CDC recommends pertussis vaccination for all pregnant women

On October 24, 2012, the Centers for Disease Control and Prevention recommended that “providers of prenatal care implement a Tdap immunization (Tdap or DTaP vaccine) program for all pregnant women.  Health-care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap.  If not administered during pregnancy, Tdap should be administered immediately postpartum.” This recommendation is based upon the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States, guidelines, published Fall 2011, for whooping cough(Bordetella pertussis).

ACIP reviewed published and unpublished data from VAERS, Sanofi Pasteur (Adacel) and GlaxoSmithKline (Boostrix) pregnancy registries, and two small studies here and here. ACIP concluded “that available data from these studies did not suggest any elevated frequency or unusual patterns of adverse events in pregnant women who received Tdap and that the few serious adverse events reported were unlikely to have been caused by the vaccine.” In addition, both  tetanus and diphtheria toxoids (together) and tetanus toxoid (alone) vaccines have been used worldwide in pregnant women to prevent neonatal tetanus without negative effects. The ACIP concluded that administration of the pertussis vaccine after 20 weeks of pregnancy was preferred to minimize any risk of a low percentage adverse event.

According to the CDC, only about 3% of pregnant women receive the vaccination. However, the CDC believes if the new recommendations are implemented, there would be a 33 percent reduction in cases, a 38 percent reduction in hospitalizations and a 49 percent reduction in deaths from whooping cough.

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Whooping cough update: Colorado outbreak hits 1000 cases

The Colorado Department of Public Health and Environment has reported that as of October 6, 2012, a whooping cough (Bordetella pertussis) outbreak has hit over 1000 cases since the beginning of the year, far exceeding the 5 year average of 2007-2011. The chart below shows the dramatic weekly increases in cases in Colorado since beginning of the year.

Continue reading “Whooping cough update: Colorado outbreak hits 1000 cases”

Mark Crislip’s Dumb Asses and Vaccines

It’s getting close to flu season, and it’s time to get your flu shot. Of course, there are myths for why people won’t get their flu shots. All of them are amusingly bad. 

Last fall, Dr. Mark Crislip published A Budget of Dumb Asses (requires a Medscape account) that takes on anti-science with a whole new level of snark. I have part of it here for you, thanks to Biodork’s (great name) Time for your flu shot! It’s all about getting (or not getting) the flu vaccination, but you can replace flu with any other vaccination. Apparently, he wrote it for health care workers, but hey, I think it works for patients too!

Mark Crislip starts out his snark with a quick statement about not getting a flu shot. You might be a dumb ass, if you’re unwilling to get the vaccine:

I wonder if you are one of those Dumb Asses who do not get the flu shot each year? Yes. Dumb Ass. Big D, big A. You may be allergic to the vaccine (most are not when tested), you may have had Guillain-Barre, in which case I will cut you some slack. But if you don’t have those conditions and you work in healthcare and you don’t get a vaccine for one of the following reasons, you are a Dumb Ass.

Continue reading “Mark Crislip’s Dumb Asses and Vaccines”

New research shows vaccine denialists put others at risk

In a recent article published in the American Journal of Public Health, Exposure of California Kindergartners to Students With Personal Belief Exemptions From Mandated School Entry Vaccinations, by Alison Buttenheim, Malia Jones, and Yelena Baras, parents worried about the safety of vaccinations have caused a new problem in the comeback childhood diseases that haven’t been seen in a couple of generations. Buttenheim et al. wrote that a greater number of parents are refusing to get their children vaccinated through legally binding person belief exemptions, and explained that this increases the risk of infection for those with compromised immune systems and those who cannot get vaccinations. Traditionally, these individuals relied upon herd immunity, which describes a form of immunity that occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not developed immunity. Continue reading “New research shows vaccine denialists put others at risk”

Whooping cough: North Carolina reports first infant death in 2012

The North Carolina Department of Health and Human Services has reported North Carolina’s first infant death from whooping cough on August 20, 2012. The child was only 2 months old. “Babies and young children are not fully immunized until they have finished a series of vaccinations, so their only protection against whooping cough is the people around them,” said State Health Director Dr. Laura Gerald. “Anyone who lives with or will be around a baby should be vaccinated.” In other words, someone who was not vaccinated or not fully vaccinated passed the infection to this child. Continue reading “Whooping cough: North Carolina reports first infant death in 2012”

Whooping cough update: Washington state epidemic hits 3400 cases

The Washington State Department of Health is reporting  that as of August 4, 2012, the current whooping cough (Bordetella pertussis) epidemic has hit 3400 cases, over 15X more than the 214 cases reported at the same time last year. The epidemic has finally shown a big drop off in new reports this past week (pdf), although there are concerns that the numbers will increase against this fall as children return to school in the autumn.

