitals, physicians, and the public need to become more aware of this new CDC-recommended vaccine and its appropriate use.
Feldman, M.D., is director of medical education and family medicine residency at St. Francis Hospitals and health Centers and is a former state health commissioner.
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http://www.indystar.com/apps/pbcs.dll/article?AID=/20060919/OPINION/609190353/1002
http://www.indystar.com/apps/pbcs.dll/article?AID=/20060919/OPINION/609190353/1002
Whooping cough is back. Caused by pertussis bacteria, this disease was responsible for countless thousands of deaths, mostly among children, before a vaccine was developed in the 1940s. Whooping cough was almost eliminated by childhood immunization in the intervening years, but since 1976 it's made a steady comeback. Recently, the reported cases have skyrocketed to epidemic proportions.
<!-- ARTICLE SIDEBAR --> <table align="left" border="0" cellpadding="0" cellspacing="0" width="210"> <tbody><tr> <td colspan="2" height="5">
</td> </tr> <tr> <td> <!--MAIN PHOTO--> <!--MAIN FACTS BOX--> </td> <td width="10"></td> </tr> </tbody></table> A 40-year high in the incidence of pertussis was recorded in 2004, and it is believed that there are now up to 3 million cases yearly in America. While the infection rate has increased in all age groups, the largest increases have been among adolescents and young adults. Experts believe many children are still incompletely immunized, and that there is a longstanding lack of natural immune boosting that previously occurred before the first pertussis vaccine was developed and the disease was commonplace. The disease also has been under-diagnosed in adolescents and adults and their close contacts have not received prophylactic antibiotics to prevent further spread.But the biggest reason for the prevalence is that pertussis immunity is not life long, whether conferred by childhood vaccination (diphtheria-tetanus-pertussis) or by natural disease. Immunity wanes and the illness resurfaces beginning in the adolescent years.
Whooping cough is a serious life-threatening infection, especially in infants younger than 6 months. They can smother in their own bronchial secretions too thick to clear, develop seizures, encephalopathy, pneumonia, sudden respiratory failure and death. Illness in adolescents and adults is much milder only sometimes leading to the classic fits of severe coughing and post-tussive vomiting that may last for weeks and even months. And unlike young children, they may not manifest the characteristic inspiratory whoop after coughing.
Antibiotic treatment of suspected whooping cough cases is important, because it will interrupt further transmission to others, especially family members and other close contacts. In fact, adolescents and adults, especially young mothers, are the primary source of infection to infants who are not old enough to begin immunizations or who are only partially through the immunization schedule. The infant mortality rate from pertussis has doubled in the last 20 years.
Pertussis can be a difficult clinical diagnosis to make, particularly early in the disease process. Culturing or otherwise testing for the bacteria is problematic and the procedure to obtain specimens from the patient is uncomfortable. The best way to address this resurgent infection is through prevention.
Fortunately, new pertussis vaccines for adolescents and adults are now available for the first time. The Centers for Disease Control and Prevention has issued recommendations for routinely vaccinating 11- to 12-year-olds and catch-up vaccinations through age 18 with the new "adult" tetanus-diphtheria-pertussis vaccine replacing the old tetanus-diphtheria booster. The recommendations also include boosting all adults 10 years after their last "tetanus booster" was received. However, new parents, health-care workers, and caregivers of infants should receive the new immunization at a much shorter interval since their last tetanus shot.
We can now virtually eliminate this scourge from out of the past.
But hospitals, physicians, and the public need to become more aware of this new CDC-recommended vaccine and its appropriate use.
Feldman, M.D., is director of medical education and family medicine residency at St. Francis Hospitals and health Centers and is a former state health commissioner.