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Whooping Cough: Whoop There It Is!

7/5/2016

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After seeing a patient whose baby required hospitalization for pertussis, she told me how she wished that she had accepted the tdap booster during pregnancy, but at the time, she didn’t understand how important maternal vaccination was in helping to provide immunity to her baby.  I thought I’d provide a quick review of why we care, especially during pregnancy.

What is pertussis (whooping cough) and who is most likely to get it?  Pertussis is a very contagious bacterial infection that affects the respiratory tract and causes coughing spells.  It is commonly known as “whooping cough” because people with pertussis often make a “whooping” sound when they try to breathe (sounds more like seal barking than Tag Team).   During 2014 there were more than 30,000 cases in the US.  The highest rates of disease were noted to be in babies, and the majority of deaths occurred among babies younger than 3 months old. Half of babies with pertussis will be hospitalized as their immune systems are so fragile and one in one hundred of those who receive treatment in a hospital will die.  

Why is pertussis on the rise?  In 1976 there were only 1,010 cases in the US, but in 2012, there were 48,277 cases nationwide!  What is contributing to this?  Decreased vaccination by parents plays a role, but the primary reason is because the newer vaccine doesn't last as long. In 1997 the US switched from a whole cell to an acellular vaccine to decrease side effects of the older version, but researchers have noticed that the immunity decreases over time with the newer vaccine.  However, this vaccine is still very effective: In 1940, before the vaccine became available 200,000 children/infants became sick and 9,000 died; today the number is 30,000 become infected and 20 deaths a year (way to go science!).  

Why are babies so susceptible to whooping cough?  First, their immune systems are not as developed as that of an adult, and second, they cannot receive their first vaccine against pertussis until 2 months of age (even then, good luck bribing them with a lollipop and sticker!).  This leaves a window of vulnerability for newborns to contract pertussis from family members or a caregiver.  

What can you do to protect your baby from getting whooping cough?  The CDC and ACOG recommend that all pregnant women receive a Tdap booster in the third trimester from 27 to 36 weeks.  First this protects mom from getting whooping cough (30% of babies who contract whooping cough get it from their mother).  Second, the antibodies mom's immune system creates after receiving the vaccine gets transferred through the placenta to baby (mom’s literally taking one for the team).  This will provide your baby with some short term immunity until he/she can begin the vaccination series at 2 months of age.  These antibodies can also protect your baby from some of the more serious complications of whooping cough.  Third, if you are breastfeeding you may pass some additional antibodies you may have made in response to the vaccine to your baby.  Lastly, try to encourage those around baby to be up-to-date on their pertussis vaccines (if you want to hold MY baby, then here’s some hand sanitizer and a tdap).  

Where can I get the Tdap vaccine during pregnancy?  Your OB/GYN office may offer the vaccine, and it is also available at some pharmacies.  If you have any further questions, please ask your provider about pertussis and the Tdap vaccine at your next prenatal visit.
Pam


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