Whooping cough is making a comeback in the U.S. Nearly 50,000 whooping cough cases were reported in 2014. Whooping cough has caused nearly 300 deaths since 2000.
The 2016-2017 winter is shaping up to be another bad year, and California, where I live has been especially hard hit.2
At our last well-child check for my 4-month-old, our pediatrician warned against high school babysitters. Several large whooping cough outbreaks are underway at our local high schools in Menlo Park and Palo Alto (two small cities in the Bay Area) 3. One outbreak, she said, “had affected the whole football team.” The other kept the homecoming queen home from the dance. But the dance itself, which was not cancelled, caused whooping cough to continue to spread.
Unlike measles and mumps, which are making a comeback because of vaccine refusal, whooping cough cases are resurging because the new whooping cough vaccine is not as effective as the older version it replaced in 1996.
To wit, all the infected teenagers our pediatrician has seen in clinic were fully vaccinated, but their protection had faded.
Most adolescents receive their last shots when they were 4-6 years of age; by the time they hit puberty, only 10-30% of them remain immune. (For this reason, the CDC has now begun calling for a Tdap booster shot for 11-12-year-olds.4)
Whooping Cough Vaccine
The vaccine for whooping cough (pertussis) DTaP is combined with vaccines for two other serious bacterial infections: tetanus and diphtheria. DTaP stands for Diphtheria, Tetanus, and acellular Pertussis.
DTaP is typically given in 5 shot series to infants and young children. A booster shot, Tdap, is given to adolescents, pregnant women and other adults to help maintain immunity.
The first vaccines against whooping cough were introduced in the 1930s. Until 1996, vaccines for whooping cough contained whole cell pertussis, whereas DTaP contains acellular pertussis, a change that reduces the number of severe side effects like high fevers, but also causes its protection to wane more rapidly.
DTaP doesn’t provide greater than 95% protection until after three shots, and protection can wane as quickly as 3 years after the last dose.1
Whooping Cough Symptoms
Whooping cough is serious business. It begins innocuously, like any other common cold, with a runny nose, mild cough, and sometimes a slight fever.5 But within 7-10 days, the cough progresses spells so severe that they deprive the sufferer of breath. This results in to the classic whooping sound (listen to it here) as sufferers struggle to inhale air back into their lungs. These spells can last for months, which is why whooping cough is sometimes also called the 100 day cough.
Before widespread vaccination in the U.S., whooping cough killed 6 out of every 100,000 Americans.
In babies, whooping cough is extremely dangerous and can be fatal. About half of babies under a year old who contract whooping cough require hospitalization. Young babies cannot cough as hard as children or adults. They may not inhibit the classic whooping sound but instead vomit or cease to breathe and turn blue during severe coughing spells.6
Severe whooping cough is most common babies under 6 months of age, who have yet to receive their full series of first-year DTaP immunizations, at 2 months, 4 months, and 6 months. (Children should receive additional DTaP shots at 15-18 months and 4-6 years of age).
What You Can Do
Because newborns are especially vulnerable, the CDC recommends that, every pregnant woman, regardless of when she last received Tdap, should receive an additional booster shot between 27-36 weeks of pregnancy, to pass antibodies through the placenta and provide protection to her newborn.
Many OBs fail to mention this to pregnant women. I know, because I did not receive Tdap during my second pregnancy. No one brought it up… until I was in labor. The delivery nurses tried to give me a TDaP shot as I was delivering my second. I guess they figured, what’s another poke compared with contractions? Unfortunately, by that point, it was too late to protect my daughter. The maternal immune response requires about a month before to provide protection to the unborn.
In short: If you’re in your third trimester of pregnancy, remind your doctor that you need a TDaP booster shot, ideally before 36 weeks.
In areas where local whooping cough outbreaks are occurring, as in parts of the Bay Area this winter, also make sure everyone in close contact with your baby has had a booster shot.
And, of course, make sure your baby receives DTaP as scheduled. Although single dose of DTaP vaccine is only about 50% effective, the first dose of DTaP can be given to babies as young as 6 weeks and, while not providing complete protection, can cut their risk of hospitalization in half.4,9
- Website. Available at: https://well.blogs.nytimes.com/2016/02/22/why-pertussis-is-making-a-comeback/?_r=0. (Accessed: 3rd February 2017)
- [No title]. Available at: https://www.cdph.ca.gov/programs/immunize/Documents/Pertussis_report_2017-1-23.pdf. (Accessed: 3rd February 2017)
- Lee, J. Whooping cough hits Palo Alto schools. The Mercury News (2016). Available at: http://www.mercurynews.com/2016/12/07/whooping-cough-hits-palo-alto-schools/. (Accessed: 3rd February 2017)
- Summary of Pertussis Vaccination Recommendations | CDC. Available at: https://www.cdc.gov/vaccines/vpd/pertussis/recs-summary.html. (Accessed: 3rd February 2017)
- [No title]. Available at: http://www.webmd.com/children/guide/whooping-cough-symptoms-treatment#1. (Accessed: 3rd February 2017)
- CDC. Whooping Cough. Centers for Disease Control and Prevention (2016). Available at: http://www.cdc.gov/features/pertussis/index.html. (Accessed: 3rd February 2017)
- Whooping Cough (Pertussis) Fact Sheet for Parents | CDC. Available at: https://www.cdc.gov/vaccines/parents/diseases/child/pertussis.html. (Accessed: 3rd February 2017)
- Pertussis Summary Reports. Available at: https://www.cdph.ca.gov/programs/immunize/Pages/PertussisSummaryReports.aspx. (Accessed: 3rd February 2017)
- Bisgard, K. M. et al. Pertussis Vaccine Effectiveness Among Children 6 to 59 Months of Age in the United States, 1998–2001. Pediatrics 116, e285–e294 (2005).