A: Since the early s, there has been an overall trend of an increase in reported pertussis cases. Pertussis is naturally cyclic in nature, with peaks in disease every 3 to 5 years.
But for the past few decades, peaks got higher and overall case counts went up. There are several reasons that could help explain why CDC is seeing more cases. These include:. The bacteria that cause pertussis are also always changing at a genetic level. Research is underway to determine if any of the changes are having an impact on public health. However, the latest studies suggest that pertussis vaccines continue to be effective despite recent genetic changes. When it comes to waning immunity, it seems that the acellular pertussis vaccines DTaP and Tdap used now may not protect for as long as the whole cell vaccine DTP doctors used to use.
Whole cell pertussis vaccines are associated with higher rates of minor and temporary side effects such as fever and pain and swelling at the injection site.
Serious neurologic adverse reactions, including chronic neurological problems, occurred rarely among children who had recently received whole cell vaccines. Studies have inconsistent results about whether the vaccine could cause chronic neurological problems. However, public concern in the United States and other countries led to a concerted effort to develop a vaccine with improved safety.
Due to these concerns, along with the availability of a safe and effective acellular vaccine, the United States switched to acellular pertussis vaccines DTaP.
A: You can make sure you and your loved ones are up to date with recommended pertussis vaccines. There are two types of pertussis vaccines — DTaP for babies and young children and Tdap for preteens, teens, and adults. Getting vaccinated with Tdap during every pregnancy is especially important for women. Also, caregivers of babies should keep them away from anyone with cough or cold symptoms.
A: No, but those traveling to an area with a pertussis outbreak should make sure they are up to date on their pertussis vaccines. People who did not get all the recommended pertussis vaccines, including babies too young to be vaccinated, are putting themselves at risk for catching pertussis. However, their parents are putting them at greater risk of getting a serious pertussis infection and then possibly spreading it to other family or community members.
We often see people blaming pertussis outbreaks on people coming to the United States from other countries. This is not the case. Plus, every country vaccinates against pertussis. In general, pertussis starts off with cold-like symptoms and maybe a mild cough or fever.
But after 1 to 2 weeks, severe coughing can begin. The pertussis vaccination is given in combination with tetanus and diphtheria vaccines. It's called tetanus diphtheria and acellular pertussis booster and is abbreviated as Tdap. Even if you've had the vaccine before, you may need it again to increase the protection that you had from an earlier dose. After a week or two, a pertussis infection usually leads to a cough. Signs and symptoms that point to a pertussis infection include coughing that lasts longer than two weeks and gets worse over time; long coughing fits that may lead to vomiting or near-vomiting; and coughing attacks followed by a sudden, deep inhalation — making a "whoop" sound as you catch your breath after coughing.
Not every cough means you have pertussis. And not every case of pertussis has a cough or the telltale "whoop" sound after a cough. Pertussis starts with coldlike signs and symptoms that could include a runny or stuffy nose, sneezing, a sore throat, or a mild fever.
Another sign of pertussis is feeling exhausted after coughing. The hacking cough during a pertussis infection can be so severe in older adults that it can lead to a fractured rib. Does this include half doses? Half doses of DTaP are also not recommended under any circumstances, and should not be counted as part of the vaccination series. Only documented doses i. Remember that the minimum age for DTaP 5 is age 4 years. If the child has not received all of the age-appropriate doses of pertussis-containing vaccine, it would be best to try to administer as many doses of DTaP as possible before the child reaches his 7th birthday in order to confer protection against pertussis.
Then, give additional doses with 6-month intervals, not to exceed 6 total doses of diphtheria- and tetanus-containing vaccine by the child's 7th birthday. Are there data that state these should not be given concomitantly? A CDC study has shown a small increased risk for febrile seizures during the 24 hours after a child receives the inactivated influenza vaccine at the same time as the PCV13 vaccine or DTaP vaccine.
However, the risk of febrile seizure with any combination of these vaccines is small and ACIP recommends giving these vaccines at the same visit if indicated. As with all vaccines, a severe allergic reaction e.
A history of encephalopathy within 7 days of receiving a previous pertussis-containing vaccine that is not due to another identifiable cause is a contraindication to both DTaP and Tdap. For the pertussis-containing vaccines DTaP and Tdap an additional precaution is a progressive or unstable neurologic disorder, including infantile spasms, uncontrolled seizures or progressive encephalopathy.
