Home > Expert Insights, Parent Perspective, Preventable Diseases, Science & Research, Testimonials > Pertussis Losses and Immunization Challenges

Pertussis Losses and Immunization Challenges

This week I read another story of an infant who lost her life to pertussis.

SebennaSebanna’s story.

It begins with a young wife – a first time mom – responsible for two stepchildren and her newborn daughter while her husband serves his country in Iraq.

Sadly, it progresses like many other pertussis stories.

Sebanna had a persistent cough and some wheezing. Over the course of the next few days, it took several visits to the doctor and the ER before she was admitted into the hospital, and far too long before she was finally diagnosed with pertussis.

Then comes the part that you really don’t want to hear.

Sebanna’s uncontrollable coughing fits got worse. She suffered from blue spells, lack of oxygen, dehydration, and seizures. She was transferred from one hospital to another for specialized pediatric care and hospital staff worked diligently to try to save her.  Sadly, Sebanna’s mother Lucy could only watch and pray while they performed an emergency incision to drain Sebenna’s lung.

In the end, Lucy was told that they could do no more.   She was left crying and rocking her lifeless daughter, numb with pain and disbelief.

While this is just one pertussis story, Sebanna’s story has been repeated by so many others over the years.  Different families with slightly different circumstances, and too many of which have also ended in death.

In 2012, 17 infants lost their lives to pertussis and thousands more were hospitalized.  In all, there were 41,880 reported cases in the U.S. last year.

Lucy explains,

“Whooping Cough doesn’t care how much you love your child, or how good of a parent you are. It simply ravages through and destroys, leaving lifelong scars behind.”

So, how can we prevent these tragedies from being repeated?

While we continue to hear stories like Sebanna’s, public health professionals have been analyzing the data, pouring over the research and working to identify the specific challenges we face in the fight against pertussis.

This week, representatives from Every Child By Two attended a meeting of the CDC’s Advisory Committee on Immunization Practices (ACIP) in Atlanta where they were briefed on the current pertussis data.   Thomas Clark, MD, medical epidemiologist for the CDC, gave a detailed presentation which evaluated the current Tdap vaccination recommendations and outlined the possible reasons for the ongoing outbreaks of disease.

Infectious Disease News presented some of Clark’s finding as follows:

Thomas Clark, MD

Thomas Clark, MD

  • There has been a tremendous reduction in pertussis in the U.S. since the vaccine’s inception, but we’ve seen more recent increases with notable outbreaks in various states.
  • In 2000, an emergence of pertussis among fully-vaccinated children aged 7-10 years was likely due to waning of protection from the acellular vaccine.
  • In 2012, there was another high period of adolescent disease despite high coverage with Tdap, suggesting that the Tdap booster may wane more quickly than anticipated.
  • Despite high vaccination coverage among children, with 96% of children aged 19 months to 35 months having had three or more doses of the vaccine, the national overall pertussis incidence in 2012 was 13.4 cases per 100,000, with the rate reaching as high as 100 cases per 100,000 in some states.
  • Infants continue to have the highest risk for pertussis and are most likely to be hospitalized with the disease.

It’s important that this data is considered in connection with the current recommendation that newborns receive DTaP vaccination at 2, 4, 6 months, 15-18 months and again at 4-6 years. After that time, a single dose Tdap booster is recommended for children 11 -18 years of age. The CDC prefers this adolescent booster occur at the younger ages of 11-12 because, as Dr. Clark’s data revealed, antibodies from the pertussis portion of the DTaP vaccine wane over time.  Although the vaccine may be 98% effective at warding off disease among fully vaccinated infants, Dr. Clark explained that it may be as low as 71% effective after just five years.

Additionally, adults over the age of 19 should receive a Tdap booster in place of one of their 10-year Td booster (which only offers protection from tetanus and diphtheria).  However, in response to the recent pertussis outbreaks – especially among infants who have not yet completed their pertussis vaccination series – the CDC has been encouraging all adults, but in particular, expectant parents and caregivers who are in close contact with infants, to get their booster immediately.

In a further attempt to reduce the risk of pertussis among infants, the CDC recently added a recommendation in January that pregnant women get aTdap booster during each pregnancy, preferably at 27 through 36 weeks gestation.

