Worrying about Whooping Cough

Recently, one of my mom’s friends had a new grandchild and this friend’s daughter, who works in a neonatal care unit, requested that all family members get a Pertussis vaccine.

My mom wanted to know if this was something she needed to worry about too.

Pertussis is the fancy name for Whooping Cough.  And, until a few years ago, I honestly thought that Whooping Cough was a thing of the past.  Something that your computer game children caught and died from when electronically traveling on the Oregon Trail.
And then there was an outbreak of the disease in California (and other parts of the country) in 2010.  Thousands of children got sick. Ten infants died.  Frightening stuff and no longer bound to the confines of a pixelated computer screen.

In the US, Whooping Cough outbreaks are actually more common that I would have thought. And this disease is cyclical: outbreaks tend to occur every 3-4 years.  I guess we’re due!  Yikes.

So, back to the query from my mother.

Do I (and my family) have to get vaccinated for Whooping Cough/Pertussis?

An info sheet about the Tdap vaccine (Tetanus-Diptheria-Pertussis) that I received from my doctor addresses this question very vaguely.  The info sheet only suggests women who “have never had a dose of Tdap” get one.  Well, my mom definitely made sure I got all of my shots as a child and I know that I have had a tetanus booster in the last 10 years (I am accident prone… especially around sharp metal objects!) but I cannot tell you the last time I had a booster that covered all three.

Taking a less ambiguous approach, the CDC recommends that ALL pregnant women get a Tdap vaccine during the 3rd trimester. As the CDC notes 30-40% of the cases involving infected infants in the 2010 outbreak could be directly attributed to the mother.  70+% could be attributed to any family member.  The “cocooning” strategy that my mom’s friend was subjected to addresses this level of prevention.  “Cocooning” is when all persons who may be coming into contact with the pre-vaccine baby (this vaccination series starts at 6-8 weeks of life) also gets vaccinated.  Apparently, vaccination as a child is not enough, your immunity to the disease starts to wear thin after about 10 years so you may still catch the disease and unknowingly pass it along to the non-vaccinated baby.

But the cocooning method seems a bit extreme to me.  And I feel justified in saying that given that an article in Clinical Infectious Diseases entitled “Infant Pertussis: Is cocooning  the answer?” appears to agree.  The authors note that cocooning just isn’t practical and a bit too “logistically complicated” to provide the benefits that a simple maternal immunization would allow [1].  So, I think I just might take the “don’t come around if you are sick” and “don’t cough on my baby” approach instead of making everyone around me double check their vaccination history.

You are off the hook, mom.

But what about that maternal immunization/booster?

The recommendation for all pregnant women to get the shot before or immediately after having the baby is a straightforward approach to making sure the mother will not catch and transmit Whooping Cough to the new bundle.  Holding off on the vaccine to watch and wait for an outbreak isn’t the most effective strategy – it takes about two weeks for the antibodies to build up to amounts that would effectively fight the illness and limit its spread.

But there is another reason to get the shot during pregnancy.  Recent research has suggested that a Tdap vaccination during the third trimester can actually confer some degree of protection to the infant for when it enters this dangerous, disease ridden world.  Studies have shown evidence for increased Pertussis antibodies in the cord blood and in the circulation of infants whose mother’s were vaccinated as compared to infants of unvaccinated mothers [2].  Effectively, this allows a brand new baby to have some antibody fighting power against Whooping Cough even before the first vaccine series initiates baby’s self-built antibody stockpile.

Important to note, though, there does appear to be a Goldilocks sweet spot for the timing of getting this shot:  post-birth may be too late but before the third trimester may be too early.  Getting the vaccine pre-conception or early in the pregnancy does not confer the same placenta-hopping-antibody benefits [3].  That’s right, if you are cooking up your second, third, fourth baby, you will still need to get that arm poked if you want to potentially pass along the benefits of the vaccine.

What about negative side effects?  An extensive review of reports sent in to an oversight body, VAERS (Vaccines Adverse Event Reporting System) turned up absolutely nothing of concern for maternal/infant/fetal outcomes post Tdap vaccine [4]..

So, I’m pretty convinced.  I think that passing along a bit of immune system fightin’ power against any potential Whooping Cough outbreaks seems more practical than hanging a sign around the baby’s neck that reads “Please do not cough on my baby”.

 

But, seriously, please do not cough on my baby.

 

 

1. Munoz F, Englund J,. Infant pertussis: is cocooning the answer? CID 2011;53:893–6.

2. Leuridan E, Hens N, Peeters N, de Witte L, Van der Meeren O, Van Damme P. Effect of a prepregnancy pertussis booster dose on maternal antibody titers in young infants. Pediatr Infect Dis J 2011;30:608-10.

3.Healy CM, Rench MA, Baker CJ. Importance of timing of maternal combined tetanus, diphtheria, and acellular pertussis (Tdap) immunization and protection of young infants. Clin Infect Dis 2013;56:539-44.

4. Zheteyeva YA, Moro PL, Tepper NK, et al. Adverse event reports after tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines in pregnant women. Am J Obstet Gynecol 2012;207:59, e1–7.

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4 comments

  1. Dr. E

    I agree cocooning is probably overkill, but I’m going to suggest my baby’s grandparents (who live close enough to see the baby weekly) get immunized, especially since both gmas work in schools, aka cesspools of disease-carrying vector children.

  2. Gluten Free Traveller

    Great post! I’m 31 weeks pregnant and my husband and I just had our Tdap vaccines this week. As my parents are coming to stay with us for a week when our baby will be less than a month old, I’ve asked them to get the vaccine too. They too are teachers who spend time surrounded by disease carriers! 🙂

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