Pertussis can be prevented by giving the Tdap vaccine to adults


by Joyce Frieden

A recent report from the CDC found that not enough adults were getting their tetanus booster — specifically, their tetanus, diphtheria, and acellular pertussis (Tdap) booster shot. Overall, the report found that more than a third of adult patients (36.5%) were overdue on these booster shots.

Although the report focused on the tetanus part of the vaccine, the editors of the Morbidity and Mortality Weekly Report, where the figures were published, noted that the pertussis part of Tdap was equally important for adults, especially since healthcare workers and adults who care for infants are at increased risk of transmitting pertussis. Yet only about 5% of adults in the general population and 16% of healthcare workers received Tdap in 2008, the researchers said.

And pertussis is actually much more common than tetanus: although there were only 19 reported cases of tetanus in 2008, there were 13,278 pertussis cases reported in that same year.

I was talking about this study the other day with my sister, an infection preventionist in Phoenix, Ariz. She said that in her former life as a disease surveillance nurse for her local public health department, vaccinating adults for pertussis was rarely done, even though adults also can get very sick from the disease.

In one particular case she remembered, this led to serious consequences: when an unvaccinated sickle-cell patient who was also the father of a 12-year-old with pertussis did not receive prophylactic erythromycin, he came down with pertussis and, during coughing spasms, went into sickle cell crisis several times, requiring hospitalization.  The crisis was caused by the decrease in oxygen levels in the blood during the coughing fits.

My sister admitted that this incident had taken place about 15 years ago, and she thought that today there was greater understanding among primary care physicians that adults can contract pertussis (my sister is nothing if not a perpetual optimist). I certainly hope she is right.

What has your experience been? If you are a primary care physician, do you talk to your patients about getting a Tdap booster? If you are a specialist, do you know whether your patients have had the vaccine? And a question for all healthcare professionals: Is your practice or hospital encouraging or requiring the booster shot?

Joyce Frieden is a MedPage Today News Editor and blogs at In Other Words, the MedPage Today staff blog.

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