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Whooping cough is on the rise; Adults failing to get booster shots.

Byline: Karen Nugent

The sound is terrifying - a high-pitched squawk that matches the familiar name of the disease: whooping cough.

It's an old-fashioned name for pertussis, a serious upper respiratory bacterial infection that was pretty much brought under control 60 years ago with the introduction of a vaccine, and further reduced in 1967 when the vaccine was made a public school requirement.

But the number of childhood cases has been inching back up. And it's not because infants are no longer vaccinated, but because adults, especially parents and caregivers, do not get booster shots. A vaccination combination for immunization against diphtheria, tetanus, and pertussis, commonly known as a DTP shot, is recommended every 10 years for adults.

According to the Centers for Disease Control and Prevention, there were approximately 200,000 cases a year of pertussis reported before the first vaccine was introduced in 1949. That dropped to a low of 1,010 cases in 1976.

However, since then there has been a steady increase, with more pertussis reported in adolescents and adults.

August is National Immunization Awareness Month, the perfect time for the start of a recent television advertising campaign by the March of Dimes, with a disturbing recording of a child with whooping cough played in the background. The commercial, which portrays parents and other caregivers cradling babies in their arms, contends that parents are transmitting the disease to their children.

According to Dr. Lucille Kanjer Larson, a pediatrician at Clinton Hospital, pertussis cases, and infant deaths, are on the rise because most adults do not keep up with their pertussis booster shots. The booster shots adults tend to keep up with are for tetanus only, she said, with the last DPT combination vaccines usually given around age 12.

"Adults who do not get their tetanus combination vaccinations within the past 10 years are not covered, as the immunity for pertussis wears off in the middle school years,' she said.

In 2005, a new type of vaccine, called "TDaP" (tetanus, diphtheria and acellular pertussis) was introduced for use in adolescents and adults. Dr. Kanjer Larson said it has a pertussis immune booster, as opposed to just the formerly recommended tetanus boosters for adults.

"The good news about this booster combination vaccine is that the side effects are no different than in prior years when it was tetanus alone," she said.

Dr. Kanjer Larson, who recommends that her infant patients' parents get their vaccines updated with the newer vaccine, said there have been several recent deaths caused by pertussis in infants younger than three months old.

"Keep in mind, these are the diagnosed cases. (No one) is sure about the quantity of undiagnosed individual cases or deaths, or near deaths," she said.

A June report from the CDC's Morbidity and Mortality Weekly Report says cases reported in California increased to 1,337 - a jump of 418 percent - in the first six months of this year. The report says pertussis outbreaks tend to occur in three-to-five year cycles in the U.S., with the last peak in 2005. That year, approximately 25,000 cases were reported nationwide, with 3,000 in California.

Reported pertussis cases in Massachusetts are also on the high side. They began increasing in the early 1990s and peaked in 2005 with about 1,980 cases. The all-time high in Massachusetts was around 13,000 cases in the mid-1930s.

Dr. Alfred DeMaria Jr., medical director of the Bureau of Infectious Disease Prevention, Response and Services for the state Department of Public Health, in February co-authored a Clinical Infectious Diseases magazine article called "Vaccinate the Village," about the importance of pertussis vaccinations.

Although the disease is curable with antibiotics, the article says its increase among adolescents and adults puts more young infants at risk. Mothers, it says, account for 38 percent of the implicated transmissions. Mentioning the three-to-five year cycle of pertussis, he said there seems to be a decrease of the disease in Massachusetts, especially among adolescents, concurrent with the increasing use of TDaP.

In an e-mail, Dr. DeMaria, who is also the state epidemiologist, said while Massachusetts has traditionally had a higher proportion of nationally reported pertussis cases, the state decrease could be because of the use of the only CDC-approved blood test for diagnosis, which is done at the state laboratory.

"So our higher numbers are related to this, and other reasons for enhanced surveillance," he said. "The highest rates used to be in adolescents because of waning immunity from doses of vaccine given prior to age 7. But since the introduction of TDaP as a vaccine for adults and adolescents, we have seen a reduction in that age group."


CUTLINE: (1) Dr. Lucille Kanjer Larson, a pediatrician at Clinton Hospital, with Amy Holwell, who holds her son, 16-month-old Finn. (2) Dr. Lucille Kanjer Larson administers a pertussis vaccination to an infant.

PHOTOG: T&G Staff Photos/MARK C. IDE
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Title Annotation:LOCAL NEWS
Publication:Telegram & Gazette (Worcester, MA)
Date:Aug 15, 2010
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