Whooping Cough Makes a Comeback

When last we discussed the Tdap vaccine, which protects against tetanus, diphtheria and pertussis, the Centers for Disease Control and Prevention had recommended it for adults over 65 who had contact with small children.

But after an advisory committee meeting last winter, the CDC has revised its recommendation and now urges all adults to get a single dose – and just in time.

Diphtheria has been nearly eliminated in the United States, and tetanus has become fairly rare, with about 30 or 40 documented cases a year. But pertussis, a k a whooping cough, is surging in most states, an unwelcome comeback that makes vaccination much more urgent.

Washington State, whose health officials declared pertussis to be an epidemic in April, has recorded more than 3,000 cases this year, a rate not seen since the early 1940s. Wisconsin, Montana, Vermont, Minnesota and Iowa have also reported particularly high rates of disease.

Nationally, the CDC has tracked nearly 18,000 cases this year, more than twice as many as last year at this time, said Dr. Anne Schuchat, director of the agency’s National Center for Immunization and Respiratory Diseases, at a recent news briefing. “We may need to go back to 1959 to find a year with as many cases reported by this time,” she said, adding, “I think there may be more coming to a place near you.”

Even adults who had whooping cough as children (vaccinations began in the 1940) or who were previously vaccinated should get a dose of Tdap, said Dr. Tom Clark, a CDC medical epidemiologist. Officials’ concern is not only for older adults themselves, but for the very young, for whom the disease is particularly perilous. Grandparents, take heed.

“Because babies are too young to be vaccinated themselves, we rely on everyone around them to be vaccinated,” said Dr. Clark. As of mid-July, pertussis had killed nine infants this year, according to the CDC, which has also noticed a spike among 13- and 14-year-olds, perhaps because a switch to a different form of vaccine in the late ’90s means that immunity wears off more quickly than it used to. That, along with normal cycles in which the disease ebbs and then spreads, may be contributing to the current increase.

Though close to 70 percent of adolescents are vaccinated, a 2010 survey found, only 8 percent of adults have gotten a Tdap booster. “I know we can do better than this,” Dr. Schuchat said at the briefing.

Tdap – sold under the brand names Boostrix and Adacel — is covered under Medicare Part D, which means that patients who go to doctors’ offices may have to pay for it out of pocket (it’s in the $40 to $65 range) and then file for reimbursement. The simpler way for many will be to get vaccinated at a pharmacy, where the bill can go directly to Medicare.

Getting vaccinated when you’re older is responsible citizenship, but it’s not pure altruism. Thought the CDC says an average of 318 adults over age 65 have reported pertussis each year, it believes the true number is at least 100 times higher. The disease can have different symptoms in adults (they may not whoop), and non-pediatricians often don’t recognize them. “Doctors who take care of adults don’t think about whooping cough,” Dr. Clark said. “They see it as a childhood disease.”

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