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Health authorities battle rise in NC whooping cough cases

By Jessica M. Morrison
Correspondent

More Information

  • Vaccine guidelines

    The Centers for Disease Control and Prevention recommends that infants receive their first pertussis vaccinations at two-, four- and six-months. Boosters should be given at around 18-months and again at about 5 years old.

    Since 2008, rising 6th graders in North Carolina have been required to receive another pertussis booster. This vaccine, called Tdap, offers protection against tetanus, diphtheria and pertussis.

    In South Carolina, rising 7th graders should receive the vaccine before the start of school.

    • The CDC recommends that pregnant women receive the pertussis vaccine between the 27th and 36th weeks of pregnancy.

    • Any adult who didn’t get a booster as a preteen should ask their doctor about getting a Tdap.

    Getting the vaccine

    Tdap is available from doctor offices and national retailers – CVS, $64.99; Walgreens, $63.99; and Target clinics, $60.

    Contact your local health department for information about clinics offering free or low-cost vaccinations. Mecklenburg County Health Department, 704-336-4700.

    To hear what whooping cough sounds like, watch this short video. http://www.cdc.gov/pertussis/pubs-tools/audio-video.html



Outbreaks of pertussis, known as whooping cough, are on the rise in North Carolina and across the U.S., and the reason is one that scientists never expected.

An updated version of the vaccine introduced in the 1990s to address adverse reactions is too weak to offer long-lasting immunity, experts say. For infants too young to be vaccinated, contracting whooping cough can be fatal. To combat the increase, schools nationwide are requiring students to have a pertussis booster prior to entering middle school.

Whooping cough, a highly contagious bacterial infection that affects the upper respiratory system, is spread through coughing or sneezing. The name comes from the “whooping” sound that occurs as air is forcefully sucked into the lungs between periods of violent coughing. (See video link in box.)

After a vaccine was developed in the 1920s, the number of reported cases each year dropped from the hundreds of thousands to just a few thousand in the 1980s. But this year, reported cases are already nearing 12,000.

Fourteen cases of whooping cough have been reported in Mecklenburg County this year. There have been 270 cases reported statewide.

Several factors, like better diagnostics and reporting, are contributing to the higher number. But the driving factor is waning immunity, said Stacey Martin, an epidemiologist for the Centers for Disease Control and Prevention.

“While the vaccine offers very good short-term protection, we are seeing a decline in protection over time,” Martin said. “We’re at least a decade out from any new vaccines. That means we need to use the current vaccines the best we can.”

The first widely used pertussis vaccine, known at DTP, was made from whole pertussis bacterial cells. While this vaccine was successful in reducing the incidence of pertussis, it was known to cause irritation at the injection site, fever and, in some cases, uncontrolled spasms or convulsions.

The introduction of a new vaccine in the 1990s reduced adverse reactions, but it also cut the length of immunity.

Vaccinating mothers

Estimates for 2012 topped 40,000 cases of pertussis nationwide, a high that hadn’t been seen since the mid-1950s. While the highest percentage of infections occurred in the 11- to 19-year-old age group, infants are most likely to die from pertussis.

For that reason, focus has shifted to vaccinating mothers during each pregnancy so that antibodies might be transferred to babies until they are old enough to receive the vaccine.

The early signs of pertussis – a runny nose, sneezing, mild fever and occasional cough – are similar to a common cold and might be overlooked by parents. But if the coughing fits become severe enough, infants may vomit, “whoop” as they gasp for air or stop breathing altogether.

In adolescents and adults, symptoms are generally milder, often not progressing beyond those of a cold, and the classic “whoop” isn’t usually present, doctors say.

“The cases that we’re seeing are in the elementary school age,” said Julie Henry, spokesperson for the N.C. Department of Health and Human Services. And it’s not just children who need a pertussis booster, Henry said. “Anyone who is going to be around a newborn baby needs to be vaccinated.” (See box for info on adults.)

‘No one told me’

Felicia Dube, 38, of Lancaster, S.C., wishes she had heard that advice three years ago before she delivered her son Carter. Nearly 10 years had passed since Dube’s first son was born, and she and her husband were excited.

“I re-read all the mommy books. I took my flu shot. I did everything they suggested to keep myself healthy and to keep the baby healthy,” she said. But those books didn’t mention the adult pertussis booster, she added.

A few days after Carter’s 5-week check-up, he became fussy. Even though it felt like they were overreacting, Dube and her husband, Daryl, called Carter’s pediatrician. That same day he was admitted to Levine Children’s Hospital, where he was treated for whooping cough even though doctors weren’t yet sure that he had pertussis. Less than two weeks later, the infant died.

“We found out the next day that he had whooping cough. The test finally came back,” Dube said. “It was my job to protect him, and I didn’t protect him. No one told me that I needed that booster.”

Although Dube blames herself, there’s no way to know where Carter picked up the infection.

Two years ago, the Dubes welcomed a baby girl, Brennan, to the family, and this time they didn’t take any chances.

“We didn’t give anyone an option with Brennan. ‘Have the shot, or you don’t see the baby,’ ” Dube said.

And experts recommend just that.

“It’s important to emphasize that this can be really dangerous in infants,” said Dr. Melissa Taylor, a pediatrician with Novant Health Randolph Pediatrics. “It’s important to vaccinate everyone around an infant – the cocoon strategy – if everyone is vaccinated, the infant is much less likely to catch the illness.”

Dube is now speaks for Sounds of Pertussis, a public service campaign started by the March of Dimes and Sanofi Pasteur, the vaccine division of a French pharmaceutical company.

“I feel like I have made a difference, even if it is just one person,” Dube said. “In the end, that’s what it’s all about, protecting the ones who can’t speak up to protect themselves.”

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