In PA school, we’re taught about the “barking” cough thatheralds croup. We’re told that while it sounds horrible, it’s self-limited. Reassuranceis the one of the main treatments. But over the past two years, I’ve learned toperfect my imitation of seals as compared to cranes. Whooping cough, so namedbecause of the distinctive “whoop” sound with inspiration, is making afrightening comeback.
Spurred by decreased immunization rates, we have recentlyseen deaths from this easily preventable condition. The state of Washingtonjust declared a pertussisepidemic, asking the Centers for Disease Control to send investigators andbring truckloads of vaccines.
The CDC notes that therehave been more than 1,000 cases already this year in Washington, compared to110 during the same period in 2011. In the last few years, California has beenthe hot bed of pertussis, watching it burn though its population while killing 10infants in the process. This rate is comparable to one seen in the past: from1947. Keep in mind the pertussis vaccine was not widely available until the mid-1940s.
Just last week, a 9-week-oldinfant died in Idaho, another state that is seeing a rise in pertussiscases. Infants should be immunizedwith DTaP (diphtheria, tetanus and acellular pertussis) vaccines at 2, 4 and 6months of age and between 15 to 18 months. The fifth booster is given with the“kindergarten series” between 4 to 6 years of age. In the last few years, the AdvisoryCommittee on Immunization Practices (ACIP) has recommendeda Tdap booster (tetanus, diphtheria, acellular pertussis) at the adolescenthealth care visit, preferably around the ages of 11 to 13 years.
All healthcare workers are also recommended to get a Tdap at some point. While thevaccines available — Boostrix and Adacel — are only licensed for individuals up toage 64 years, ACIP has also recommended those over 65 years get a booster,particularly if they will be around grandkids or other infants.
But if you live on the east coast, why should you care aboutthe problem on the Pacific coast? Because these are just the CONFIRMED cases — manymore go unreported and unrecognized. The treatment for pertussis is simple: a Z-packwill suffice. And what’s the most common antibiotic given for “bronchitis”? Z-pack!So people figure, “Why test? I’m covering for it anyway.” It’s a fact that thepatient goes home to a new baby or visits a grandchild, not knowing that theirlingering cough has the potential to kill those they care about most.
In the last 2 years, I’ve already had three positive testsand been on prophylaxis once — more than my supervising physicians have seen intheir entire careers. Consider testing any person with vomiting fromcoughing, coughing spasms that leave them breathless or coughs that lingerfor weeks. Talk to your lab staff about the preferredtesting process for your practice, and remember that the whoop is usuallyonly heard in those most at risk, including infants and the unvaccinated.
Aswe head in to summer, recommend a Tdap booster to every patient you see. (RememberTdap is for Teens and older, DTaP isfor kids in Diapers). You canencourage the tetanus booster by noting the increased outside activities thatcome with the potential for injury, from baseball and hiking to gardening andmowing the lawn. Be sure to bring up the added bonus ofpertussis coverage, which is getting more and more media attention. And don’tforget to protect your own family by baring your arm and taking the shot!
Deanna Bridge Najera, MPAS, PA-C is a member of the AAPA Health Disparities Work Group.
This article originally appeared on JAAPA