More than 150 children have been hospitalised this year with pertussis (whooping cough) and three babies in all have died since the outbreak began in August 2011. TRISH WELLS-MORRIS, education facilitator for the Immunisation Advisory Centre* puts the argument for all those caring for infants – be it as nurses, parents, or grandparents – to be immunised against the disease.
We are currently experiencing a large outbreak of pertussis disease or “whooping cough”.
There have been more than 10,000 cases since the outbreak began in 2011. Last year, it resulted in over 300 hospitalisations and two deaths, and this year, a further 150 infants have been hospitalised and one more baby has died. Each pertussis case is required to be notified to Public Health (even on suspicion) so that contacts of cases can be offered prophylactic treatment if they have not been immunised recently.
It seems like a good time to review immunisation recommendations to control the spread of this serious infection as although district health boards (DHBs) have staff vaccinations programmes there are inconsistencies (see sidebar for current vaccine recommendations for nurses).
Young babies most at risk for pertussis
Babies are most at risk of pertussis because they are just too young to be fully vaccinated, and they are most vulnerable to severe complications, including death.
Stories from some of the parents whose babies have suffered pertussis have been shared on the Ministry of Health’s website www.health.govt.nz and the kidshealth website features the video and the story of Te Uru, who was hospitalised at just two weeks old with whooping cough: www.kidshealth.org.nz/whooping-cough-videos
Adolescents and adults have also had pertussis during this outbreak including some healthcare workers. Experts say that pertussis is actually a common disease but underreported due to lack of recognition in adolescents and adults. Although most adult disease is mild, some are very unwell, experiencing frequent coughing spasms, especially at night, continuing for weeks. Pertussis is sometimes referred to as the “100 day cough”.
Who should have pertussis vaccination?
The pertussis vaccination is recommended for staff in contact with infants less than 12 months old.
For secondary care providers, this would involve staff in several areas – obstetrics, (especially lead maternity carers), neonatal units, emergency departments, and paediatric inpatient and outpatient units, plus some allied health staff.
In primary care practice nurses, GPs, well child nurses, and outreach immunisation providers will all have contact with babies and should be vaccinated. But there appears to be no consistent implementation by health care employers of this recommendation. This year there has been a call from one paediatric expert for a national policy.
In most cases health care workers want to be vaccinated but do not want to have to pay for it. So if your employer does not offer this vaccination it is something worth advocating for.
The length of immunity from either infection or vaccine is thought to wane quite quickly after about 4–6 years and serology tests do not assist with determining protection or susceptibility. Because of this short length of immunity, it is necessary to plan for boosters, which are currently recommended ten-yearly, but some experts believe this should be shortened.
Pertussis vaccination – a duty of care?
You can acquire pertussis without knowing and transmit this potentially fatal disease to susceptible infants. So is it a reasonable assumption that you have a ‘duty of care’ to be vaccinated? For some health care workers vaccination poses an ethical dilemma. Researchers have found that these staff may want to be free to choose or not (autonomy) since they may believe that their professional self is separate from their private self. They may have trust issues about the safety of the vaccine. It is interesting that we rarely seem to have this discussion about Hepatitis B vaccination of health care workers.
Is the pertussis vaccine safe?
Which vaccine are we talking about anyway? There is no single pertussis vaccine available, but the two products on the market with acellular pertussis antigen also include both diphtheria and tetanus toxins – so we get a three-for-one deal and end up with better protection.
The 0.5ml intramuscular injection includes minute amounts of other ingredients: an adjuvant to minimise amounts of antigen and increase immune response, diluents, preservative, stabiliser, and emulsifier. These are sub-unit, not live, vaccines, so they cannot cause the disease. Both vaccines are well tried and tested so safe for injection but local signs of immune response can be expected for a few days. Let’s face it, a sore arm beats weeks of coughing spasms – for me, anyway.
Cocooning’: pertussis vaccination of other adults
What about those of you who do not work with infants – are you vaccinated for pertussis? Many adults are vaccinated to ‘cocoon’ and protect small babies who are not old enough to be vaccinated. Cocooning is an internationally recommended practice. These include parents, child carers, early childhood workers, grandparents, and other extended family.
Some health care workers are not provided with this vaccination by their employer and may have to purchase the vaccine through their health provider. The only adults currently funded for pertussis vaccination by the Ministry of Health are pregnant women between 28th and 38th weeks gestation for each pregnancy. All others receive this vaccine privately either through their own primary care provider or their employer.
The Ministry of Health-funded vaccine stock cannot be used so the vaccine needs to be ordered from Health Care Logistics privately. The cost of private purchase of this vaccine is in the vicinity of $25, plus GST, administration costs, and possibly transport costs.
So during this epidemic of Pertussis let’s ‘up the ante’ and get vaccinated if you are working in contact with infants or other susceptible children. Even if you are not – before you go near any babies get yourself vaccinated. Our newborns are precious and we can protect them better.
Take home messages:
- The pertussis outbreak is serious – three deaths: two in 2012 and one this year.
- Health care workers in contact with infants need to be vaccinated regularly.
- It is recommended anyone in contact with infants should get vaccinated.
- There is a safe vaccine available.
*The Immunisation Advisory Centre (IMAC) is based at the University of Auckland and aims to provide independent evidence-based information on the benefits and risks of immunisation, training for health professionals and national immunisation coordination.
References will be available with the online version of the article at www.nursingreview.co.nz or by emailing firstname.lastname@example.org
Caption to photo: Ramona and Peter Muliaga’s then 8-week-old daughter Marliena-May was hospitalised for four weeks with whooping cough that saw her “coughing and coughing until her face went purple”. She had had her first immunisaton at six weeks, but as she was still so young she struggled to fight the disease. Her twin sister Ayva-Rose had received two vaccinations before she, too, caught whooping cough at the age of four months, but her illness was much less severe. She didn’t need hospitalisation and with antibiotics the worst was over in five days (thanks to the Ministry of Health and the Muliaga family for sharing the photo and story).