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Pertussis booster important for household contacts
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Infants too young to be vaccinated are at high risk for pertussis-related death, according to results from a CDC study.
Researchers from two divisions of the Department of Health and Human Services identified several infant and maternal risk factors for pertussis-associated deaths early in life after performing a retrospective case-control study using data from the U.S. Multiple Cause of Death and Linked Birth/Infant Death databases.
“We found that the greatest risk of pertussis-related death was among infants too young to be vaccinated according to the current schedule,” Dana L. Haberling, MSPH, and other researchers wrote.
The researchers examined 91 pertussis-related infant deaths reported from 1999 through 2004. All infants were aged 7 months or younger at the time of death, with 58% aged younger than 2 months. The average annual infant mortality rate attributable to the disease was 3.8 per 1,000,000 live births, but for infants aged younger than 2 months, this rate jumped to 13.1 per 1,000,000 live births.
“Ensuring pertussis booster vaccination of adults and adolescents in close contact with an infant is warranted to prevent transmission of pertussis to vulnerable infants, particularly infants too young to be immunized,” the researchers wrote.
Independent risk factors included birth weight less than 2,500 g, female sex, Apgar scores less than 8 and maternal education less than 12 years.
Data also indicated the infant’s likelihood of pertussis mortality was increased for infants of Hispanic ethnicity, particularly among infants aged younger than 2 months, whose mortality rate was 2.6 times greater than the rate for similarly aged infants of non-Hispanic ethnicity. Citing U.S. Census Bureau statistics, the researchers speculated that this increased risk may be attributable to greater numbers of household contacts among Hispanic populations, increasing the opportunity for pertussis exposure and transmission.
Haberling D. Pediatr Infect Dis J. 2009;28:194-198.
This analysis of particularly high pertussis mortality in newborns reminds us that we must be much more proactive in three particular areas of our practices. First, we must insist that before the newborn leaves the hospital, the mother and father and all siblings have been vaccinated with tetanus toxoids, reduced diphtheria toxoids and acellular pertussis vaccine adsorbed (Tdap, Boostrix, Adacel) or diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (DTaP), or are at least up to date with their pertussis vaccine status. This should become a hospital mandate postpartum, and also part of the Joint Commission on the Accreditation of Healthcare Organization’s standards to give it some teeth.
Second, incorporate the two-month well check at six weeks, instead, to get DTaP administered as soon as possible. Third, every child and his family who refuses infant vaccines and continues to be seen in our offices must be considered highly contagious and a potential source of pertussis (measles, chickenpox, Haemophilus influenzae type b, etc). They should be quarantined from contact with all other infants and toddlers in our offices. As such, they should not be allowed into our well waiting rooms, ever. They should be whisked directly into an examination room immediately when they hit the office door, have no contact with any of our responsible patrons and completely discharged and billed only from the same exam room.
– Stan L. Block, MD
Professor, University of Kentucky Bardstown, Kentucky