24 August 2012

PERTUSSIS: A new outbreak in the US Raises Concerns



Pertussis or whooping cough was once one of the most common childhood diseases and a major cause of death, particularly in young children. A generation ago the disease was placed on the back burner in developed nations, mainly because high immunization rates had markedly lowered the incidence.  Unfortunately the disease continued to be a major problem in developing countries.  In s spite of a massive worldwide immunization push by the World Health organization beginning in 2000, the disease remains endemic in many countries, resulting in 20,000,000 cases each year, and an estimated 200,000 deaths, mainly in small infants.
Another problem that has surfaced recently is the marked increase in the number of pertussis cases in the US and Europe.  Several factors have contributed to this resurgence, including waning immunity in older adults, and concerns about the toxicity of the previously used vaccine.  The new acellular pertussis vaccine, often given as TDAP, which includes tetanus and diphtheria, is much less toxic than the older vaccine, and can be given safely to older children and adults.  However it is somewhat less immunogenic, so the protection is not as complete and is not as long lasting.  This situation has definite implications for volunteers in mission.  If we are not protected as adults, we are at definite risk for contracting this serious and potentially life threatening disease when we serve in locations where pertussis is endemic.  We are also at risk for passing pertussis to our family and other contacts when we return.  The Center for Disease Control warns that all travelers to developing countries must protect themselves and others by obtaining a TdAP booster.  In fact, considering the significant risk and the recent epidemics of pertussis in the US and Europe, all of us, even the homebodies, should receive the vaccine.
    Submitted by Roger Boe MD
            

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