This guest post was written by Carolyn who works as a Home Health Community Nurse and who originally shared her son’s story on the Nurses Who Vaccinate blog to help raise awareness of the symptoms and dangers of pertussis.
My son is a healthy 16-year-old, middle linebacker for his Varsity football team. He jet skis, is an avid boater, plays lacrosse, and enjoys working out, eating healthy and exercising. I never suspected he would suffer with a vaccine preventable disease.
His cough was mild at first. Not a nagging cough, not a wet cough, just a mild cough. I asked my son if he was feeling well and although he said he was fine, I gave him cough syrup and took his temperature. It was normal (hint #1) and we both went to sleep, although I did hear him cough occasionally through the night.
This marked the beginning of the longest 7 weeks of our lives.
The occasional cough continued for a week, but then I noticed it was worsening, and it was making him very short of breath. One day he called me from school and asked me to pick him up. I took him to urgent care, where they diagnosed him with bronchitis, gave him amoxicillin, put him on a five-day dose of prednisone and gave him an inhaler.
That night was the beginning of the nightmare. He coughed so violently that he became short of breath. He was gasping and choking and even began vomiting (hint #2). This continued through the next day and night. He was exhausted. I was exhausted. And even though I am a nurse, I felt helpless.
I took him to the local Emergency Department where the pediatric physician prescribed an albuterol nebulizer and a chest X-ray. The chest x-ray came back crystal clear (hint #3). When I questioned the doctor about the vomiting, they suspected it was due to a gag reflex, but they decided to give him saline for dehydration and take blood and urine samples.
All of his blood work came back fine except for his neutrophils and his monocytes which were only slightly elevated (hint #4). They treated him as a case of atypical pneumonia and put him on a five-day dose of Zithromax and advised us to continue the prednisone until finished.
During the next 10 days, as he completed the medications, my son continued to have these bouts of uncontrollable violent coughing, always resulting in vomiting, choking on phlegm and gasping. He was eating, but also losing weight, and he was in and out of school, often due to being up all night coughing.
One evening he vomited in the basin where I noticed black stringy flecks. I immediately thought it was blood, but he assured me it was something he had eaten. The next morning he vomited again, and this time it was phlegm with blackened red strings (hint #5). I put the vomit in a baggie, put him in the car and took him back to the emergency room.
His sample tested positive for blood and so they gave him several nebulizer treatments, upped his prednisone, repeated the chest x-ray (which again came back clear), prescribed the inhaler every four hours and released him. With the increased prednisone, the cough did slow down a bit, but he still was vomiting phlegm and gasping, so I made a follow-up appointment with his physician where they did a thorough exam and diagnosed him with pertussis.
Pertussis? Really? How did my healthy kid get whooping cough? I was diligent in getting him vaccinated. How did three different doctors miss this?
Every Child By Two’s “State of the ImmUnion” campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan. In this second guest post we hear from a California colleague who has a particular interest in Maternal-Child Health.
Dr. Elizabeth (Betsy) Rosenblum, who is a Professor of Clinical Medicine at UC – San Diego Health System, with joint appointments in the Departments of Family Medicine & Public Health and in Reproductive Medicine, works hard to help protect pregnant women and their babies from pertussis.
The shattering loss of a child is something no family ever wants to experience. Unfortunately, this year in California, two families have suffered this loss in a particularly devastating manner. These two children, both under six months of age, died from a vaccine-preventable illness: whooping cough.
Whooping cough? Isn’t that a disease from the past, like bubonic plague or smallpox?
The unfortunate answer is no. Whooping cough, or pertussis, is a disease that is still very much with us. It can infect both children and adults. It is most dangerous, however, for young infants. When whooping cough infects babies under two months of age, 90% will be hospitalized, 2-4% will suffer seizures, and 1 in 100 will die from complications of the disease.
How do infants get whooping cough?
The sad fact is, they get it from those around them. The disease is spread by infectious droplets in the air and is highly contagious. Adults with pertussis infection, who may only have a mild cough, may not realize they have the disease. And, tragically, adults have been shown to be a frequent source of infection to infants with whom they have close contact.
Is there any way to prevent pertussis in infants?
Fortunately, we have a vaccine, called Tdap. We know that when pregnant women are vaccinated during mid-pregnancy, their body has time to pass protective antibodies to their babies. These antibodies can help protect infants from the disease, until they are old enough to mount an immune response to their own pertussis vaccine.
I am a family physician, and care for many pregnant women and young families. I know from experience that some pregnant women are hesitant to get a vaccine, wondering if this might harm their growing baby. I try my best to explain that the opposite is true: that getting Tdap vaccine during pregnancy is far safer for their baby than NOT getting the vaccine. If born without protective antibodies, babies risk getting sick and dying from a potentially preventable disease.
