Mariah Bianchi explained how her whooping cough case caused the death of her newborn son at a press conference by the Centers for Disease Control and Prevention (AP Photo/Reed Saxon)
Copyright 2010 AP. Unauthorized reproduction is prohibited.
As my colleague Joshua Cohen pointed out last month, whooping cough (whooping cough) cases are on the rise this year, especially around the back-to-school season. Recently, several cases were found near me in Frostburg, Maryland. Two of the cases were confirmed cases among students, and three cases were strongly suspected to be caused by family members. Amazingly, in my 40 years of practice, although I have seen many rare infections, I have never seen a case of an infectious disease such as diphtheria or measles. These included two memorable and fatal cases of tetanus, which is also vaccine-preventable.
In retrospect, I have more questions about the role of vaccination in pertussis prevention and changes in recommendations.
Pertussis infections occur in periodic waves. The Centers for Disease Control and Prevention has preliminary reported that “as of Week 40, reported on October 5, 2024, more than five times as many cases have been reported compared to the same period in 2023.” There is. The number of infected people so far this year is 17,611! The number of deaths in the United States increased from about 5 in 1990 to 14.75 in 2008 and 10 in 2019.
At the height of the COVID-19 pandemic, remote work and learning and relative social isolation through masks led to a decline in many respiratory disease cases. Now that most people have abandoned even modest efforts to protect themselves, infections are spreading again.
Dr. Paul Offit, a virologist and director of the Vaccine Education Center at Children’s Hospital of Philadelphia, puts all this into perspective in an interview. “The first whooping cough vaccine became available in 1947, and it was just dead bacteria,” he began. “At that time, whooping cough caused as many as 8,000 deaths each year, mostly children.” The vaccine was highly effective, but had “challenging” safety issues such as fever, seizures, and fainting. profile, but had no long-term side effects. In 1991, we switched to cell-free vaccines made from protein fragments rather than whole, inactivated bacteria. Offit described it as trading “safety for some degree of efficacy.” This also meant that multiple boosters had to be administered.
“The goal of any vaccine is to keep you out of the hospital. That’s the goal. The goal is not to prevent mild illness. You’ll get mild illness,” Offit said. This also applies to the RSV, COVID-19, and rotavirus vaccines.” Pertussis cannot be eradicated because it remains contagious for three weeks after the cough starts unless antibiotics are given, and it can be misdiagnosed. This is because there are many cases.
However, the immune protection provided by the vaccine wanes over time, and periodic boosters are required. The Alleghany County Health Department did not say whether the sick children here were vaccinated, but the data shows Maryland’s vaccination rate has increased from 87% for kindergarteners in 2020-2021. , which has recently risen to 97% (though it was only 63% in the early stages in Alleghany County). . This is better than the national average of 93%.
One practical change is “cocooning” newborns to protect them from whooping cough, meaning vaccinating everyone around the pregnant woman. This is no longer recommended as immunity may not last very long. It is much more effective to vaccinate pregnant women with Tdap (tetanus-diphtheria-acellular pertussis vaccine) from 26 to 27 weeks to 36 weeks of pregnancy. She develops protective antibodies that last until the baby is 4 to 6 months old and can receive vaccines. Children receive six pertussis vaccines before reaching adolescence. The CDC also recommends that adults receive a booster shot of Tdap or Td (another vaccine that protects against tetanus and diphtheria but not pertussis) every 10 years.
I expect they will continue to recommend boosters for whooping cough as well, and I think they have reached out to the CDC for clarification.
An expert panel was convened in 2022 to discuss changes in epidemiology (infection patterns) and vaccine strategies. Their report was notable to me in several ways. One is that less reactive acellular pertussis vaccines have replaced the older, original whole-cell pertussis vaccines, and cases are occurring more commonly in older children and adults. The diagnosis of whooping cough is often overlooked. Too few clinicians have experience with pertussis, and many of the symptoms overlap with those of patients with COPD and asthma. The authors write, “Infection among older people is also a concern. Not only are older people more likely to suffer serious complications and loss of independence, but grandparents may also be involved in caring for vulnerable infants.” As a result, vaccination may prevent the spread of whooping cough to young grandchildren. ”
The studies they cited raise ongoing questions about vaccine efficacy and strategies, especially for adults. They agree on the need for better vaccines, especially live attenuated (weakened) vaccines that provide better immunity. BPZE1 is a nasally administered live vaccine under development.
Until then, if given a choice, it is safer to give adults Tdap every 10 years than tetanus vaccine (Td) alone, agrees lead author Peter Kardos, MD. I am doing it.
