The Resurgence of Pertussis

Although the DTaP and Tdap vaccines, which protect against diphtheria, tetanus and pertussis, are recommended by the Center for Disease Control and Prevention (CDC) as part of the standard immunization schedule, as of July 2013, Washtenaw County had four times more reported cases of pertussis than typically seen per year (Hoedl, 2013).  An epidemiologist from the Washtenaw County Public Health Department states the increase in pertussis cases may be related to the number of children not vaccinated, as 9% of children in Washtenaw County have not received the recommended immunizations (Hoedl, 2013). The immunization schedule for infants and children involves a vaccine at 2, 4, 6 and 18 months, as well as a booster at 4 years.  

“Despite routine vaccination strategies, pertussis remains an important global public health problem” (Spector & Maziarz, 2013, p. 539). In the past, efforts were aimed at preventing pertussis in infants, as this population is extremely vulnerable, but recent trends indicate that prevention strategies should be aimed at all age groups. For example, in 2012, 50% of pertussis cases were diagnosed in adolescents and adults (Spector & Maziarz, 2013, p. 540).  Before 2006, only infants and children were routinely immunized against pertussis, which was problematic as adolescents and adults are potential sources of transmission of pertussis due to waning immunity, atypical symptoms and later onset of symptoms.  Adolescents and adults may present with atypical pertussis symptoms, which can lead to unrecognized infection or later diagnoses.   They also may have later onset of symptoms, which would make standard diagnostic methods less likely to be positive (Spector & Maziarz, 2013). Although adults may have received a pertussis vaccine as a child, the CDC’s Advisory Committee of Immunization Practices (ACIP) now recommends a Tdap booster every 10 years (CDC, 2011). 

“Pregnant women and those in close contact with infants warrant special consideration” (Spector & Maziarz, 2013, p. 548).  The American College of Obstetrics and Gynecology (ACOG) recommends that pregnant women who have not previously received a Tdap booster, should receive one during late second trimester or third trimester.  If the booster was not received during pregnancy, it should be given immediately postpartum (ACOG, 2013).  Not only will this protect the mother from passing pertussis to her child, but partial protection against pertussis may be gained by the infant in the time before the initiation of the DTaP immunization series.  Because the ACOG also recommends that anyone who will be in close contact with an infant should be vaccinated, pediatric offices are now offering the vaccine to parents who can conveniently receive the immunization while in the office with their children (Pediatric Associates of Livingston, 2012). 

                                                                                            cdc.gov/features/pertussis

With the above research available, it is important that nurses disseminate this information to their colleagues and patients.  The way the healthcare system educates about pertussis needs to change, especially in the adult population.  According to the Michigan Department of Community Health, there has been a worrisome steady rise of pertussis cases in Michigan over the last decade.   Sadly, in 2013, the cases are at an all time high.  Something needs to be done, and as future nurses, we have a responsibility to educate our patients about pertussis and offer the vaccine whenever possible.