Controlling the cough
Waking up to the sound of a child coughing violently and struggling to breath is enough to send any parent straight to the emergency room in a panic. “It’s terribly frightening,” said Dr. Dean Smith, pediatric physician at Essentia Health St. Joseph’s-Baxter Clinic.
Pertussis, also known as whooping cough, can cause serious and sometimes deadly complications in infants and young children, particularly those who are not fully vaccinated.
“It can be prevented,” Smith said. “But it is important to know that it is not eradicated — there is still a very real risk of exposure.”
In 2012, a notable jump in pertussis cases raged across Minnesota. While numbers of reported cases in the Brainerd lakes area were fairly low, the spike was still significant — cases jumped from 1 in 2011 to 51 in 2012.
According to the Minnesota Department of Health, reported pertussis cases jumped form 661 in 2011 to 4,639 in 2012. There were 995 reported cases in 2013.
Smith said pertussis outbreaks tend to come in 3-5 year cycles and are typically worse in winter months. “It was kind of the perfect storm,” Smith recalled.
While complications in adults are usually less serious — less than 5 percent are hospitalized — complications in infants and young children can be life-threatening.
According to the Center for Disease Control and Prevention (CDC), of those children diagnosed with pertussis, 1 in 4 will get pneumonia, 1 in 100 will experience violent, uncontrollable shaking, two-thirds will experience slowed or stopped breathing, 1 in 300 will have encephalopathy (disease of the brain) and 1 in 100 will die.
“It can be a nasty thing,” Smith explained.
No one is sure why the jump in 2012, but the alarming number has led Minnesota doctors to step up their discussion with parents of young children about considering the Tdap vaccination, which includes vaccines for tetanus, diphtheria and pertussis and is recommended as early as six weeks of age in infants.
Doctors also strongly recommend pregnant women be vaccinated.
The pertussis vaccination for the disease has changed over the years.
While the old vaccine was more effective (95 percent) in preventing the disease, concerns over potential side effects, including seizures, caused many to shy away from the vaccine.
The new vaccine has less chance of side effects, but studies have also shown less effective immunity from the disease.
Despite the decrease in immunity, Smith said he still strongly recommends the vaccine.
“Vaccination is the best form of prevention,” Smith said.
Smith explained that under-vaccination can play a large role in those more at risk of contracting pertussis. “It’s just a general fear,” Smith said. “People are not seeing sick kids so they tend to feel safer — they don’t know what it was like before vaccines.”
Diseases like polio, measles, mumps and rubella have been effectively eradicated because of vaccines, however parents who have never lived in an era when theses diseases crippled their victims, don’t understand the lasting consequences of foregoing vaccinations. “The problem is they’re running from the arms of one monster right into the arms of another,” Smith said.
Smith added that parents of unvaccinated or under-vaccinated children who do contract serious, preventable illness, often live with lasting regret of their decisions. “It’s a hard thing to watch,” Smith said. “It’s hard for the parents to come to terms with.”
Dr. Robert Westin, chief medical officer at Cuyuna Regional Medical Center in Crosby, echoed Smith’s support for the vaccine, saying as vaccination numbers decline, inevitably reported disease numbers tend to spike.
“It takes a while to gain momentum once you lose it,” Westin said. “Vaccination is the key.”
Westin said fears of side effects associated with most vaccines have been proven unfounded but still play a major role in parents’ decision whether to vaccinate their children or not.
Westin said patients are often left paranoid and feel like their doctors are trying to sell them something rather than help them make conscious decisions to protect their health and the health of their children. “There’s too much information floating around,” Westin said. “People don’t know who to trust anymore.”
Westin said when people do have reliable information they understand, they are more apt to consider the vaccine.
While 2012 saw an alarming increase in pertussis cases in Minnesota, Westin was quick to point out that the number of local cases was significant compared to years past but small compared to cases reported in the metro region.
“Population centers are where people see it most,” Westin said, adding that the prevalence among young patients more susceptible to serious complications is generally low — less than 50 percent.
Westin added that numbers could be significantly higher because older children with milder forms of the disease are less likely to be tested and treated.
“We really believe that reported numbers are gross underestimates of actual cases,” he said.
In addition to unvaccinated children, Westin and Smith both pointed out that unvaccinated adults can be a major source of the spread of pertussis.
Healthy adults tend to believe they can fight off the illness on their own and are at less risk for potential complications — which is generally true but a dangerous reasoning.
“Risk may be low for you personally, but that doesn’t mean you won’t expose others,” Westin warned.
Smith added that newborns have a particular risk of exposure because they don’t receive the vaccination until they reach two months of age.
Smith pointed out the importance of parents remaining vigilant in protecting their infants, going as far as to suggest it’s not unreasonable to ask any adult who comes in contact with the infant to be vaccinated.
“Everyone in the family, daycare providers — ask everyone to wash their hands,” Smith said, adding that the general rule is a baby under six weeks who contracts a fever is readmitted to the hospital for observation.
“The risks just aren’t worth it,” he added.
Infants receive the Tdap vaccination in several doses at 2, 4, 6, 15 through 18 months and a booster is administered at 4 through 6 years of age.
Westin said CRMC providers recommend the vaccine to all pregnant women sometime between 27-36 weeks gestation. The vaccine is administered during pregnancy because if the mother happens to contract the illness it goes right to the baby and can cause unnecessary complications at birth.
The CDC explains the vaccine helps the body create protective antibodies to fight off the disease and passes antibodies to the baby, providing short-term protection against pertussis.
Protective antibodies are at their highest about two weeks after the vaccine is administered, so the time period between 27 and 36 weeks gestation is optimal for providing the baby the most protection when he/she is born.
Statistics show that 30-40 percent of infants who contract pertussis get it from their mother.
“It’s about protection from the very beginning,” Westin said.
Westin and Smith agreed that the goal of health care providers is not to frighten patients into getting vaccinated — their goal is to help educate the public and prevent the unnecessary spread of disease. “Chances are you won’t get it,” Westin said, “But you’ll be part of the problem not part of the protection.”
SARAH NELSON KATZENBERGER may be reached at firstname.lastname@example.org or 855-5879.