DTaP and Tdap should be deferred until the neurologic status of the patient is clarified and stabilized. Is it acceptable to give breastfeeding mothers Tdap vaccine?
Women who have never received Tdap and who did not receive it during pregnancy should receive it immediately postpartum or as soon as possible thereafter. Breastfeeding does not decrease the immune response to routine childhood vaccines and is not a contraindication for any vaccine except smallpox.
Breastfeeding is a precaution for yellow fever vaccine and the vaccine can be given for travel when indicated. Tdap is an inactivated vaccine and may be given at the same prenatal visit with RhoGam. Mom comes in with her month-old. A family history of a neurologic disorder or reaction to a pertussis-containing vaccine is not a contraindication to vaccination of this child.
The child should receive additional DTaP doses as indicated in the catchup schedule. Can an adult receive Tdap if they had a contraindication or precaution to DTaP as a child? Probably, but this depends on the contraindication or precaution the person had to DTaP. The contraindications are 1 severe allergic reaction e. I have an adult patient with controlled epilepsy who wishes to receive the Tdap vaccine. May I vaccinate him? Controlled epilepsy is not a contraindication to receipt of Tdap.
To access IAC's table of vaccine contraindications and precautions, go to www. CDC also makes this information available at www. Can we give further doses of DTaP to an infant who had an afebrile seizure within 3 hours of a previous dose?
An infant who experiences an afebrile seizure following a dose of DTaP requires further evaluation. An infant with a recent seizure or an evolving neurologic condition should not receive further doses of DTaP or DT until the condition has been evaluated and stabilized. Other indicated vaccines may be administered on schedule. To assure that the child is at least protected against tetanus and diphtheria, the decision to give either DTaP or DT should be made no later than the first birthday.
Is there guidance for pertussis protection for an adult who cannot receive the tetanus portion of the Tdap vaccine because of allergy? Usually, an "allergy" to tetanus toxoid is anecdotal and not a true anaphylactic reaction to modern tetanus toxoid.
Patients often claim to be allergic to tetanus toxoid because of 1 an exaggerated local reaction which is not an allergy or 2 a reaction to a tetanus vaccine received many years ago probably serum sickness from equine tetanus antitoxin. A history of one of these events is not a contraindication to modern tetanus toxoid, Td, or Tdap. Only an allergist-confirmed severe allergy e. A person who has an allergist-confirmed anaphylactic allergy to tetanus toxoid has no recourse for pertussis vaccination because no single-antigen pertussis vaccine is licensed for use in the United States.
Does tetanus toxoid contain horse serum? Tetanus toxoid has never contained horse serum or protein. Equine tetanus antitoxin horse derived was the only product available for the prevention of tetanus prior to the development of tetanus toxoid in the s. Equine antitoxin was also used for passive post-exposure prophylaxis of tetanus e. Equine tetanus antitoxin has not been available in the U.
Tetanus and Wound Management Back to top What is the dosing for tetanus immune globulin for an adult with suspected tetanus? Although the optimal therapeutic dose has not been established, experts recommend international units IU , which appears to be as effective as higher doses ranging from 3, to 6, IU and causes less discomfort. Available preparations must be administered intramuscularly; TIG preparations available in the United States are not licensed or formulated for intrathecal or intravenous use.
Infiltration of part of the dose locally around the wound is usually recommended if feasible, although the efficacy of this approach has not been proven. In addition, anti- tetanus antibody content varies from lot to lot. When a patient seen in the ER needs tetanus protection, which type of tetanus vaccine should be given?
Otherwise they may receive Td or Tdap. If additional doses are necessary for full tetanus protection, they may be administered as Td or Tdap. Adolescents, and adults age 11 years and older should receive a single dose of Tdap, if they have not received a dose of Tdap after the 11th birthday, otherwise they may receive Td or Tdap. If a person gets a puncture wound or laceration on Friday night, does the person need to receive tetanus wound management that night or can it wait until Monday?
