Whooping cough making a comeback in Md., U.S.
Public health officials encouraging vaccinations, booster shots
Medical assistant Bronte Brown administers a TDAP (combined Tetanus, Diphtheria and Pertussis) shot to Joshua Hubbard, 11 of Carney. (Karl Merton Ferron, Baltimore Sun / August 14, 2012)
More than 20,000 cases of the respiratory disease were reported in the first seven months of the year in the United States, almost 21/2 times the number in all of last year, according to the U.S. Centers for Disease Control and Prevention. The agency says there are likely many more cases that are not reported.
In Maryland, the CDC has preliminarily logged 125 cases this year, and state data show about a quarter of the cases are in infants too young to be vaccinated.
Washington State, with more than 3,000 cases, was the first to declare an epidemic in April, but CDC officials said so many states are logging large outbreaks that this could be the worst year for whooping cough since 1959.
Officials say outbreaks of the disease, officially called pertussis, are cyclical, though they can't say for sure what is causing this year's unusually high number of cases. They say it's possible the disease is being better diagnosed, and that the effectiveness of the vaccine, routinely given only to children, not adolescents and adults, is waning.
"The vaccine isn't perfect, but it's good," said Dr. Lucy Wilson, chief of the Center for Surveillance, Infection Prevention and Outbreak Response at the Maryland Department of Health and Mental Hygiene. "That's why we're advocating for boosters."
State and federal officials say anyone older than 6 months can get the booster, called Tdap, a combination vaccine with diphtheria and tetanus. Because cases are most dangerous to infants, officials strongly advise parents and other caretakers and pregnant women, as well as health workers, to get another vaccination.
More than half of children with whooping cough are hospitalized, Wilson said. One in five gets pneumonia and one percent die.
Small children generally get a series of five vaccinations, but officials say boosters should be given to 11- and 12-year-olds, the age when immunity appears to begin waning. Boosters aren't required for school in Maryland now, but will be in 2014, Wilson said.
Lisa Hubbard, a Carney mother of two, decided to have her children vaccinated regardless of the law. Joshua Hubbard, 11, got his shot Wednesday. She's also made sure her pregnant sister and sister-in-law know about the outbreak and protect themselves.
"To keep children safe you have to pro-actively get these shots and take that small risk of side effects, versus taking the bigger risk of a child contracting a highly contagious even deadly disease," she said. "It's our job to make decisions that are in the best interests of our children and all children."
The doctor who recommended the boosters to Hubbard was Dr. Scott Krugman, chairman of the department of pediatrics at MedStar Franklin Square Medical Center and the president of the Maryland Chapter of the American Academy of Pediatrics.
He said to protect children and the community at large, enough people need to be vaccinated: "Pediatricians are encouraging all teenagers to come in for their annual physicals to make sure they have received their Tdap booster shot, not only to protect themselves, but to protect vulnerable infants through herd immunity."
A problem doctors can have is that only adolescents tend to make the whooping noise associated with whooping cough, so the illness sometimes is mistaken for the common cold. Early symptoms are runny noses, congestion, sneezing and a mild cough and fever. The heavy coughing usually begins after a couple of weeks. CDC officials recommend antibiotics for treatment of the sufferer and for prevention in those who have come in contact with it.
Vaccine experts at the CDC and elsewhere still stand behind the vaccine, though some evidence suggests that a newer version is less likely to provoke immunity and could be linked to more cases.
The formulation was changed in 1997 to reduce side effects such as pain at the vaccination site, listlessness, prolonged crying and some other rare and serious complications in babies, said Dr. Andrea A. Berry, a pediatric infectious disease specialist at the University of Maryland School of Medicine's Center for Vaccine Development.
The older vaccine was made using the whole pertussis bacteria, which is grown and later inactivated. The newer one contains only individual antigens of the bacteria that still produce an immune response but with fewer side effects.
A recent study from Australia published in the Journal of the American Medical Association found children given the newer, "acellular" vaccine had higher rates of disease. But Berry said it doesn't explain the severity of this outbreak, and she's not advocating a return to the older vaccine.
"The vaccine is not perfect, but I would not recommend returning to the whole-cell vaccine," she said. "The acellular vaccine does provide protection and has a much better safety profile. The key is using it more broadly."