January 14, 2011
New vaccine recommendations aimed at combating high rate of pertussis
Use of Tdap booster approved for younger children, seniors; no waiting needed
In an effort to combat a persistently high level of pertussis or whooping cough, state and federal health officials are urging physicians and their patients to make wider use of a pertussis booster vaccine called Tdap (tetanus-diphtheria-acellular pertussis).
Despite the availability of Tdap, a vaccine designed as a booster for adolescents and adults, pertussis cases have been increasing in Minnesota as in other parts of the country, such as California. Minnesota is in its third year of a peak pertussis wave, with more than 1,000 cases reported each year in 2008 to 2010. This is about 20 cases per 100,000 people in Minnesota.
New recommendations published today by the Centers for Disease Control and Prevention (CDC) are designed to remove some of the barriers to Tdap's use and to address specific issues contributing to the high rate of pertussis.
Tdap vaccine has been available since 2005 and has been recommended for children entering seventh grade and adults needing a tetanus booster. Tdap was instituted after health officials found that the effectiveness of the primary series of DTaP (diphtheria-tetanus-pertussis), typically given to infants and children under seven, wears off as children approach adolescence.
However, health officials suspect the Tdap booster is not being used as widely as it should be. "We want all Minnesotans to be aware that the pertussis booster vaccine can help protect them and others from this disease, which can be most serious for young children and infants," said Kristen Ehresmann, director of infectious disease for the Minnesota Department of Health. Patients should be asking their health care provider to give them the pertussis-containing tetanus-diphtheria shot, if needed, at their next clinic visit.
According to the new recommendations:
- Adults and adolescents may be given Tdap regardless of when the last tetanus-diphtheria (Td) shot was given. Previously, a minimum interval of five years was recommended between the last Td and a Tdap. Recent data indicates that it is safe to give the Tdap sooner than two years after the tetanus shot. No waiting is necessary to get a pertussis shot.
- Tdap may be given to children 7 to 10 years of age who have not completed the recommended DTaP series or who have never received a primary series of tetanus, diphtheria and pertussis. This recommendation closes a gap in coverage for children of that age group with those factors.
- Seniors who work with young children should get Tdap. Tdap should be given to adults 65 years of age and older who have contact with infants younger than 12 months, and Tdap may be given to adults 65 and older needing a tetanus booster if they haven't already received the Tdap.
MDH staff has sent information on pertussis and the new recommendations to local public health agencies and health care providers in the state.
Pertussis is a disease that affects the lungs. Pertussis bacteria are spread from person to person through droplets in the air. A person with pertussis develops a severe cough that usually lasts four to six weeks or longer. Pertussis can be very serious, especially in infants.
The first symptoms of pertussis are similar to a cold: sneezing, a runny nose, possibly a low-grade fever and a cough. After one or two weeks, the cough becomes severe, as noted by the following:
- The cough occurs in sudden, uncontrollable bursts where one cough follows the next without a break for breath.
- Many children will make a high-pitched whooping sound when breathing in after a coughing episode. Whooping is less common in infants and adults.
- During a coughing spell, the person may vomit.
- The person's face or lips may look blue from lack of oxygen.
- The cough is often worse at night.
- Between coughing spells, the person seems well, but the illness is exhausting over time.
- Coughing episodes gradually become less frequent, but may continue for several weeks or months until the lungs heal.
Pertussis in infants is often severe, and infants are more likely than older children or adults to develop complications. The most common complication of pertussis is bacterial pneumonia. Rare complications include seizures, inflammation of the brain and death.
People with pertussis can spread it to others in the first three weeks of coughing if not treated with antibiotics. After a person with pertussis has taken antibiotics for five days, he or she can no longer spread the disease. Antibiotics are sometimes recommended and prescribed to prevent development of the disease in people who have had close contact with someone who has pertussis.
"The best way to prevent pertussis is to vaccinate all children on time and to use the booster vaccine as recommended," Ehresmann said.
In addition, everyone should:
- Avoid close contact with others who are coughing or otherwise ill
- Wash their hands often
- Stay at home if ill
- Cover their cough with a tissue or cough into their sleeve
- Seek medical attention if they develop pertussis-like symptoms or have been exposed to someone with pertussis
More information on pertussis can be found at www.health.state.mn.us/divs/idepc/diseases/pertussis/index.html.
Infectious Disease Division Director