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Nancy Welch, MD, MHA, MBA and director of the Chesapeake Health Department warns healthcare providers are at risk both of exposure and exposing others to pertussis also known as whooping cough. Pertussis among HCP is about 1.7 times that found in the general population.

 


If not for yourself, do it for others:  get your TdaP!

By Nancy M. Welch, MD, MHA, MBA
Director, Chesapeake Health Department

Uniqueness of Health Care Providers (HCP)

Up to nine HCP are exposed on an average for each one case of pertussis that has a delayed diagnosis.  Pertussis among HCP is about 1.7 times that found in the general population.  In one study, annual rates of infection among a group of clerical HCP with minimal patient contact ranged from 4% to 43%.

Infants are more likely than any other age group to suffer from pertussis and pertussis deaths.  They account for about 19% of national cases and 92% of deaths.

HCP are at risk both of exposure and exposing others to pertussis.   Pertussis infection is relatively common among adults with acute and prolonged cough illness. Although, it is estimated that 8% to 26% of adults with cough illness of at least 5 days duration who have sought medical care are infected with B. pertussis, these are undiagnosed because they are usually just treated/not tested; and there is no contact follow-up for treatment. In one study, 25% of cases of pertussis in infants had recently been exposed to an adult with a cough illness.  You can break that chain and help keep both you and the community well by getting your TdaP.

What is Pertussis?

Pertussis is an acute respiratory infection caused by B. pertussis.  It is also known as whooping cough, named in 1640 for the characteristic “whoop” when the person inhales to cough.  Although it can be asymptomatic in adults, it classically presents in three phases of illness: catarrhal, paroxysmal coughing and convalescent.   After an incubation period of 7-10 days the patient experiences intermittent cough and runny nose.  Fever is uncommon.  This is a highly contagious period and lasts 1-2 weeks.  The paroxysmal phase lasts 4-6 weeks and consists of spells of spasmodic cough, posttussive vomiting and the characteristic whoop.   This is also a highly infectious period.  The convalescent phase typically lasts 2-6 weeks; however, in adults it can last months.  The attack rate for secondary infection among exposed, nonimmune household contacts is 80% to 90%. The disease is transmitted from person-to-person through respiratory droplets generated by the coughing and sneezing.

Before the introduction of the routine vaccination against pertussis in the late 1940’s, the annual number of cases nationally was about 200,000 and there were over 4,000 pertussis-related deaths.  Post-vaccine era, we went to a low of 1,010 cases in 1976 but since then we have seen a steady increase in the number of reported cases (see the following graph).  In 2009 there were 16,858 pertussis cases and 12 infant deaths in the United States.

annual_pertussis_cases_us

persussis_virginia_region_chesapeake *Total number of provisional cases for the Eastern Region is 60

The reports of cases among adults and adolescents have increased disproportionately.  We have learned that immunity to pertussis wanes approximately 5-10 years after completion of childhood vaccinations, leaving adolescents and adults susceptible.  In 2005 there were 25,616 cases of pertussis in the United States.  In Chesapeake, we had 11 cases in 2007, 11 in 2008, 7 in 2009 and 25 in 2010.  Until 2005, we had no vaccine for persons older than 7 years, only antibiotics to prevent or treat disease.  Although, if given early enough, antibiotics may prevent disease, they generally do not modify illness after the onset of cough but do help to prevent transmission.

Vaccine Advancements

  • In 2005, an acellular pertussis vaccine (TdaP) was developed with less side effects and safe for use for adolescents and adults.
  • October 2005, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of TdaP for persons up to age 64.

─   However, only about 56% of adolescents and less than 6% of adults were immunized.

  • In February 2006, ACIP recommended TdaP for HCP at an interval as short as 2 years since the last Td.
  • October 2010, ACIP recommended expanded use of TdaP:

─   Use of TdaP regardless of interval since last tetanus-or diphtheria-toxoid containing vaccine,

─   Use of TdaP in certain adults aged 65 years and older, and

─   Use of TdaP in undervaccinated children aged 7 through 10 years.

Prevention Pays

The morbidity and societal cost of pertussis in adults is substantial.  Adults with pertussis miss work.  In one study, 78% of employed adults with pertussis missed work for a mean of 9.8 days; however, the actual mean time to full recovery may be a couple months.  The mean cost is $773.  If the cost of antimicrobials to treat contacts and the cost of personal time were included, the societal cost would be as high as $1,952 per adult case.

BOTTOM LINE:  PROTECT YOURSELF AND OTHERS—GET YOUR TdaP.

WORKS CITED

1)      http://www.acgov.org/PublicHealth/organization/divisions/ems/Newsletter/2009-2012/newslette201003_online.pdf

2)      http://www.immunize.org/nslt.d/n47/n47.pdf

3)      http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a1.htm

4)      http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm

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