This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
Pertussis Activity Spiking in Several States
Vaccination Critical in Preventing Illness
By News Staff
The CDC said June 25 that as of June 19, 5,120 cases of pertussis had been reported nationwide. Although that number was less than the 6,326 reported at the same time last year, several states reported significant increases in pertussis activity, including Texas (1,154 cases), Ohio (523 cases), Michigan (380 cases) and Arizona (163 cases).
In addition, the South Carolina Department of Health and Environmental Council issued a public health advisory (3-page PDF; About PDFs) June 8, saying reported pertussis cases were above an epidemic threshold. The state agency said that in the first 20 weeks of 2010 there were 81 confirmed or probable cases of pertussis, which doubles the number of cases reported during the same period during each of the previous three years. The department said the case total was above an epidemic threshold because it was two standard deviations above the annual mean.
California Bill Addresses Vaccine Payment Issues
The bill (8-page PDF; About PDFs), which is co-sponsored by the California Academy of Family Physicians, would require health plans that cover immunizations to pay physicians an amount no less than the actual cost of acquiring a vaccine, including shipping and handling, as well as the cost of administering a vaccine, including physician time, staff time, storage, insurance, supplies and medical equipment.
Assembly member V. Manuel Perez (D-Coachella) introduced a similar bill last year, but it failed to pass the Appropriations Committee. He introduced a revised version of the bill in February, and it has received bipartisan support thus far.
The bill passed the California Senate's Health Committee by a 7-1 vote on June 30. It now moves to the Appropriations Committee, although no date for a hearing had been set as of July 1.
The bill draws attention to the fact that vaccines are one of the biggest costs incurred by pediatric and family practices, and the failure to adequately pay for the direct and indirect costs of providing immunizations can threaten the viability of a practice.
A study published last year in Pediatrics reported that 5 percent of pediatricians and 21 percent of family physicians surveyed said they had seriously considered not offering recommended childhood vaccines because of cost concerns.
In the news release on the California outbreak, Mark Horton, M.D., M.S.P.H., director of the California Department of Public Health, urged parents to vaccinate their children. He also said that parents, family members and caregivers of infants should get booster shots.
The CDC’s Advisory Committee on Immunization Practices, or ACIP, and the AAFP recommend (1-page PDF; About PDFs) that children receive five doses of diphtheria, tetanus, and pertussis, or DTaP, vaccine, including a primary series at 2 months, 4 months and 6 months. Additional doses should be given at 15-18 months and 4-6 years.
However, the California Academy of Family Physicians posted a recommendation on its website for members to use an accelerated DTaP infant schedule -- initial vaccination at 6 weeks of age with subsequent doses recommended at four-week intervals -- during the outbreak.
More than half of infants less than 1 year of age who get the disease must be hospitalized, according to the CDC. The agency also said one in 20 infants with pertussis get pneumonia.
The CDC said many infants are infected by older siblings, parents or other caregivers who don't even realize they have the disease, which is difficult to diagnose.
A single dose of tetanus, diphtheria and pertussis, or Tdap, vaccine is recommended for adolescents (1-page PDF; About PDFs) aged 11-18 years old and adults (4-page PDF; About PDFs) aged 19-64 years old.
The CDC said protection received from DTaP, the childhood vaccine, fades over time, so adolescents and adults should receive Tdap even if they were vaccinated as children. The agency also said only 2 percent of adults received Tdap from 2005 through 2007.
The CDC issued the following recommendations for physicians June 30.
- Make sure patients of all ages are up-to-date on pertussis-containing vaccines.
- Consider the diagnosis of pertussis in patients and close contacts. Atypical presentation is common in infants. Their cough may be minimal or absent, and the primary symptom can be apnea.
- Use the correct tests (2-page PDF; About PDFs).
- Treat suspected and confirmed cases promptly because pertussis may progress rapidly in infants.
- Quickly report cases to local public health departments.
- Use pertussis educational materials in your office.
- Review clinical guidance materials.
- Vaccinate all people with potential contact with infants.
- Encourage your hospital to implement a postpartum Tdap immunization program.
- Protect children, adolescents and adults through vaccination to improve community immunity levels.
- Offer Tdap vaccination to staff to protect them and patients.
- Stay informed of new developments and recommendations regarding pertussis.
More than 25,000 cases were reported nationally in 2005, which was the last peak year. However, the CDC said the actual number of illnesses likely was significantly higher because of cases that were not diagnosed or not reported.
AAFP Expands Pertussis Vaccination Awareness Campaign
Second Phase of Initiative Focused on Consumer Education
AAFP Special Report: Vaccines and Immunizations
More From AAFP
Vaccination Matters: Help Protect Families from Whooping Cough
MMWR: Notifiable Diseases and Mortality Tables
(June 25, 2010)
California Department of Public Health: Whooping Cough Resources
CDC: Pertussis Vaccine
CDC: Preteen Vaccine Campaign
CDC Manual for the Surveillance of Vaccine-Preventable Diseases: Pertussis
CDC: Guidelines for the Control of Pertussis Outbreaks