Written by Christina Moore, Edited by Nancy Pham
Coughing spells at night, vomiting after dinner, and severe fatigue – not symptoms usually associated with a healthy high school freshman. No medical diagnosis could be offered, so the family practitioner prescribed nausea medication to decrease the vomiting, but the fatigue continued and the coughing spells lasted for months.
Fast forward eight years later: “The symptoms of whooping cough are coughing fits, fatigue, and vomiting. Preteens, teens, adults, and those already immunized, are usually asymptomatic or have mild symptoms that often go undiagnosed,” the professor explained. A light bulb went off in my head as I reflected on my high school experience and came to the conclusion that the likely culprit was “whooping cough”, or pertussis, an infection caused by Bordetella pertussis bacteria. I combed through my immunization records to confirm that I had been vaccinated with DTP, a vaccine for diphtheria, tetanus, and pertussis.
If I was vaccinated as a child, how did I end up getting pertussis as a teen?
Based on the CDC pertussis website, I learned that the vaccine does not protect for life, which means there is a chance of getting pertussis when immunity from the vaccine wears off – a phenomena known as waning immunity. Furthermore, in the last few decades there have been changes to the vaccine type administered and pertussis vaccine recommendations. First, the whole-cell DTP vaccine I received as a child is no longer recommended in the United States. In 1991, DTP was replaced by the acellular DTaP vaccine after public concern of DTP side effects[i]. The current DTaP recommendations consist of five shots at: 2, 4, and 6 months of age, between 15-18 months, and at school age between 4-6 years of age.[ii] Secondly, studies have shown that there is waning immunity after the fifth dose of DTaP[iii], thus requiring TDaP boosters to “boost” immune response to tetanus, diphtheria, and pertussis.
I had not received a booster for TDaP, which may explain why I suffered from pertussis as a teen. What are the other effects of waning immunity?
Although teens and adults are often asymptomatic or have mild symptoms that resolve without treatment, the TDaP booster is extremely important in lowering the likelihood of transmission to more vulnerable populations. The most vulnerable population is infants less than one year of age whom can suffer from severe symptoms like violent coughing fits that lead to gasping of air, resulting in the “whooping” sound, as well as vomiting, fatigue, and temporary absence of breathing. Due to severity of the pertussis disease, about 50% of children less than a year of age are hospitalized and about 1.6% of hospitalized children die [iv].
My pertussis episode taught me that it is important to keep an up-to-date immunization record, not only to protect myself, but also to protect others. Thankfully, I did not have contact with any infants or young children while I had pertussis, and have since received a TDaP booster. Let’s not forget: It is important to do our part in protecting ourselves and infants by consulting with our physicians about current vaccinations.
The current TDaP booster recommendations are as follows:
- TDaP boosters for preteen, teens, and adults including 65 and older[v]; especially those who have contact with infants and young children.
- TDaP boosters for adults with no history of a TDaP booster.
- TDaP booster for mothers-to-be between 27-36 weeks of pregnancy since mother’s antibodies can be transferred to the infant and protect them.
If you have more questions about pertussis, check out the CDC’s FAQs page. Additionally, the CDC has a fun and adorable “Protect Babies from Whooping Cough” infographic that you can check out here.
Updated Recommendation for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine in Adults 65 Years and Older – Advisory Committee on Immunization Practices (ACIP), 2012. MMWR 2012;61(25):468-70.
[ii] CDC. Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines. Recommendation of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for the Use of Tdap Among Healthcare Personnel. MMWR 2006;55(RR17):1-33.
[iii] Klein N, Barlett J, Rowhani-Rahbar A, Fireman B, Baxter R. Waning protection after fifth dose of acellular pertussis vaccine in children. N England Journal of Medicine 2012; 367-11.
Happy Public Health Month!