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By Erika Edwards
The pertussis vaccine is not working as well as it has before, and new research suggests that it is largely due to the fact that the bacterium that caused the disease has mutated.
Researchers from the Centers for Disease Control and Prevention analyzed laboratory samples from whooping cough patients between 2000 and 2013 and found that Bordetella pertussis, which causes whooping cough, has undergone genetic changes over time.
This means that the current vaccine does not perfectly match the bacteria. The researchers hope the new data released Wednesday in Emerging Infectious Diseases will help change that.
"The genomic data we provide will help open research to improve vaccine development and disease control strategies," the CDC authors wrote in their report.
The experts in infectious diseases agree.
"The pertussis vaccine is not optimal," said Dr. William Schaffner, professor of preventive medicine at the Vanderbilt University Medical Center.
"We are making the best use of the vaccine, as we do frenzied research to improve the vaccine," said Schaffner. But a new pertussis vaccine is far from ready, he said.
Babies are most at risk
Everyone can have whooping cough, but newborns are the most vulnerable.
Babies and children are currently receiving a vaccine called DTaP. It is a vaccine that protects against three diseases: whooping cough, diphtheria and tetanus. Studies have shown that the vaccine is safe and that it works very well against diphtheria and tetanus, protecting almost all those who contract it for a decade.
But DTaP is less effective in preventing whooping cough. Almost all children who receive the recommended five doses are protected for one year. After that, the immunity decreases. Five years after the last dose, the CDC states that DTaP only protects about 70% of children with pertussis.
The CDC recommends recalls for pre-teens, teens and adults every 10 years.
Babies are not eligible for the DTaP vaccine before the age of 2 months. The CDC recommends that women receive a booster shot every pregnancy so that babies are born with protection from whooping cough until they are old enough to receive the vaccine themselves.
"The best thing to do is vaccinate a pregnant mother. It's the number one way to protect the baby, "said pediatrician Wendy Sue Swanson of Seattle Children's Hospital.
Paradoxically, many babies with whooping cough may not be coughing at all. They can simply stop breathing, causing dangerous and life-threatening situations.
According to the CDC, about half of all 1-year-olds with whooping cough are hospitalized, often because of breathing difficulties. A quarter of those hospitalized develop pneumonia. One in 100 will die.
The new report comes amidst ongoing epidemics of another infectious disease: measles. The CDC has confirmed 228 cases of measles since the beginning of 2019, with infections in 12 states. The measles virus has spread rapidly in communities where people who have not yet received the measles vaccine called MMR have been living.
Pertussis is different. The experts in infectious diseases attribute the increase in the number of cases of whooping cough to better diagnostic tests, but also to a decline in immunity. The most recent peak of pertussis cases in the United States occurred in 2012, when states reported 48,277 cases to CDC.
No ordinary cough
Pertussis is not an ordinary cough. The intense piracy associated with the infection has inspired its two nicknames: "100-day cough" for its propensity to linger for weeks and "whooping cough" for the sound of patients who urgently aspire after a violent coughing crisis .
Episodes can be so severe that patients are unable to eat or sleep normally. Some patients broke their ribs while coughing. Schaffner said he had already treated an adult with whooping cough, injured after a loss of consciousness and a fall during a particularly painful cough.
How to stop the spread of whooping cough
Whooping cough is extremely contagious. The disease is spread by coughing, sneezing or simply in very close contact with another person.
Doctors recommend basic hygiene practices to prevent whooping cough from spreading:
- Cover your mouth and nose with a tissue or the top of your sleeve when you sneeze or cough.
- Be sure to throw used tissues in the trash.
- Wash your hands often with soap and water for at least 20 seconds.
Pediatricians say that whooping cough often starts with a cold with runny nose. The cough may develop only several weeks later.
"Pertussis is insidious," said Swanson. "You do not know you have it right now."
She says that parents can not take their children to a doctor before coughing to the point of vomiting, which means that the child can spread the disease without knowing it for several weeks.
"If you have whooping cough, you should not be with others, especially pregnant women and infants," said Swanson.
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