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Health Alerts: Pertussis

Snohomish County Health Alert: Pertussis
Sept. 21, 2011
from the Snohomish Health District

To Snohomish County health care providers:


Pertussis continues to circulate widely in Snohomish County. For 2011 to date (September 21), the Health district has had 80 laboratory-confirmed or epidemiologically-linked cases of pertussis reported. In contrast, for all of 2010, Snohomish County had only 25 cases and for 2009 only 33 cases. In part this reflects the medical community’s vigorous response to previous alerts, with testing for pertussis increasing significantly in 2011. However, in the past two months, three Snohomish County infants under one month of age have been diagnosed with pertussis; two have been hospitalized and one died. I consider this a serious public health issue. Although we should be striving to assure that everyone is vaccinated, the current situation demands that health care providers assure that all medical staff, pregnant women, and persons anticipating contact with infants be alert to symptoms of pertussis infection and be vaccinated with Tetanus/diphtheria/acellular pertussis (Tdap) vaccine.

Pertussis commonly presents as a mild upper respiratory illness with intermittent cough. Within weeks, the cough becomes paroxysmal and in young children is often followed by vomiting, whooping, or gasping. Older children and adults often have milder symptoms. Although infants are at high risk for severe disease and death, atypical presentation is common–cough may be absent and apnea may be the presenting symptom.

I urge providers caring for pregnant women to vaccinate pregnant women who have not had a Tdap booster. As I noted in my alert last month, this represents a change to current practice. However, at its June 2011 meeting, the CDC’s Advisory Committee on Immunization Practices (ACIP) issued the following recommendation (which I expect CDC will adopt soon):

Women’s health care providers should implement a Tdap vaccination program for pregnant women who previously have not received Tdap. Health care providers should administer Tdap during pregnancy, preferably during the third or late second trimester (after 20 weeks gestation). Alternatively, if not administered during pregnancy, Tdap should be administered immediately postpartum.

Tdap vaccine is appropriate for all adolescents and adults, as well as 7-10 year olds who are not fully vaccinated. It is especially important to vaccinate populations that may care for infants, such as family members (including grandparents) and child care staff, as this “cocooning” approach is the only way to protect vulnerable infants. If you have vaccine questions, please contact the Snohomish Health District Immunization Clinic at 425-339-5220.

Snohomish County Health Alert: Pertussis infant death
August 18, 2011
from the Snohomish Health District

To Snohomish County health care providers:


Physicians caring for pregnant women should be alert to potential pertussis infection and should consider vaccinating pregnant women who have not had a tetanus/diphtheria/acellular pertussis (Tdap) booster. This issue is timely because we have had a pertussis death locally and because the CDC’s Advisory Committee on Immunization Practices (ACIP) has just endorsed new recommendations for pregnancy.

A Snohomish County infant too young to be vaccinated has died of pertussis. The mother became symptomatic during the final month of pregnancy, but pertussis was not diagnosed until the infant became ill. The mother had received her full childhood immunization series; she received a Tdap post-partum. This case reminds all of us that pertussis should be considered whenever patients present with mild upper respiratory illness and intermittent cough. The case also raises questions about the optimal time to vaccinate pregnant women.

At its June 2011 meeting, the ACIP reviewed the evidence addressing when pregnant women should receive Tdap vaccine and issued the following recommendation:

Women’s health care providers should implement a Tdap vaccination program for pregnant women who previously have not received Tdap. Health care providers should administer Tdap during pregnancy, preferably during the third or late second trimester (after 20 weeks gestation). Alternatively, if not administered during pregnancy, Tdap should be administered immediately postpartum.

Although CDC has not yet formally adopted the ACIP recommendation, I expect CDC will do so soon. Although this represents off-label use, such use is legal. Because we have seen an increase in pertussis cases on the west coast this past year, I urge providers to consider implementing the ACIP recommendations immediately.

Tdap vaccine is appropriate for all adolescents and adults, as well as 7-10 year olds who are not fully vaccinated. It is especially important to vaccinate populations that may care for infants, such as grandparents and child care staff, as this “cocooning” approach is the only way to protect vulnerable infants. If you have vaccine questions, please contact the Snohomish Health District Immunization Clinic at 425-339-5220. 

Snohomish County Infant Dies of Whooping Cough (Everett Herald, August 18, 2011)