American Nurse Today…Online reported on the nationwide pertussis, or whooping cough, outbreak in June. Unfortunately, four months later, the updated news is not good.
In California, where the outbreak is most severe, health officials reported that as of Oct. 5, there have been 5,272 confirmed, probable, and suspected cases of pertussis. Analysis of that statistic reveals that one in 7,500 people in California have potentially had pertussis, and this represents the highest incidence rate in the state since 1959. There have been nine deaths, all in babies less than two months of age — an age too young to be vaccinated. Eight of the nine babies were Hispanic. By the same time last year, the Centers for Disease Control and Prevention (CDC) had reported just 143 cases, and only 394 cases in all of 2008.
But the severe uptick in cases is not limited to California. According to the CDC, as of September 25, there has been a two-fold increase in pertussis when compared to historical data.
In 2009, the same assessment graph by the CDC showed a 0.5 decrease in incidence.
The data is also startling for other states – there have been 353 cases in New York, 505 cases in Indiana, 269 cases in South Carolina, 1,923 in Texas, and 270 in Washington. Almost every state has experienced an increase in cases over 2009. Outbreaks are even occurring internationally.
Nurses have an important role to play in curbing this unsettling resurgence of such a dangerous and burdensome disease. (For a reminder of what a child with pertussis sounds like, listen to a clip here.) Of course, nurses are primary educators on the importance of vaccines, and administer a major proportion of vaccines to children and adults. But the target for pertussis vaccines, in addition to infants and children, must be adolescents and adults. As reported by the CDC, as many as 75% of cases are transmitted by a close contact with the infants, and of those cases, 55% were parent-to-child transmissions. Nurses, especially those caring for pregnant and post-partum women and families, should offer Tdap vaccine (the form of pertussis vaccine for adolescents and adults). Tdap is an evidence-based approach to curbing outbreaks, as demonstrated in a school outbreak in the U.S. Virgin Island in 2007.
Nurses can even explore implementing standing order protocols in their unit or clinic – there are templates available from the Immunization Action Coalition for adults and adolescents. The importance of vaccination should be stressed at prenatal and new parent classes, as well as part of pre-conception and wellness education.
But, as with any vaccine, it’s important for nurses to be vaccinated to protect themselves and their patients. Tdap should replace the Td vaccine in the routine vaccination schedule for adults (Q10 years), or be given sooner if the nurse has or will have close contact with newborns and infants (for example, labor and delivery nurses, NICU nurses, and pediatric clinic nurses).
A county in New York is taking a very active step in offering vaccine to health care workers. According to Mary Beth Petraco, DNP, MS, PNP-MS, CPNP, child health coordinator for the Suffolk County Health Department, and a vaccine expert and member of the American Nurses Association’s (ANA) Bringing Immunity to Every Community advisory group, her county plans to provide free vaccine to any health care provider with patient contact.
“Our commissioner decided that as [the leader of] a public health agency, she wanted to not just protect our providers from pertussis, but to be an example to other health care providers in the community,” Petraco said.
And nurses get pertussis, too. A recent published study explored transmission of pertussis from an infected patient to oncology nurses in the United Kingdom. Petraco said a maternity nurse in her area recently developed pertussis.
“I hope this is a wake up call for this and all hospitals in our area to offer no cost Tdap vaccine to their staffs,” she said.
The outbreaks have also been serious enough for the CDC to examine the current vaccine recommendations around use of Tdap vaccine. Specifically, there are two confusing aspects to the current recommendations. The first is that Tdap vaccine is only licensed for children over the age of 10, and adults younger than 65. That leaves a gap in coverage for children ages 7 to 10 that need tetanus-diptheria vaccine, as well as older adults. In addition, there is a somewhat ambiguous recommendation that a two-year interval be observed between Td vaccine and Tdap, to avoid local reactions (i.e. soreness at the injection site). The working group of the CDC’s Advisory Committee on Immunization Practices (ACIP) has begun reviewing the literature to determine whether there is evidence to address these two issues, such as this study on local reactions after Tdap within two years of Td. At the ACIP meeting on October 27, the workgroup will present its findings, and most likely propose that ACIP recommend use of Tdap in all ages, and eliminate the need for an interval. ANA is a seated liaison member to ACIP and will be attending and Twittering, but nurses can also watch the live ACIP meeting via webcast.
Pertussis is more than just a bad cold. It causes serious illness, spasms of uncontrollable coughing, and is killing vulnerable infants. Vaccine hesitancy and waning immunity in adults are both being named culprits in allowing serious national outbreaks like this one. Nurses are vital to helping to curb the outbreak and prevent future ones through vaccination. We thank you in Bringing Immunity to Every Community, and so do families like this one.
Katie Brewer is a senior policy analyst at ANA.