TAMPA — Warren McDougle laid down the law when his grandson, Ethan, was born three years ago. No adults could get near the infant unless they had been vaccinated against pertussis, the highly contagious bacterial infection also known as whooping cough.
"You have to do it," says McDougle, epidemiology program manager for the Hillsborough County Health Department. "Adults don't realize they carry diseases very young children can get. They may carry it and not realize it."
Once killing thousands of children a year, whooping cough had been in decline for decades due to the introduction of the vaccine in the 1940s. But now it's back on the rise, experts say, in large part because immunity fades unless adults get booster shots, and even symptomless carriers can pass the disease to babies and young children who aren't yet fully immunized.
Today, it's the most common vaccine-preventable disease in American children under the age of 5.
In 2000, just 48 cases were reported in Florida; last year, there were 497. In California, eight infants have died this year from pertussis because, health officials said, the cases weren't diagnosed until it was too late to treat them.
Between 2000 and 2008, there were 181 deaths in the United States from pertussis; 166 were babies less than 6 months old.
Hard to recognize
Pertussis can be tough to diagnose because the early symptoms — runny nose, sneezing and nasal congestion — are so similar to the common cold. What follows next — violent fits of coughing marked by the "whoop'' sound patients make when gasping for air — can make it difficult to catch a breath, eat and sleep.
The most serious cases can require hospitalization, where the child can be sedated to quell the coughing. Antibiotics can stop the infection, but whooping cough is immune to cough suppressant medication. It can take months to recover fully.
Because pertussis is so serious, most newborns are given the combination childhood vaccine known as DTaP (diphtheria, tetanus and pertussis) when they are just 8 weeks old. Several doses follow up to age 6, with the final booster given to Florida children right before they enter the seventh grade. Health departments give the vaccines to children for free; the fee for adults is around $45.
Booster shot helps
Many people think their childhood immunizations protect them for life.
But adults who got their shots in childhood can become infected with pertussis, and may just think they have a bad cold, or have no symptoms at all.
Yet they can unknowingly spread the disease to unprotected children — newborns who haven't begun the shots or children up to kindergarten age who haven't completed the five-dose series.
The Centers for Disease Control and Prevention recommends that adults up to age 65 get at least one dose of pertussis vaccine whenever they get a tetanus shot. "That's our best prevention method, to reimmunize adults against pertussis," McDougle says.
A second explanation for increased cases are parents who decide against having their children vaccinated. Children who are not immunized are 23 times more likely to get whooping cough, according to a study published last year in the journal Pediatrics.
Although vaccinations have a strong safety record, and there is no scientific link to autism, "a lot of people have a distrust of vaccines,'' lamented Dr. Patricia Ryder, director of disease control for the Pinellas County Health Department. "The more shots kids have to get, especially at one time, the more reluctant parents are to get them."
St. Petersburg pediatrician Lynne Ellis said that some parents ask to divide immunizations, thinking it's safer. "There's really no reason to do that,'' she said. "It just delays getting children the protection they need."
Far worse is declining them entirely. "The biggest problem is parents who refuse to have their children vaccinated because they believe the vaccine isn't safe or may cause autism,'' she said.
She agrees adults need boosters. "If the whole community gets immunized, the germ can't get through, we have herd immunity. Everyone gets protection."
Pertussis is easily transmitted, so a chance encounter in a store or at the park could do it. "You never know when you're going to be around babies and children," McDougle said.
"Get the vaccine. If you don't, don't go kissing and hugging babies."
Irene Maher may be reached at firstname.lastname@example.org.