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2010 may be a peak year for pertussis
There has been an increase in the number of cases of pertussis (commonly referred to as "Whooping Cough") in San Mateo County and throughout the U.S. this year. The California Department of Public Health (CDPH) is very concerned that 2010 will be a peak year for pertussis, as was 2005 when at least eight infants died. So far in 2010, five infants are known to have died of pertussis in California. This year all infant deaths are under 3 months of age.
What is pertussis? Pertussis is an infection of the respiratory tract that usually lasts 6-10 weeks. Symptoms begin with a runny nose, sneezing, possibly a low-grade fever, and mild cough. After a week or two, a persistent cough develops, which may occur in explosive bursts, sometimes ending in a high-pitched whoop and vomiting. Older children and adults may have a less typical cough. Although the disease is less severe in adults and older children, they can unknowingly infect infants and preschoolers who are at risk for serious illness.
Pertussis can lead to serious complications, such as seizures and pneumonia, and even death. 83% of deaths from pertussis occur in infants younger than 3 months of age and household contacts have accounted for the majority of implicated transmissions to infants.
Pertussis is spread when an infected person coughs or sneezes tiny droplets into the air and another person breathes them in. An infected person is contagious at the time of the early cold-like symptoms, before persistent coughing starts. Persons remain contagious until about three weeks after the persistent cough begins (for a total contagious period of about five weeks for untreated pertussis). Those treated with antibiotics are no longer contagious after completing five days of treatment. San Mateo County Health System Communicable Disease Control Program recommends that students ill with pertussis remain home from school during their contagious period. |
Why are we concerned about pertussis among infants? 
Infants under the age of 12 months have more serious illness from pertussis and they are more likely to have complications and be hospitalized than persons in other age groups. In the 1990s, about two thirds of infants reported with pertussis were hospitalized. Infants are more likely to have pneumonia or convulsions. Infants also are at greatest risk of fatal pertussis. In recent years, 8 to 40 infant deaths from pertussis are reported to CDC annually. |
Children should be vaccinated against pertussis Children should be vaccinated with DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine). DTaP is safe and effective, and prevents severe pertussis and death among infants and young children. The best way to protect infants from pertussis is to give DTaP vaccine on time at 2, 4, and 6 months of age. At least three DTaP doses are needed to have the maximum benefit from the vaccination. However, per the American Academy of Pediatrics 2009 Red Book, "If pertussis is prevalent in the community, immunization can be started as early as 6 weeks of age, and doses 2 and 3 in the primary series can be given at intervals of 4 weeks." Your pediatrician may recommend an accelerated DTaP schedule for your infant during the current pertussis epidemic. Vaccine will then be given at 6 weeks, 10 weeks, 12 weeks, 15-18 months, and 4-6 years of age.
Parents play a key part in helping to minimize and control the spread of pertussis
 Parents are urged to make sure their infant receives all recommended doses of DTaP on time to best protect their infant. An additional dose of DTaP vaccine is recommended at 15-18 months and at 4-6 years of age to maintain protection. Protection from childhood vaccine
Boosters for adolescents, adults and pregnant women
There is another vaccine that protects against tetanus, diphtheria and pertussis, called Tdap. Tdap is recommended for all pre-teens going to the doctor for their regular check-up at age 11 or 12 years. Adults should get one dose of Tdap in place of the Td booster. There is no minimum time requirement between the administration of the last dose of Td and the Tdap booster. Women considering pregnancy are encouraged to get their Tdap booster shot before they become pregnant. Pregnant women can also receive Tdap during their 3rd trimester or immediately post partum. All San Mateo County birthing hospitals routinely offer Tdap to women post partum. |
What populations should get a Tdap vaccine? 
A dose of Tdap is recommended by the California Department of Public Health (CDPH) for all individuals ages 7 years and older who have not previously received the vaccine. In particular, healthcare workers, preschool teachers, parents, people who travel to countries where rates of pertussis remain high, and those who work with infants, such as caregivers are highly encouraged to get a Tdap vaccine. |
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Mariah's Story
On September 14, 2005 my son, Dylan, died of a contagious, vaccine- preventable disease that he contracted from me. We had pertussis.