“By getting Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines. Tdap will also protect the mother at time of delivery, making her less likely to transmit pertussis to her infant. DTaP or Tdap (depending on age) is recommended for all family members and caregivers of the infant – at least two weeks before coming into close contact with the infant.”

At the direction of the ACIP, a working group has now been formed to determine the safety and cost-effectiveness of shortening the intervals between revaccination with the Tdap vaccine to combat waning immunity to pertussis.  As they work through these challenges and consider new recommendations, there will likely be ongoing conversations about the need for a more effective vaccine.  While it is reassuring to know that these issues are being considered, the reality is that these bigger developments will take time.

sebenna_angelWe can’t simply sit and wait. 

Until we have something better, we must make the most of what we do have.  For instance, data reveals that families are the main source of pertussis infection among infants with mothers responsible for 30-40% of infant infections and all household members responsible for about 80% of infections.  However, statistics show that only 13% of adults ages 19-64 were vaccinated with Tdap as of 2011.  Perhaps if we can increase the adult Tdap booster rates especially among pregnant women, while we continue to encourage parents to immunize their children according to the recommended schedule, we may still be able to save others from suffering like Sebanna.

As the ACIP reconvenes in June, the working group will be reporting on their findings and we will be sure to keep you updated on any new developments.
  1. February 22, 2013 at 3:43 pm

    Before our anti-vaccine commentators chime in with their same ole’ stories – please check out the legitimate research on the subject:

    http://www.cdc.gov/vaccinesafety/Concerns/Index.html

    http://www.cdc.gov/vaccinesafety/Vaccines/dtap/dtapindex.html

    And yes, while the Pertussis portion of the DTaP vaccine is not 100% effective, it is still an important part of the margin of safety that should be provided to young children (and practiced by parents and caregivers of young children – by getting boosters).

    Pertussis kills – and it kills the most fragile and delicate of us – our babies; please keep up to date on your vaccinations.

    Like

  2. February 22, 2013 at 4:29 pm

    Hello, just an editing note. Sebanna is misspelled in your article.

    It is a sad story and we are trying to pass Sebanna’s Law in Oregon that would create an epidemic warning plan, requiring the Health department notify citizens of any contagious diseases at epidemic levels in their neighborhood. Please Share Sebanna’s law for Oregon and Kaliah’s Law for Washington.

    Please follow this link to sign Sebanna’s Law Petition for Oregon:
    http://www.change.org/petitions/oregon-doh-warn-us-when-there-is-a-contagious-disease-of-epidemic-proportions-in-our-community

    There is legislation in work in Washington currently passed in the House, and heading to the Senate. Kaliah’s Law, House Bill 1139 and Senate Bill SB 5228 for Washington state.
    Here is the link to the law.
    http://www.leg.wa.gov/legislature/Pages/Overview.aspx

    Like

  3. February 22, 2013 at 4:53 pm

    If immunizing during pregnancy was a good idea, why do newborns still get pertussis and other illnesses? If the vaccines have any strength, the immune system of the mother will produce the antibodies anyway in the breast milk, wouldn’t they? How do they know the antibody exposure during pregnancy (which, I assume, is higher if the mother gets the vaccine at that stage of pregnancy) would not cause neurological damage to glial cells? Brain development is heightened at the stage of 6 months gestation and the first year of life. An immune response that is heightened in a pre-born infant could result in lower white matter due to immune attack of the glial cells, or it may result in the genetic flipping of a switch that prevents the normal process of neurogenesis.

    I just have grave concerns about exposing newborns to anything that will initiate an immediate immune response. Are there studies to support the use of vaccines in pregnancy?

    Like

  4. Gray Falcon
    February 22, 2013 at 5:05 pm

    If having a police force is a good idea, then why does crime still happen? There are no perfect solutions, do not demand one.

    Like

  5. Dani
    February 22, 2013 at 5:26 pm

    Reblogged this on Dragon Deliberations.

    Like

  6. February 22, 2013 at 5:59 pm

    @Maria – because women getting those diseases during pregnancy can be an even greater threat to the unborn child? Getting Rubella during pregnancy causes congenital birth defects – and during the last major outbreak in the 1960’s over 10,000 babies died because of the disease (not to mention many more that were born with severe disabilities – including autism).

