More expert answers to viewers' whooping cough questions

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by KING 5 News

KING5.com

Posted on May 11, 2012 at 4:35 PM

Updated Friday, Jan 4 at 10:45 AM

During KING 5's May 9 special report on the whooping cough epidemic in Washington state, Dr. John Dunn from Group Health Cooperative answered viewers' question in an online chat.

Dr. Dunn agreed to get answers to the many questions that came in but which he didn't have time to answer.

The first group of questions below were answered by his Group Health colleagues -- Drs. David Grossman, Rob Nohle, and Andrew Sinfuego (all physicians at Group Health).

The second group was answered by experts at Seattle-King County Public Health.

(Questions are in bold.)

GROUP HEALTH ANSWERS:

I'm over 65 and had "whooping cough" as a child but no booster since.  Where am I on the risk chart?

There is no real good way to assess where you are on risk chart. Simple answer is that you need the Tdap, as even with you having had the disease the immunity wanes over time (disease-induced immunity lasts only 4-to-20 years).
 
What kind of intervention are public health officials currently working on besides the media based announcements to get vaccinated.  Are they working to make vaccines more readily available to the most at risk population or sending information home from school?

The state and local public health authorities are working to make vaccine available for free to uninsured individuals. Local health facilities will be receiving extra vaccine for this purpose.  Group Health is sponsoring a vaccine clinic on Saturday may 12th to immunize high risk individuals who are uninsured.

Is there a concerted effort to make contact with non-English speaking folks, i.e., posted in their community centers and other such gathering places? 

State and local public health authorities have printed pertussis information flyers in many languages.   There has been extensive communication with health clinics and providers working in diverse communities. Access materials in other languages at the Seattle-King County Public Health website.

Why won’t the CDC change the recommendations for the vaccine? They know it only last 5-10 years. Why do they continue to tell the public that the adults only require one dose?

They want to make their decision based on evidence – the vaccine has been available to the public for less than ten years, so we are just now getting data on long-term effectiveness. It certainly seems that immunity is not lasting that long, and we all suspect the recommendation will change. The question will become what is the right interval and that is what they need to determine.
 
I worry that the adults around my infant won't get vaccinated - what are the most useful things to tell them so they will?

Pertussis can be a deadly life threatening infection for infants. It is more than just a stubborn cough that most adults will get. I know some families that refused to let the grandparents see their grandchild until they had their Tdap. Even if you aren’t regularly exposed to infants, you could still potentially pass a pertussis infection to another susceptible adult that does spend time around infants.    ------

I am also finding (I work in a clinic) that Medicare Advantage Plans only cover this vaccine IF the patient receives the vaccine at a pharmacy. I have had to turn countless patients away because they will be charged $124 if they get it at a clinic also Regence and Premera are not covering this vaccine People should watch for free clinics.

Medicare Advantage will cover this vaccine if you have Part D (medications) coverage.  Your cost share will vary depending on your deductible and on if your current expenditures are in the “doughnut hole.” It’s best to call your health plan customer service to be certain. Many retail pharmacies are offering the vaccine for a fee ($50-90).
 
I am an ARNP in Sumner.  We have many Medicare patients hesitant to get the vaccine due to cost.  According to what was just said in the news program, there is medicare coverage for the booster if the patient has Part D coverage.  Is that the case if the shot is given in clinic, or only if the patient goes to a pharmacy?

Part D is medication coverage.  It’s best to check with the customer service office of your health plan to be certain what, if any, cost you might incur from your Medicare coverage.  If you do not have Medicare part d coverage, you may get the vaccine for your doctor or pharmacy, but will have to pay the full cost.

I have a 20 year old son. Does he need another dose or is he good 10 years from the last one?

This depends on whether his last dose of tetanus vaccine contained pertussis.  The pertussis-containing “Tdap” form of tetanus vaccine has only been available since 2005.  If your son received a tetanus vaccine prior to that time (and possibly even after that time), it would not have contained pertussis – we always recommend checking your child’s records to see what was actually given.  Although we recommend that people get a booster dose for tetanus 10 years after their last dose, if he has not yet received a dose of Tdap, he should get this vaccine now (no matter how short the interval since the last dose of tetanus vaccine has been).