Some of my patients tell me “I’ll get the Tdap vaccine, but I want to wait until after the baby is born.” Certainly, getting the vaccine is better than never getting it. However, this plan offers far less protection. In order for a baby to have protective antibodies circulating in his/her system from the moment of birth, the vaccine must be given at least 3-4 weeks prior to delivery. Currently in the United States, the recommended time of Tdap vaccination for pregnant women is between 27-36 weeks (6-8 months of pregnancy).
I care for some pregnant women whose children are closely spaced in age. When these women reach 27 weeks in a given pregnancy, I recommend Tdap. On occasion, they will tell me “I don’t need it, because I had it last year in my prior pregnancy.” However, in order to protect a newborn from whooping cough, a pregnant woman needs Tdap in each and every pregnancy. It is only when a woman receives the vaccine in a current pregnancy that she sends an abundant and protective amount of antibodies into the baby growing inside of her.
In order to protect infants from whooping cough, do other family members need to be vaccinated?
The answer to this question is a resounding YES! All family members, caregivers, and others who will be around an infant should be certain they are up-to-date with Tdap vaccine. When everyone around a baby is vaccinated, this provides a ‘cocoon’ of protection, greatly minimizing the chances a baby will get sick from the disease.
Children need five DTaP vaccines(the pediatric form of Tdap) at 2, 4, 6, 15 months and between ages 4-6. They need a Tdap booster at age 11. Adult men only need a single lifetime Tdap. Adult women only need a single lifetime Tdap, unless they are pregnant, in which case they need a Tdap in every pregnancy.
If a murderer was on the loose in California, intent on harming babies, there would be an immense outcry and demand for protection. Well, that murderer is pertussis. And, the best way to protect every infant from this disease is to spread the word of the importance of both maternal Tdap vaccination and vaccination for all members of our communities.
To determine what vaccines are needed before, during and after pregnancy, take a brief Pregnancy and Vaccination Quiz or visit the Pregnancy section of the Vaccinate Your Family website.
Dr. Rosenblum has completed a fellowship in Vaccine Science and Safety through the American Academy of Family Physicians. She chaired the Tdap Working Group in 2010, which coordinated UCSD’s response to the California pertussis epidemic. Her innovative work in designing and implementing a Tdap Cocooning Clinic led to her receiving the APhA Immunization Champion Award in 2011. She was chosen by the CDC to be the Childhood Immunization Champion for the State of California in 2014, in part due to her work in educating pregnant women and their families regarding the importance of childhood immunizations. She currently serves on two Advisory Committee on Immunization Practices (ACIP) work groups; the Tdap Work Group and the Combined Vaccine Work Group. She is also on the Steering Committee of the San Diego Immunization Coalition.
National Immunization Awareness Month is a reminder that we all need vaccines throughout our lives. This week we are focusing on the importance of vaccines during pregnancy. These vaccines help protect expectant mothers while also passing immunity to babies that can help protect them from disease before they are old enough to receive their own vaccines.
From the moment you found out you were pregnant, you started protecting your developing baby. You might have changed the way you eat, started taking a prenatal vitamin, or researching the kind of car seat you’ll buy. But did you know that one of the best ways to start protecting your developing baby against serious diseases is by making sure you get the whooping cough (Tdap) and flu vaccines while you are pregnant?
The vaccines you get during your pregnancy will provide your developing baby with some disease protection (immunity) that will last the first months of life after birth. By getting vaccinated during pregnancy, you can pass antibodies to your baby that may help protect against diseases. This early protection is critical for diseases like the flu and whooping cough because babies in the first several months of life are at the greatest risk of severe illness from these diseases. However, they are too young to be vaccinated themselves. Passing maternal antibodies on to them is the only way to help directly protect them.
In cases when doctors are able to determine who spread whooping cough to an infant, the mother was often the source. Once you have protection from the Tdap shot, you are less likely to give whooping cough to your newborn while caring for him or her.
When it comes to flu, even if you are generally healthy, changes in immune, heart, and lung functions during pregnancy make you more likely to have a severe case of the flu if you catch it. If you catch the flu when you are pregnant, you also have a higher chance of experiencing pregnancy complications, such as premature labor and delivery. Getting a flu shot will help protect you and your baby while you are pregnant.
You also can rest assured that these vaccines are very safe for you and your developing baby. Millions of pregnant women have safely received flu shots for many years, and the CDC continues to monitor safety data on flu vaccine in pregnant women.
The whooping cough vaccine also is very safe for you and your developing baby. Doctors and midwives who specialize in caring for pregnant women agree that the whooping cough vaccine is important to get during the third trimester of each pregnancy. Getting the vaccine during your pregnancy will not put you at increased risk for pregnancy complications.
