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Whooping Cough Rise Underscores the Need for Up-to-Date Vaccines

By Sam Smith, MD, Surgeon in Chief, Arkansas Children's Hospital

When I first graduated medical school, it was hard to imagine that the United States would see a resurgence of some of the diseases we had nearly stamped out thanks to the modern miracle of vaccines. Think polio, measles and whooping cough.

Early in my residency, we rarely saw cases of these diseases because the vaccines against them were easy to acquire and worked well, especially by providing herd immunity. But somewhere in the early 2000s, parents became more and more suspicious of vaccinations – despite the rigorous research that proved them safe and effective. This led to more people opting out of vaccines, leaving fewer children protected against deadly diseases like whooping cough, also known as pertussis.

In 2010, California saw the largest outbreak of whooping cough since the 1940s, infecting more than 9,100 people and killing 10 infants. Children and newborns are especially susceptible to pertussis because it causes severe breathing problems.

Research published earlier this fall in Pediatrics, the journal of the American Academy of Pediatrics (AAP), showed that the California outbreak was tied to clusters of unvaccinated kids, mostly those whose parents had requested non-medical exemptions so their children wouldn't have to take the vaccine. The research showed that those living in places where lots of people opted out of vaccines were 2.5 times as likely to be in area with an exceptionally large share of pertussis cases.

This shows a very strong link between opting out of vaccines and the rise of whooping cough.

How does this affect Arkansas? Directly. Our state lags behind the national average in compliance with vaccines, as just 63.9 percent of children between 19 and 35 months of age were on target with the vaccination schedule between 2008 and 2009, according to the Centers for Disease Control (CDC) and Prevention.

We know that many of the children in Arkansas schools who are not fully vaccinated received "philosophical exemptions" from the requirements to enroll – much like those in the California outbreak. Between 2009 and 2010, more than 2,700 Arkansas children went unvaccinated in public schools. According to the report Natural Wonders: The State of Children's Health in Arkansas, children who are exempted from vaccines are six times more likely to contract whooping cough.

Have you ever heard a young child with whopping cough struggle to breathe? It is one of the most heart-breaking sounds imaginable. They make this rattling whoop and gasp over and over again, trying as hard as they can to get air into their little lungs. Their terrible coughs also scatter pertussis bacteria into the air, making it easier for others who aren't protected to also become infected.

Children who come down with whooping cough will likely have lengthy hospital stays and have to take strong courses of antibiotics, though they may not be as effective if the disease isn't caught early.

Whooping cough can also be difficult for adults. I had it several years ago – during an ice storm when our home was out of power. There is nothing worse than being stuck in a cold room with that kind of lingering, nearly violent cough. Adults who contract pertussis will cough hard for at least a month.

We all have a responsibility to protect each other by taking the vaccines against whooping cough and other diseases that can be fatal. Decades ago, when a physician instructed a patient to undergo a preventative measure like a vaccine, there was little argument. Our culture has changed with the vast amount of information available today, and people want to do their own research. There is nothing wrong with satisfying that curiosity, but people need to be careful about where they turn for reliable information.

Do not listen to celebrity spokespeople and be wary of websites that have an agenda. Turn instead to more objective data-based resources, like the CDC, AAP and the Food and Drug Administration (FDA). Each of these organizations has a commitment to protecting patients and provides volumes of information to back up the safety and reliability of vaccines.

Ask your physician about the timelines for the pertussis vaccination. Infants should take the DTap shot, which also protects against diphtheria and tetanus, at 2, 4 and 6 months of age, again at 15 and 18 months, and at some point between their fourth and sixth birthdays. There are additional recommendations to protect older children who did not receive the full vaccine schedule early on. In addition, adults should take a Tdap booster every 10 years, according to the CDC.

Physicians will also instruct women to take an updated Tdap vaccine during each pregnancy, between 27 and 36 weeks gestation. This transfers pertussis antibodies to the baby before he or she is born, providing crucial protection against whooping cough in the early weeks of life before babies can take vaccines.

We hope that the coming years will bring greater understanding of the safety of vaccines, resulting in fewer cases of diseases like whooping cough. Wouldn't it be great to eliminate one more worry for our kids?

Sam Smith, MD, is surgeon in chief at Arkansas Children's Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids' medical concerns. If you have a topic you'd like him to consider addressing, email achconnect@archildrens.org.

Arkansas Children's Hospital
1 Children's Way
Little Rock, AR 72202-3591

Call: 501-364-1100

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