A DOSE OF THE TDAP VACCINE IN THIRD TRIMESTER CAN PROTECT BABY FROM PERTUSSIS
I am four months pregnant and live in an area where there has been a pertussis outbreak. What's the best way to keep my newborn baby safe until he or she can get the vaccine?
The best way to prevent your baby from getting pertussis, also known as whooping cough, is for you, while you are pregnant, to get a dose of the tetanus, diphtheria and acellular pertussis booster, or Tdap, ideally between 27 and 36 weeks of pregnancy. A recent study showed that when pregnant women receive the vaccine, it dramatically increases newborns' immunity to pertussis — effectively protecting the infants until they start their own series of pertussis immunizations.
Pertussis is a highly contagious bacterial respiratory infection that causes a severe, hacking cough and other complications, such as pneumonia. The coughing spells can be followed by a high-pitched intake of breath that sounds like a whoop and gives the illness its name. Coughing spasms can cause extreme fatigue and vomiting, and make it hard to breathe. Severe coughing spells also can create small hemorrhages in the eyes and brain.
In babies, pertussis is often serious, because infants' airways are so small. Therefore, they may have trouble breathing during coughing spells. When newborns get pertussis, about half require care in a hospital due to serious complications. About 1 percent of infants who get pertussis die. It is crucial that young infants be protected from this potentially life-threatening condition.
In the past, it was thought that the only way to shield a newborn from pertussis was to keep him or her away from anyone who might have the infection until the baby had received the first series of pertussis shots given at 2, 4 and 6 months. Those vaccinations are still important. Ensure your child gets them on schedule. The pertussis vaccination is given in combination with tetanus and diphtheria vaccines. It's abbreviated as DTaP for diphtheria, tetanus and acellular pertussis, and is a different strength than the adult vaccine booster, which is abbreviated Tdap.
A recent study that included 150,000 infants showed clear health benefits for newborns when their mothers receive the Tdap vaccine during the third trimester. The research found that 90 percent of infants born to mothers who received the vaccine during pregnancy had full immunity against a pertussis infection during the first six months of their lives. That means the immunity the babies received from their mothers' vaccine during pregnancy served as an effective bridge until they received their newborn DTaP vaccinations. When a mother is not immunized, her baby is vulnerable to pertussis infection until the infant receives the full course of three vaccinations.
The Tdap vaccine is safe for pregnant women and their unborn babies. It does not raise your risk for complications during pregnancy. The vaccine does not contain any live bacteria, so you cannot get pertussis as a result of the vaccine. The most common side effects of the Tdap vaccine in adults are temporary tenderness, redness, swelling and pain at the site of the injection. Severe side effects from the Tdap vaccine are rare.
To maintain your child's immunity to pertussis as he or she grows, DTaP boosters are recommended at 12 to 18 months; 4 to 6 years; and again at age 11. A single pertussis booster shot is strongly recommended for all adolescents and adults, especially for anyone in close contact with infants, particularly during a pertussis outbreak. Women need to receive a pertussis booster vaccine with every pregnancy to protect the baby.
Talk to your health care provider about receiving a dose of the Tdap vaccine between 27 and 36 weeks of pregnancy. Do this regardless of when you last received a Tdap vaccine before your pregnancy. By getting your Tdap vaccine, you'll be protecting your infant from a serious illness.
Gregory Poland, M.D., Vaccine Research Group, Mayo Clinic, Rochester, Minn.
HELP MANAGE URINARY INCONTINENCE WITH BEHAVIORAL TREATMENT
For the past few years, I've noticed that when I cough or sneeze I sometimes leak a small amount of urine. Twice in the past month, I had this happen without warning. And, instead of it being a small leak, it was as if I had wet my pants. Is this a normal part of aging, or should I see my doctor? Can it be prevented? I am an otherwise healthy 57-year-old woman.
Urinary incontinence becomes more common with age, especially in women. But that doesn't mean you have to just put up with it. Instead, see your health care provider for an evaluation. In many cases, behavioral treatment, in which you learn techniques that help reduce incontinence, can control this condition.
Urinary incontinence is the loss of bladder control that results in accidental loss of urine. Women are twice as likely as men to suffer from it. Research conducted by the National Institutes of Health shows that between 25 and 45 percent of women have some degree of urinary incontinence. The frequency of this condition in women is due to various factors, including pregnancy, childbirth, menopause and the anatomy of the female urinary tract.
It sounds like you are actually experiencing two kinds of urinary incontinence. The first is called stress incontinence. It's triggered by stress placed on the bladder and pelvic floor. That can happen, as in your case, when you cough or sneeze. Running, jumping or other physical activity also can cause stress incontinence. Typically, stress incontinence results in slight to moderate urine leaks.
The second type is called urge incontinence. It's a sudden, intense urge to urinate, followed by an involuntary loss of urine. It's caused by bladder muscle contractions. Urge incontinence usually results in more significant urine loss than stress incontinence. Whereas stress incontinence often can be anticipated based on a person's activity, urge incontinence is more random and difficult to predict. That can make it much more disruptive to your day-to-day activities.
There are ways to regain control of your bladder. One of the most effective is learning pelvic floor muscle exercises to strengthen the muscles that regulate urination. The exercises differ somewhat for stress incontinence and urge incontinence. Your health care provider can instruct you on how to do the exercises and how often to do them, based on your individual symptoms.
Other behavioral techniques that may be useful, depending on your specific circumstances, include bladder training, in which you delay urination after you get the urge to go, scheduled toilet trips and fluid and diet management.
When you see your health care provider, he or she may ask you to keep a record of your fluid intake and urination for several days. This information can help your health care provider diagnosis incontinence and pinpoint its cause.
Studies have found that 60 to 75 percent of women who have urinary incontinence can control the condition using behavioral treatment. When that's not enough, however, there are medications and other treatment options, including surgery, that can be used to treat urinary incontinence.
Make an appointment to see your health care provider and talk about your symptoms. In many cases, urinary incontinence can be managed such that it doesn't interfere with daily life.
Deborah Lightner, M.D., Urology, Mayo Clinic, Rochester, Minn.
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