You should get your whooping cough vaccine between your 27th and 36th week of pregnancy. You can get a flu shot during any trimester. You can get whooping cough and flu vaccines at the same time during your pregnancy or at different visits. If you are pregnant during the flu season, you should get a flu vaccine soon after vaccine is available.
If you want to learn more about pregnancy and vaccines, talk to you ob-gyn or midwife, and visit the pregnancy pages at Vaccinate Your Family and the Centers for Disease Control and Prevention (CDC).
Each year I look over the list of Childhood Immunization Champion Award winners and I am truly inspired.
During National Infant Immunization Week (April 18-25, 2015) the CDC and the CDC Foundation recognizes “Champions” from every state. While the Champions are often public health professionals, doctors and nurses, being selected as a Champion isn’t just about doing your job.
Being a Champion requires an extraordinary effort. It’s about going above and beyond. And it’s about promoting childhood immunizations in a way that exemplifies a commitment to change, even in the face of adversity or resistance.
This year I’m proud to say that I know a true Champion, and she is a parent advocate just like many of you. The truth is that Katie Van Tornhout didn’t need a formal award to be considered a Champion in my eyes, but I’m thrilled to know that her passion and commitment are being recognized by people who devote their entire professional lives to promoting childhood immunizations.
I came to know Katie in a very unfortunate way. After five years and four miscarriages, Katie and Craig Van Tornhout celebrated the birth of their daughter Callie in 2010. Although their baby arrived a few weeks early, she was truly a miracle. Despite the fact that they had barely left the house with Callie after her birth, their joy quickly turned to grief when a disease called pertussis, also known as whooping cough, claimed her life at just 38 days old.
It is in these challenging moments of adversity that we are often tested, and yet it was through the pain and sorrow of their loss that the Van Tornhouts – along with their angel Callie – have become forceful agents of change. Since losing her daughter, Katie has been determined to spare other children from pertussis and prevent other parents from suffering a similar tragedy. Read more…
Being a mom to Molly and Frankie is, without a doubt, the most rewarding role I’ve ever had. As we prepared to welcome another baby into our home this fall, I was reminded of just how fragile and precious a newborn can be.
In recent interviews with Fox News and CNN, I shared my concerns over the growing number of unvaccinated children in the area where we live. It frightens me to think that my baby may possibly be exposed to a dangerous and life-threatening disease before he is old enough to be vaccinated himself. It seems unfair that while I do everything in my power to protect this delicate new life, others are making a choice that puts my child at serious risk.
I have real reason to worry. When my second daughter Molly was just 10 months old she contracted whooping cough (also known as pertussis). As any parent can relate, it’s scary when your child gets sick, but it’s especially upsetting when you realize that your child is part of the largest outbreak of whooping cough in over fifty years. As an advocate for Every Child By Two’s Vaccinate Your Baby initiative, I was all too aware of the fact that whooping cough can be deadly for infants, and yet here we were facing that terrible diagnosis. We were incredibly fortunate that Molly fully recovered, but I’ll admit that I was completely rattled by the experience.
Fortunately, since that time, scientists have been closely examining the possible causes for the large number of whooping cough cases over the past few years and have made recommendations aimed at curbing the outbreaks. Part of the problem is that the immunity against the disease is wearing off so that people throughout the U.S. are less immune to whooping cough. Therefore, it’s more important than ever for infants to receive all five recommended doses of the DTaP (diphtheria, tetanus and pertussis) vaccine, followed by the booster shot of the adult version of the pertussis vaccine (Tdap) at 11 or 12 years old. It’s staggering to note that 83% of infants who are diagnosed with whooping cough got it from a family member, most often their own parents. Therefore, adults need to make sure they get a Tdap booster before a new baby arrives to protect themselves and to stop the spread of the disease to infants, who are most likely to become seriously ill from the disease.
Most important for newborns, the CDC’s Advisory Committee on Immunization Practices took a good hard look at the pertussis research and concluded that we can best protect newborns by ensuring that pregnant women receive an adult Tdap booster in their last trimester of each pregnancy. By getting vaccinated during pregnancy, not only was I protected, but antibodies were transferred to my baby through the placenta, providing my baby with protection against pertussis before he could start getting DTaP vaccine at two months of age. So I followed my doctor’s advice and not only received the Tdap vaccine during my last trimester, but I also got a flu shot.
Just as I have the ability to protect my newborn from pertussis, I also have the ability to protect him and other members of my family from influenza. I’ve learned that due to changes in a pregnant woman’s immune system, heart and lungs, I was more prone to serious complications from the flu such as pre-term labor and delivery, hospitalization and even death. And, since children can’t be vaccinated against the flu before six months of age, everyone in our family must do all we can to protect our baby boy. With my child being born in the midst of flu season, I wanted to do everything I could to protect him from a disease that causes more than 20,000 children under the age of five to be hospitalized each year. I find it upsetting to learn that with all the medical resources available to us here in the U.S., last year’s flu season claimed the lives of 109 precious children.
