#17,803
This time of year it is always a viral stew out there, and while influenza, RSV, COVID and Mycoplasma pneumoniae are getting most of attention, I'm seeing reports of increased whooping cough (Pertussis) activity in some communities both here in the United States, and around the world.
We often see surges in Pertussis every 3 to 5 years, and after the hiatus from non-COVID viruses during the pandemic (see CDPH Epi Chart below), a return to pre-pandemic levels is not unexpected.
Last May I updated my Tdap vaccine (long overdue) for this very reason. While most people think of whooping cough as primarily a concern for infants and toddlers, it can be quite debilitating (and persistent, often for weeks) for anyone of any age.
A little over a week ago Sand Diego County, California announced an uptick in pertussis (see press release below).
County Health Officials Report Increase in Whooping Cough
By Fernanda Lopez Halvorson, County of San Diego Communications Office
Increasing cases of pertussis, also known as whooping cough, have County health officials recommending that people get vaccinated, particularly those most at risk of becoming seriously ill.
The number of pertussis illnesses jumped from 12 in September to 57 in October. Spikes in pertussis happen every three to five years. The last peak was in 2017. The current rise in illness reports is the first since the COVID-19 pandemic when COVID-19 prevention steps also kept pertussis down.
“We’re seeing pertussis spreading in rates similar to before the pandemic,” said Wilma J. Wooten, M.D., M.P.H., County public health officer. “This is concerning because we know that post-pandemic, many people are experiencing vaccine fatigue. Yet what we have learned over the last several years is that vaccines, hand washing, masking and other precautions help curb the spread of illness.”
Pregnant women and people who come into close contact with young infants are strongly urged to be vaccinated. Newborns are especially susceptible to pertussis since they are too young to be fully vaccinated. The last pertussis death in the County was a 5-week-old San Diego infant who died in July 2016.
A typical case of pertussis starts with a cough and runny nose for one to two weeks, followed by weeks to months of rapid coughing fits that sometimes end with a whooping sound. Fever, if present, is usually mild. Antibiotics can lessen the severity of symptoms and prevent the spread of disease to others.
The Centers for Disease Control and Prevention recommends the following schedule for the Tdap vaccination that helps protect people from pertussis:
- A Tdap booster is recommended for pregnant women early in their third trimester and during each pregnancy to protect their newborns.
- Young children need five doses of DTaP by kindergarten: at 2 months, 4 months, 6 months, 15 to 18 months and 4 to 6 years.
- After that, the first Tdap booster is due at age 11 years. All students entering 7th grade are required to have proof of a whooping cough booster immunization (Tdap).
- One dose of Tdap is recommended for adults 19 years of age and older who did not get Tdap as a teenager.
- After that, getting Tdap instead of the standard tetanus shot (Td) every 10 years will also reduce infections.
Parents can obtain the DTaP vaccine series and the Tdap booster shot for their children and themselves through their primary care physicians. Local retail pharmacies offer vaccinations for a fee, and anyone who is not covered by a medical insurance plan can get the shot from a County Public Health Center at minimal or no cost.
For more information about whooping cough and ongoing vaccination clinics, call the County’s Immunization Branch at (866) 358-2966, or visit: Immunization Program (sandiegocounty.gov).
This week, nearly 1,500 miles to the north and east of San Diego, health officials in Fargo, N.D. issued a similar warning.
Fargo Cass Public Health is stressing the importance of getting vaccinated for pertussis as cases continue to rise in Cass County.
12/04/2023 1:00 p.m.
Fargo Cass Public Health (FCPH) is stressing the importance of getting vaccinated for pertussis as cases continue to rise in Cass County. In the past month, there have been 12 reported cases of pertussis in Cass County. Cass County typically reports eight cases in an average year. Pertussis, also known as whooping cough, is highly contagious and one of the most commonly occurring vaccine-preventable diseases in the United States. People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria.
Dr. Tracie Newman, Health Officer for FCPH says, “Infants under one year of age are at the highest risk of developing severe breathing problems and life-threatening illness from whooping cough. Babies can get whooping cough from a family member or caregiver who is not aware they have it. Our best form of protection from whooping cough is vaccination for everyone who is eligible. Ensuring infants, children, caregivers, pregnant people, and the elderly are up to date with the pertussis vaccine is more important than ever.”
Pertussis typically begins with cold-like symptoms and sometimes a mild cough or fever before progressing to severe coughing fits which can include uncontrollable, violent coughing and whooping, making it difficult to breathe. Babies with pertussis may not cough, but may gag and gasp instead, as well as have a symptom known as “apnea,” which is a pause in a child’s breathing pattern.
In some cases, antibiotics are recommended for those who came into contact with an active case, including other household members and those with risk factors for severe disease which include infants, pregnant people, and people with weak immune systems. Individuals are recommended to isolate for five days from the start of antibiotics. Adults or children who are having trouble breathing should seek medical attention immediately.
It is axiomatic that alerts like these are only issued after a significant uptick in community cases have been reported, which is why getting the Pertussis vaccine when it is due makes more sense than waiting for an outbreak.
During my parent’s day, whooping cough infected more than a 250,000 Americans each year, and killed about 5,000 of them. All that began to change in the 1940s when the first whole-cell pertussis vaccine - combined with diphtheria and tetanus toxoids (DTP) - was introduced.
It what was such remarkable success, that by the time my daughter was born (1977) the number of reported cases had just reached a record-low of 1,010 cases, a decrease of 99%.
Over the past decade we've seen a bit of a resurgence in Pertussis, although the rates are still far below what they used to be. The reasons behind these increases are complex, and not entirely understood, but some factors are believed to be:- lower vaccination uptakes in children and adults
- the move away from whole cell pertussis vaccines to safer (but somewhat less protective) acellular vaccines in the 1990s
- evolutionary changes in the Bordetella pertussis bacteria.
Even though new emerging diseases get most of our attention, old scourges - like Pertussis, Measles, Scarlet Fever, and even diphtheria - are threatening to make comebacks around the globe.
Thanks to vaccines, most of these diseases were all but eliminated in the United States and Europe over the second half of the 20th century.
But post-COVID vaccine fatigue and anti-vaccine sentiment threatens to undo much of that progress.
