If you haven’t gotten your Tetanus, Diphtheria, Acellular Pertussis (Tdap) shot, now is as critical a time to do so as ever.
Pertussis, also known as whooping cough, is on the rise again, with 29,000 cases already reported this year nationwide.
Most severe in young children and babies, Pertussis often causes coughing episodes, followed by a “whooping” sound when gasping for air.
Other symptoms include what appears to be a common cold, with runny nose, congestion, sneezing, and possibly a mild cough or fever. A more severe cough generally comes about one to two weeks following initial symptoms.
As the disease progresses, particularly in infants, it can cause life-threatening pauses in breathing, also known as apnea.
The disease hit hard in 2010 with more than 27,000 cases reported in the U.S., including 9,000 cases in California, the most the state had seen in 63 years.
Despite a large decline in reported cases last year nationwide, (15,216), the State of Arizona was not so fortunate, as reported by Seema Yasmine, an Epidemic Intelligence Service Officer with the CDC, who spoke at the Tucson Medical Center last Wednesday. “In 2011, that national picture improved, and we saw a reduction of almost half in the number of Pertussis cases, but unfortunately we didn’t see that reduction reflected here locally in Arizona,” she said. “We actually saw an increase of almost 60 percent in the number of reported cases across the state, and in different counties in Arizona, it was much higher than this.”
As one example, Maricopa County saw an increase of 240 percent compared to last year, and up to 600 percent from years prior to 2010.
So far this year, Arizona has seen 700 reported cases compared to 585 this time last year, a 30 percent increase that includes the death of a three-month-old baby.
“What we found in this case was the parent actually had symptoms of Pertussis,” said Yasmine.
The case was similar to others locally, in that, unlike other states, Arizona has a higher number of adults diagnosed with Pertussis than children. Though the disease is much milder in adults, the potential of spreading it to young children is an area of concern, particularly given that young children can sometimes appear deceptively healthy while carrying the disease.
“The CDC did a study in 2004 that shows that more than 75 percent of infants are exposed to Pertussis by an adult, or adolescent in the home” said Yasmine. “This goes with the whole rationale of why we need to immunize the adult population and the idea is that by immunizing adults, we improve the chances of infants who are too young to receive their vaccine, and who are most vulnerable to the disease.”
According to the CDC website, the recommended Pertussis vaccine, called DTap, should be given five times to children, at two months old, four months, six months, 15-18 months and a final shot at age four through six.
For pregnant women, one dose of Tdap is recommended in the third trimester or late second trimester, or immediately postpartum.
Adults who have not had a Tdap shot as a preteen or teen should get one dose as well, particularly true if contact is soon to be made with an infant.
Yasmine said the CDC has developed some theories as to why the disease, which is vaccine treatable, is spreading more in recent years, and particularly so in Arizona.
Research by the CDC has shown that Arizona is one of the leading states where medical professionals are not using the recommended tests for diagnosing suspected cases of Pertussis, and where less than 20 percent of healthcare workers are up-to-date on their Tdap immunizations.
In one Arizona hospital, the consequence of such factors led to the spread of three simultaneous cases of Pertussis in infants.
The hospital’s research showed that the babies were each born premature and housed in the hospital’s Neonatal Intensive Care Unit within close proximity. It was then determined by the hospital that 39 health care workers working in the NICU had a cough illness at the time, and that those 39 employees had been in contact with about 355 additional employees of the hospital. A prophylactic was given to each of those workers.
Another 330 employees were administered a Tdap vaccine after it was determined they were not up to date on their shot.
It was determined by the CDC that at least 10 of the health care workers had Pertussis, and it was also determined that the hospital was not taking proper precautionary measures for who it allowed in the NICU. The layout of the room was also considered crammed, with infants closer together than recommended by the American Academy of Pediatricians recommends, and with minimal access to sinks for employees to wash their hands.
Despite the relatively small outbreak, the price tag was a big one for the hospital, the largest expense of which was paying the health care workers during their leave, to the tune of $55,000. The hospital was also faced with additional expenses, including lab testing for potential carriers, acquiring Tdap vaccinations, and dedicating labor toward the processes.
“The total cost for this outbreak was about $100,000,” said Yasmine. “The cost of an outbreak and the impact it has on society is much higher than the cost for getting the shot.”
Vaccines generally run about $45 for insured patients, and $15 for uninsured patients.
To date, 37 states have reported an increase in Pertussis from 2011, and 14 total deaths have been reported.