Pertussis (again) and RSV: What You Need to Know

(Some of this is a re-run from a few months ago, but bear with me… it’s still good information!)

Whooping cough, more formally know as pertussis, has been on the rise on the West Coast for the last few years. This has garnered a lot of media attention, including segments on national television news shows as well as local newspaper articles… and a lot of corresponding parental anxiety.

It’s important to take home a couple of facts from this that go beyond just recognizing that this is a serious illness. First of all, pertussis is preventable, and the rising cases are due to decreasing immunization rates in California, Washington, and Oregon. The vaccine for whooping cough is part of the regular recommended vaccine schedule and is given starting at two months of age. There are virtually no medical contraindications to receiving this vaccine; even tiny premature infants can have it right on schedule. The very best way to protect your growing family is to get those immunizations on time, on the recommended schedule.

Secondly, the most vulnerable patients are the very young babies who are either too young to have received any pertussis vaccine or are only old enough to have received a couple of doses. Studies have shown that about a third of cases of infant pertussis are from the parents; sadly (this is data that precedes use of the booster in adults) another third were caused by infections from health care workers. So that’s the logic behind vaccinating adolescents and adults as well. Tdap vaccine is given as a booster now for tetanus but also stimulates the immune system to ‘remember’ the childhood pertussis vaccine series. We give it starting at about 11 years old, but it is also strongly recommended for any adult who is planning to be around a small baby. So it should be given to new parents, grandparents, child care workers, health care workers … anyone who will care for our tiniest patients. The AAP refers to this strategy as forming a ‘cocoon’ of protection around the baby.

Before your baby is born, and certainly before you take your new little bundle of joy home, plan to get everyone in the family immunized for pertussis. Check with your PCP to see if you have had this crucial vaccine and ask for it if the answer is ‘no’ or ‘we’re not sure’. If your PCP doesn’t offer vaccines to adults, most area pharmacies can provide immunizations as well. Protect that new baby — whether that baby is your child, grandchild, or honorary nephew or niece. Don’t end up as the parent on a national news story, telling of your baby’s near-miss with whooping cough.

The other infection you will hear a lot about during your baby’s first winter is our old adversary respiratory syncytial virus, or RSV. This virus is widespread in the community during winter and early spring. While cases can be identified all year round, we usually start to see it become a major player in January with a peak in late February/early March. It then usually tapers off during April and fades back into obscurity for another year by May.

RSV can infect anyone, but adults and older children who catch it will feel as if they have a bad cold. They will get a cough, runny nose, congestion, and perhaps fever. They may not feel ill enough to stay home from school or work, which of course helps this virus spread around the community. Like other respiratory viruses, RSV is spread by all of those droplets that we spray out when we cough and sneeze. It can live on our hands and on the surfaces we touch for long enough to infect the next person who comes along to touch them. It is killed by soap and water, hand sanitizers, and cleaning sprays such as Lysol or similar products.

For small babies, and even toddlers, RSV can be a real menace. In general, the younger and smaller the baby, the higher the risk of serious respiratory disease. Babies with RSV may produce copious amounts of nasal mucus, enough to interfere with their breathing. They may experience wheezing, rapid breathing, and constant coughing. When this set of symptoms occurs, we refer to the whole package as ‘bronchiolitis’. Bronchioles are the tiniest branches of the breathing tubes in the lungs, and in bronchiolitis they are narrowed and clogged with mucus. This is different from the ‘bronchitis’ that adults get, which is usually a chronic productive cough caused by smoking or by other viruses (rarely bacteria, despite the fact that so many adults are given antibiotics for it). Very young infants can have apnea (pauses in breathing) as a symptom of RSV bronchiolitis.

RSV bronchiolitis is treated by supportive care. Mild cases and those in older infants and toddlers can usually be cared for at home, with nasal suctioning, extra fluids, and close follow-up by the physician. More serious cases are admitted for oxygen and IV fluids. There aren’t really any medications that reliably help with bronchiolitis, although the medicines that are bronchodilators (open up the bigger breathing tubes in the lungs) are often tried. Every year in our community, a few infants with RSV get very sick and have to be transferred to facilities such as OHSU/Doernbecher or Legacy Randall Childrens’ Hospital for more advanced care.

There is, as of yet, no vaccine to prevent RSV by the process of active immunization (forcing the body to form an immune response; the usual way vaccines protect children against diseases). There is a form of passive immunization, which is a product known as Synagis or palivizumab. This is an artificially produced antibody to RSV, which is given by monthly injections during the RSV season. It cannot produce a long-lasting immunity but can help protect the most vulnerable babies for short periods of time. It is usually given to very premature infants, those with significant congenital heart disease, or infants with chronic lung disease resulting from prematurity. If you have a premature infant in the NICU, your baby’s physician or NNP will discuss whether or not this product is indicated in your baby’s case.

The best way to prevent RSV is by limiting your baby’s exposure to viruses. Everyone in the family should learn and practice good hand-washing; alcohol-based hand sanitizers are also fast and useful. Older siblings should not be allowed to touch the new baby until they have learned these skills and should be kept strictly away if they develop cold symptoms. Parents who develop a cold should wash their hands regularly, touch the baby as little as possible, enlist the help of non-ill family members to help, and should consider wearing a mask around the baby. And during the peak months, it’s really best to stay close to home with your new infant. If you must go out into crowded places, keep your infant in the carrier and don’t be afraid to loom protectively over your baby, brandishing your hand sanitizer to all who might come near!


Whooping cough is on the rise

Pertussis is bacteria that causes whooping cough. It is prevented through vaccination begun at two months of age. Until recently the last booster was given around time of entry to kindergarten. In 2005 a new booster (TdaP) was made available that can be given for middle schoolers and up, including adults.

Some areas of the country have noticed large increases in the number cases, especially in areas of decreased use of vaccination. This has been most striking in the last year in areas of Northern California and Southern Oregon. Marion County data for last year was just released and we are seeing an increase as well. In 2010 there were about 30 confirmed cases which is double 2009 numbers.

Pertussis vaccine is recommended at 2 months, 4 months, 6 months and 12-18 months old. There is a booster given at 4-5 years old. Middle school pertussis booster (TdaP) is routinely recommended at age 11 years old and then repeated every 10 years. Call our office to confirm that your child is up to date on recommended vaccines.

One group we sometimes forget about is parents of young children. Adults get pertussis very easily and then spread it to young children. It is young children who are most likely to be hospitalized or die from pertussis so close contacts should get vaccinated. Discuss with your doctor if you are unsure if you have been protected against pertussis.

To learn more visit CDC Pertussis page.