Pertussis cases by week 2012 (red) vs 2011 (blue)

According to the Centers for Disease Control and Prevention, pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Approximately 1-2% of infants who are hospitalized from pertussis will die. Continue reading “Whooping cough update: Washington state epidemic hits 3400 cases”

Whooping cough–UK epidemic leads to 5 infant deaths

According to the Guardian, a total of 2,466 cases of whooping cough (Bordetella pertussis) have been confirmed in the United Kingdom between January and June of 2012, causing the deaths of 5 infants. The UK’s Health Protection Agency (HPA) said that the number of cases is six times larger than the last comparable outbreak in 2008. The government’s vaccination committee is “now considering recommending booster vaccinations for teenagers and pregnant women and has already recommended immunising healthcare workers who treat young children because infants are most at risk.”

Also according to the article, Mary Ramsay, the HPA’s head of immunization, said: “We are working closely with the Department of Health’s Joint Committee of Vaccination and Immunization to consider the most effective ways to tackle the ongoing outbreak. The committee is reviewing a number of options, including the introduction of a booster dose in teenagers and offering whooping cough vaccination to pregnant women. In the meantime we are actively reviewing our cases to see what interventions could have the quickest impact on the spread.” Continue reading “Whooping cough–UK epidemic leads to 5 infant deaths”

Parents put immunocompromised child at risk by not vaccinating sibling

Chickenpox, or Varicella zoster, is a common childhood disease that can result in fairly serious complications such as encephalitis, pneumonia, sepsis, hemorrhagic varicella, and death. Individuals at especially high risk from complications from varicella are immunocompromised, usually from some sort of immunodeficiency or immunosuppression (usually pharmaceutical treatments for cancers or autoimmune diseases). For immunocompromised individuals, it is important that any individuals around them should be vaccinated against common childhood diseases, whether chickenpox or other diseases (mumps, rubella, etc.), because the chances of transmitting these diseases is extremely high and the risk of complications are serious.

The Centers for Disease Control and Prevention reported that a 3 year old Minnesota girl, who was receiving immunosuppressive therapy for juvenile rheumatoid arthritis, was admitted to a hospital after 2 days of a high fever of 102.7°F (39.3°C) and extensive rash, including in her mouth and throat. Neither she nor her younger sibling received the first dose of varicella vaccine (recommended at 12-15 months) because their parents refused the vaccinations as a result of personal beliefs. The child eventually recovered as a result of treatment with intravenous acyclovir (which has more serious potential side effects than the imagined ones for the vaccine). Continue reading “Parents put immunocompromised child at risk by not vaccinating sibling”

Whooping cough update: Washington state epidemic exceeds 2800 cases

The Washington State Department of Health has reported (pdf) that the current whooping cough (Bordetella pertussis) epidemic has hit 2883 cases, over 10X more than the 210 cases reported at the same time last year. The epidemic seems to have peaked a few weeks ago, although concerns will remain as children return to school in the autumn.

According to the Centers for Disease Control and Prevention, pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Approximately 1-2% of infants who are hospitalized from pertussis will die. Continue reading “Whooping cough update: Washington state epidemic exceeds 2800 cases”

Whooping cough: Washington state epidemic exceeds 2600 cases

The Washington State Department of Health is reporting that there are 2647 confirmed cases of whooping cough (Bordetella pertussis) as of June 23, 2012. This number compares to only 187 cases during the same period in 2011. The epidemic has stricken 31 out of 39 counties (pdf) in the state with Skagit County having the highest number at 508 confirmed cases.

According to the Centers for Disease Control and Prevention, Pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Approximately 1-2% of infants who are hospitalized from pertussis will die.

Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud “whooping” sound. This extreme coughing can cause you to throw up and be very tired. The “whoop” is often not there and the infection is generally milder (less severe) in teens and adults, especially those who have been vaccinated.

Whooping cough can be easily prevented with the Tdap or DTaP vaccine. The problem is that infants are not initially vaccinated until they are 2 months old, and are not fully immunized until they’re 6 months old, so they are susceptible to adults who may be infected. Adults may have lapsed immunity or may have not been vaccinated.

It’s unknown why the epidemic in Washington state has grown so fast and so large, but it may be that there is a pool of anti-vaccine sentiment in the area. 

Vaccines save lives.