    Maternal antibodies only protect newborns for a very short time….our immune systems were designed to be able to handle a wide variety of challenges – vaccines are only a minute fraction of the antigens that a baby will be exposed to even over the course of just a single day….if our immune system was as fragile or weak as you claim, we would have died out as a species a long time ago.

    Like

  7. Christine Vara
    February 22, 2013 at 6:04 pm

    Maria, Perhaps you may want to investigate the sources referenced on the following page of the CDC website for more specific answers to your questions. http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm

    Like

  8. February 22, 2013 at 6:10 pm

    @Christine – I’ve bookmarked that site. Thanks!

    Like

  9. February 22, 2013 at 6:11 pm

    #3 I asked Dr. Paul Offit the same thing about this recommendation, He was on the panel of experts who created this recommendation. He said there is never all the data we need, but in this case there is enough to take this step to protect newborns. Until we have more effective vaccine, we will continue to have years with epidemic levels of this once nearly eradicated disease. The best way to protect yourself and your family is to get the recommended vaccines, and for them to tell us when it is in our community as soon as it gets to the epidemic level.

    Like

  10. dingo199
    February 22, 2013 at 7:28 pm

    Maria T. :
    If immunizing during pregnancy was a good idea, why do newborns still get pertussis and other illnesses? If the vaccines have any strength, the immune system of the mother will produce the antibodies anyway in the breast milk, wouldn’t they? How do they know the antibody exposure during pregnancy (which, I assume, is higher if the mother gets the vaccine at that stage of pregnancy) would not cause neurological damage to glial cells? Brain development is heightened at the stage of 6 months gestation and the first year of life. An immune response that is heightened in a pre-born infant could result in lower white matter due to immune attack of the glial cells, or it may result in the genetic flipping of a switch that prevents the normal process of neurogenesis.
    I just have grave concerns about exposing newborns to anything that will initiate an immediate immune response. Are there studies to support the use of vaccines in pregnancy?

    Maria, I understand your apparent confusion, since much of the reasoning appears circular wrt pregnancy.

    Specifically dealing with pertussis, the idea is for the mum to have high levels of pertussis neutralizing antibody which can then passively pass to the infant through the placenta and via breast milk, providing protection against infection by exposure until the infant generates it’s own immune response to the TDaP vaccine.

    Now mothers do not have any natural antibody levels – by the age females become mothers they have lost virtually all of their antibodies (either naturally acquired or vaccine acquired). The idea of giving adolescent and adult booster vaccines should help in this regard, as will the policy of offering boosters to pregnant women in the last trimester.

    What is generated in the mother through vaccination is an immune response, but in the mother, not the fetus, and antibodies are produced. These pass over to the fetus via the placenta. Antibodies do not damage the fetus, and do not cause glial damage. I don’t know where you get that idea from. If that were so, the prenatal infants would be more at risk from this type of damage if their mothers had the natural diseases as opposed to the vaccines (eg measles generates stronger antibody responses than measles vaccination – as any cursory scan of antivax literature would tell you). So ask yourself why should vaccination be more damaging than the natural diseases? (Clue – they aren’t).

    Like

  11. Ayan
    February 22, 2013 at 9:11 pm

    Gray Falcon :
    If having a police force is a good idea, then why does crime still happen? There are no perfect solutions, do not demand one.

    __so are you saying you’d rather remove the police force cuase crime still happens?

    Like

  12. February 22, 2013 at 9:21 pm

    @ayan – actually, that’s what the anti-vax folks want…..get rid of vaccines because some people still get sick.

    Like

  13. ER Guru
    February 23, 2013 at 4:58 pm

    Sad but this could be a case of iatrogenic death.

    Like

  14. February 23, 2013 at 5:29 pm

    @ER – why would you say that? Babies die of Pertussis, that is a fact.

    Like

  15. dingo199
    February 24, 2013 at 7:37 am

    I think ERguru may be referring to the pleural effusion that happened because of a misplaced central IV line – this needed a chest drain insertion. “They made an incision to drain her lung. I remember the clanking of the metal scissors being thrown in the sink after they had been used to cut my tiny baby. They said the IV line was sending all the fluid to her lungs.”

    However, the real culprit here is the pertussis – the infant was clearly critically ill with severe pertussis, on a ventilator and appeared encephalopathic with repeated seizures.

    Like

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