In the weeks before Dylan was born, I had a runny nose, low-grade fever and severe cough. My doctor hoped that it would clear before I delivered, but the coughing caused contractions to start two weeks early and Dylan was born on August 28th. He was a healthy, beautiful baby and the easiest delivery a mother could ask for. However, I continued to cough and was short of breath during my post-partum stay. I expressed concerns about going home sick with a newborn and was told to see my primary care doctor by my OBGYN and pediatrician.
Our pediatrician causally mentioned pertussis and despite being a nurse, I did not know much about it. So on the day of discharge, I asked my doctor and was told that pertussis, also known as whooping cough, wasn't seen anymore, that viral infections are going around this time of year and could cause the symptoms I had. So I went home hoping hand washing and breastfeeding would help protect Dylan from getting this "cold".
Within the next few weeks, I sought second and third opinions about my condition which seemed to be worsening and I was eventually tested for pertussis. At the same time I was having a hard time keeping Dylan awake during feeding - the only symptom of pertussis he ever had. The doctor wanted to get an x-ray of Dylan's lungs to make sure he didn't have pneumonia.
Less than twenty-four hours later my baby was unable to breathe on his own, his immune system was failing, and his heart and kidneys were shutting down. Pertussis was quickly taking over his body and there was no medicine to stop it. The very next day, after failed efforts of resuscitation, we watched our sweet baby close his eyes for the last time. I will never forget holding him in those last moments helpless... powerless...lifeless...
As a critical care nurse for the past 7 years, I felt like I should have done more; I should have known more about this disease. The "what ifs" haunted my every thought.
After meeting with the people from the San Francisco Department of Public Health we realized that we could have possibly spread the disease to others. Family members, friends, and children at our son's preschool were all at risk. They would need to be contacted to prevent the disease from spreading further.
As I moved through the stages of grief, I had to face the realization that no matter how much I did, Dylan wasn't coming back. He was the innocent victim of dangerously low levels of awareness about the fact that pertussis is much more common than the public and even medical providers realize and many times adults spread the disease to children.
The only thing that could have saved him was preventing him from catching it!
Some facts I wish I new before Dylan was born:
The immunity from pertussis vaccinations received as a child wane after 10-12 years, so many adults no longer have immunity from the disease; 85% of cases are spread through household contacts; there is no effective treatment for pertussis, only supportive care; and newborns are helpless and make up the highest death rates- it takes just one breath to infect them!
Although grief and guilt plague my daily life, I have to forgive myself. I have to remember that I am a good mother and a good nurse. I have slowly found the courage to move on with my life. |
Sources: Harriman, Kathleeen " 2010 California Pertussis Update"
California Department of Public Health, Immunization Branch, June, 2010
American Academy of Pediatrics Red Book, 2009
San Mateo County Health System |
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In partnership, First 5 San Mateo County and the San Mateo County Health System have provided the information contained in this Health Bulletin.
For additional information about pertussis or to schedule a 20 minute presentation about the symptoms, treatment and prevention of spreading pertussis, contact Natasha Desai at
NDesai@co.sanmateo.ca.us or (650) 573-2009.
Though First 5 San Mateo County cannot formally endorse any professional or community resource, we hope that the information provided in this Health Bulletin will aid you in your own search. We encourage you to send us additional resources for possible inclusion in future updates. |
About First 5 San Mateo County
Research shows that a child's brain develops most dramatically in the first five years of life. Early childhood relationships and experiences profoundly influence brain development, affecting how well children do in school and beyond. Therefore, providing prevention and early intervention services for young children is one of the smartest investments that we can make. Decades of research prove that supporting children during their early years significantly reduces their need for more expensive interventions later on, such as special education, foster care, and criminal justice.
In 1998 California voters passed Proposition 10, which added a 50-cent tax on all tobacco products to fund early childhood education and development, health care, parent education and other programs that improved services for children from a prenatal stage through age five and thier families. In 2008-2009, First 5 San Mateo County received approximately 8.5 million dollars in Proposition 10 funds.
In 2008-2009, First 5 San Mateo County funded programs that served 16,316 children, parents and service providers: 5,346 children ages zero to five; 8,618 parents and expectant parents; and 2,352 providers of early childhood services such as preschool and health care.
For additional information about First 5 San Mateo County, contact Chonne Sherman, Communication
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