The Need for Pertussis Vaccinations Clear as Rates Rise

Pertussis, also known as "whooping cough," has reached epidemic proportions in Texas as reported by Reuters this month.  Texas state health officials are claiming cases of pertussis are likely to set a new 50 year benchmark.  Approximately 2,000 cases have been reported in Texas this year.  Locally, here in Washtenaw County, pertussis is still circulating at a high rate, and is at its highest number of 136,  since a 2010 outbreak.  To date there have been six hospitalizations, fortunately, no deaths according to a 2013 Washtenaw County Public Health report.  Nationally, Center for Disease Control (CDC) disclose more than 48,000 cases of whooping cough in 2012, and 49 states reported two to three times the rate of prior years.  Infants had the highest rate, followed by children ages 7 to 10 (CDC, 2013).

The CDC explains pertussis is a very contagious disease of the respiratory tract caused by bacteria called Bordetella pertussis.  It easily spreads from person to person when people cough or sneeze.  It begins with similar symptoms of a typical cold, but within a week or two, a violent cough develops.  It is called whooping cough due to the whoop sound made when the infected person tries to breathe after hard coughing and choking spells (CDC, 2013).  Click here to listen to an example.

Notice the broken blood vessels and bruising due to
pertussis coughing.
http://www.cdc.gov/pertussis/about/photos.html

Whooping cough is vaccine preventable, but newborns can't get the first dose of vaccine until they are 2 months.  Then they need four more vaccinations before they reach the age of 7 to get full protection.  This is why young children are dependent on their caregivers to get vaccinated so they don't pass the disease on to them.

Reasons for not getting vaccinations are varied.  Although parents sometimes believe delaying their children's vaccines and following alternative schedules is safer, a new study by Glanz et al reinforces the need to get all vaccinations on schedule.  His team found that about 47 percent of children diagnosed with pertussis were not vaccinated according to the recommended schedule, versus approximately 22 percent of kids in the comparison group (Glanz, 2013).

Dr. Greg Poland, a vaccinologist at the Mayo Clinic, conducted a study that intended to assist health care providers to persuade on-the-fence parents about the importance of immunization.  He found three common immunity related misconceptions:

Infant being treated for pertussis.  She received
ECMO and also dialysis.
http://www.cdc.gov/pertussis/images/pertussis-baby-one-lg.jpg

1. Babies' systems aren't ready for the number of vaccines given today.
2. Vaccines can cause autoimmune diseases.
3. Natural immunity is more safe and better.

His suggested replies:

1. Babies' immune systems are meant to be challenged.  Just crawling on the floor presents innumerable foreign immunologic material, so introduction of antigens through vaccines gives them a chance to be immunologically educated.  
2. With only rare exceptions of vaccines for smallpox and rabies, immunizations can't trigger autoimmune diseases, or autism, because the bio-immunologic criteria for inducing disease against yourself isn't present. 
3. Natural immunity is not better.  Using chickenpox as an example, every year 100 U.S. kids die from complications.  As well, once exposed, the dormant virus may reemerge as shingles in 50% of people who live to the age of 80 (Poland, 2012).

As discussed in the Population Health course immunizations are a primary disease prevention activity.  Primary prevention activities are implemented to avoid suffering, the cost and burden of disease, and by intervening before the onset of any illness occurs.  As nurses we are in a position to make a difference combatting commonly held misperceptions about immunizations and educating parents and caregivers on the importance of adherence to vaccination schedules with evidenced based answers so that the risk of contracting preventable diseases, such as pertussis, can be avoided altogether.