I’ll admit that as a parent I’m concerned about the threat of vaccine-preventable diseases, especially as a result of people choosing not to vaccinate. But I refuse to stand by and watch as others put my children’s health at risk. By getting the flu and pertussis vaccines during my pregnancy, I felt empowered that I could do something positive to protect my child. And you can too.
Talk to your doctor if you have questions about vaccines. In addition, encourage your friends and family to utilize the resources provided by reputable organizations, such as Every Child By Two and the American College of Obstetricians and Gynecologists. And be sure to immunize yourself and your entire family.
I’ve had some mixed emotions these past few days. As the world rejoices in the arrival of a new prince, I’m thinking about all the babies born around the world that will suffer and die from diseases that could have been prevented.
While the overwhelming majority of these deaths occur in countries far from my own, that doesn’t make it any more acceptable to me. And what many people here in the U.S. don’t realize, is that even in countries where one may not expect to see vaccine preventable diseases, we’re still suffering with outbreaks of diseases like pertussis and measles.
According to the Wall Street Journal, measles has taken a toll on a densely populated Orthodox Jewish community in NY earlier this year. After a traveler returned from London, the disease began spreading among pockets of unvaccinated in the community. To date, as many as a 58 people have been infected in that area, including a child who suffered with pneumonia and two pregnant women, one who went on to have a miscarriage after being hospitalized with measles.
With measles on the rise there have already been 118 cases reported in the U.S. so far this year. Another 25,000 people in Pakistan have contracted measles this year, and 154 of those cases claimed the lives of children. And in Europe, we have seen as many as 8,500 measles cases over the past year. Considering the fact that measles vaccine is highly effective and children who aren’t vaccinated against measles are 35 times more likely than immunized children to catch the disease, it’s easy to see the unfortunate impact of missed immunizations.
My plea for vaccination extends to other diseases as well. For instance, plenty of people believe they are appropriately vaccinated. But have they received their adult Tdap boosters and do they know that this may help reduce the spread of pertussis, especially among infants who’ve not yet received their full course of immunizations?
This week, a child by the name of Kaliah, should have been celebrating her 2nd birthday with her family. Instead, Kaliah was a victim of pertussis, dying at just 27 days old. You can read her heartbreaking story on the Shot By Shot website, along with numerous other personal accounts of vaccine preventable diseases.
And the McCaffery’s, a grieving family in Australia, still continue to educate parents about the need for Tdap boosters in an effort to protect newborn babies from pertussis. After they lost their child from pertussis during an outbreak in Australia, the government initiated a program to offered free Tdap boosters to parents. Now that there has been a reduction in cases, the government is eliminating their program. Of course, the McCaffery’s are worried that this action will simply lead to more tragic deaths. They spoke out earlier this week on a program called The Project and they continue to encourage people to sign a petition that will highlight the importance of the Tdap booster and to once again make it easy and affordable for citizens to receive it.
I’m a glass-half-full kind of person. That’s why it’s frustrating to hear people reject vaccines on account of the fact that they aren’t “perfect”.
The fact remains that nothing (as far as I know) is perfect. And when it comes to vaccines, there will always be those who argue that they aren’t worth getting if they aren’t 100% guaranteed safe or effective.
It’s true that being vaccinated doesn’t ensure immunity, and there are times when a vaccinated person can still fall victim to the disease that they have been vaccinated for. Additionally, there have been documented instances when a vaccine has triggered an adverse event that has resulted in unintended harm. However, statistics show that it’s far more likely that a vaccine will be effective at preventing disease than not, and that millions upon millions of vaccines are administered without any serious adverse side effects.
While I accept that vaccines are not perfect, I’m still grateful that they are so widely used and accepted. The fact that no one can guarantee 100% safety or efficacy doesn’t mean vaccines are ineffective or dangerous. As with all other medical interventions, accepting vaccination is a matter of evaluating the relative risk and benefit.
First, we need to understand the dangers of the diseases we vaccinate for. Knowing that these diseases can cause permanent health problems, hospitalizations and in some cases even death is essential to understanding that the diseases themselves are far more dangerous than the vaccines. There is an abundance of scientific evidence that proves that vaccines are effective at reducing the risk of disease. And, as we continually evaluate the safety and effectiveness of vaccines, experts analyze new and ever-changing data and use it to improve vaccination policies and protocols.
Take for instance the pertussis vaccine and the past and present research that has helped to evaluate the safety and effectiveness of this vaccine over the years.
In a nutshell, concern about the pertussis vaccine began years ago. Read more…