ACIP has not addressed this issue specifically. Puncture wounds, however, should be attended to as soon as possible. The decision to delay a booster dose of tetanus toxoid-containing vaccine following an injury should be based on the nature of the injury and likelihood that the injured person is susceptible to tetanus. The more likely the person is to be susceptible, the more quickly that tetanus prophylaxis should be administered. A person with a tetanus-prone wound e. A person with a documented series of at least three tetanus toxoid-containing products, with a booster dose within the previous 10 years ago is less likely to be susceptible to tetanus, and the need for a booster dose is not as urgent, particularly if the wound can be thoroughly cleaned.
The more likely a person is to be completely susceptible to tetanus i. If an adult patient is receiving a tetanus-containing vaccine after an injury and there is no history of any prior tetanus vaccine e. Also, what is the time frame that the tetanus toxoid needs to be given following an injury? One dose of tetanus toxoid-containing vaccine Tdap or Td provides little or no protection. That is why tetanus immune globulin TIG is also recommended in this situation.
As far as timing, the toxoid and TIG should be given as soon as possible. When should tetanus immune globulin TIG be administered as part of wound management? TIG should be given as soon as possible after the injury. How long after a wound occurs is tetanus immune globulin no longer recommended?
In the opinion of the tetanus experts at the CDC, for a person who has been vaccinated but is not up to date, there is probably little benefit in giving TIG more than a week or so after the injury. For a person believed to be completely unvaccinated, it is suggested to increase this interval to 3 weeks i. Td or Tdap should be given concurrently.
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Screening for Contraindications. A 4-fold increase in anti-PT IgG with 4—6-week intervals is probably the most reliable serologic test [ 6 ]. Notably, as happened in the presented case, leukocytosis is generally uncommon in adolescents, adults, and partially immunized children and even in the absence of it, the diagnosis of pertussis should not be excluded [ 16 ].
Antibiotic agents of choice for pertussis treatment are macrolides, such as erythromycin, clarithromycin, and azithromycin. Appropriate antibiotic treatment can eliminate Bordetella pertussis from the respiratory tract and, consequently, prevent transmission to susceptible contacts. Furthermore, it has been proved that antibiotics decrease the probability of secondary bacterial infections and reduce duration and severity of symptoms, when given early in the course of the disease [ 17 ].
Unfortunately, we were not able to document the exact timing of antibiotic treatment. Still, it has been suggested in the literature that macrolides administration can weaken the subsequent immune response to infections, if given early during the course of the disease [ 18 ]. Newborns are vulnerable to infection during the first weeks of their life, given that the quantity of maternal antibodies transferred is, in most cases, insufficient to provide protection [ 11 ].
Tdap boost vaccination for subjects older than 11 years is an effective prevention strategy and, therefore, should not be omitted. Similar symptoms can be caused by other pathogens, as well, including adenoviruses, respiratory syncytial viruses RSV , human parainfluenza viruses, influenza viruses, Mycoplasma pneumonia , and rhinoviruses [ 9 ].
Coinfections, particularly with Bordetella pertussis and RSV, are commonly seen among infants [ 13 ]. In adult patients, it is essential that the differential diagnosis of persistent cough should include primary and secondary pulmonary malignancies, and imaging with X-ray or Computed Tomography CT of the chest must be accordingly performed in these cases [ 21 ]. This report aims to highlight the fact that pertussis is not only a disease of the childhood, but it should be also suspected in adults, presenting with chronic cough, even if they do have a previous history of natural infection or vaccination.
The authors declare that there are no conflicts of interest regarding the publication of this paper. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.
Read the winning articles. Journal overview. Academic Editor: Julian Thomas. Received 12 Apr Revised 08 Jun Accepted 13 Jun Published 13 Jul Abstract Pertussis is traditionally considered as a disease of the childhood; however, accumulating evidence suggests a stable increase of its incidence among adults and adolescents, during the last decades.
Introduction Pertussis also known as whooping cough is a respiratory tract infection, caused mainly by the gram-negative, aerobic, pathogenic, encapsulated coccobacillus Bordetella pertussis. Case Presentation A year-old female patient presented with complaints of prolonged, paroxysmal cough for the last 4 weeks. Table 1. Notably, leukocytosis is generally uncommon in adults and even in the absence of it, the diagnosis of pertussis should not be excluded.
Figure 1.