I am 35 weeks pregnant. My boyfriend and I went and had our boosters last week. Our parents have also gotten their boosters. I am absolutely terrified to bring a new baby into this world with this epidemic going on in our state. Should EVERYONE who comes in contact with our infant be vaccinated?

Ideally, yes, it’s best for any adult having contact with young infants, especially those infants who have not been fully immunized, to receive a Tdap booster at least two weeks before the baby's birth or first contact.  This is especially important for any household contacts. 

I'm expecting a baby in November and have been vaccinated 1 year ago.  Would getting vaccinated again during the later part of my pregnancy offer some immunity to the baby?

If you have already been vaccinated with Tdap as an adult over 18, you do not need to get re-immunized.  It will not provide any further protection for the baby. 

I had whooping cough as a child.  Am I still susceptible to the disease?

You might be.  You should follow the usual vaccination recommendations for whooping cough for adults.  If you have not had a Tdap booster as an adult, you should receive one. 

My infant son stopped breathing and turned blue, going completely unconscious days after a DPaT vaccine, which is a well documented side effect of the pertussis component of the vaccine. His pediatrician never made any referral to immunology or neurology because she didn't personally "see" the events, even though I had witnesses. He now has immune system and mitochondrial dysfunction. Would you recommend he get another pertussis vaccine?

You should consult with your doctor on this decision.
 
I believe I had whooping cough starting February 14 and still have a cough today. (I was diagnosed in March with chronic asthmatic bronchitis.) How long after onset of whooping cough can I get vaccinated?

You should consult your doctor. More information is needed before we could give you an answer. 

Our 23 year old son was unable to be fully immunized as an infant due to his reaction to his first DTaP vaccination.  Is it safe for him to be vaccinated now as an adult?

Your son should consult with his doctor to answer this question.  A detailed history would be necessary and the type of reaction would be an important part of this decision.
 
Why can’t we either keep kids out of school who are not vaccinated or require mandatory vaccinations for all school children like when I was a child.  We were just lined up and vaccinated.

Some children cannot receive the vaccine for medical reasons. Though parents can request an exemption for the vaccination requirement for schools, they must consult with their child's physician before receiving an exemption. Unimmunized children do pose a risk to other children so all efforts should be made to offer and encourage vaccinations prior to school entry.

My 9 year old daughter was diagnosed with whooping cough in March of last year.  She had all her immunizations and still got a very bad case of whooping cough.  Her doctor did not want to test her because he didn’t think she had it.  I had to insist although I did not know of any exposure she would of had.  We live in Pierce County.  I wish the authorities would report that even if your child is immunized they can still get it.  

If they get a bad cough, insist on getting tested.

Even in fully-vaccinated children, immunity to pertussis does wane -- usually after 4-to-12 years -- and this might have caused your daughter to catch the disease. We look for "bursts" of coughing, turning blue while coughing, or vomiting after coughing as possible signs that you might have the whooping cough. It is difficult to listen for the "whoop" at the end of the bursts of the coughing spell, as is usually only heard in young children who have the whooping cough. Adults, babies, and older children usually do not have that characteristic. If we have a high suspicion that they have it, we will usually test for it.

I'm just getting over a cold--do I need to wait until I'm completely healthy before I can get the vaccine?

No, having a cold is not a barrier to getting the vaccine. You can contact your health professional and get your vaccine as soon as possible.

Are licensed daycare providers required to have their staff vaccinated for pertussis?

To the best of our knowledge, there is no requirement for daycare staff to get the vaccine for pertussis.  It would be nice if they can check and make certain they have this vaccine as they deal with babies and small children, the population most likely to be affected the most by whooping cough.  But as of now, this is not mandatory.

I was told by my children’s doctor that even though my 8 year old has the shot and my 6 month old is getting the shots, and us adults have the shot, that we can still get whooping cough...is this true?

Yes. Unfortunately, immunity to pertussis does wane, both in people that have been vaccinated and in those who have actually had whooping cough in the past.  On average, vaccine-induced immunity to pertussis will usually wane after 4-to-12 years, and disease-induced immunity will wane after 4-to-20 years – this is why we recommend a Tdap booster for children at 11 years of age, and for adults that have not yet received the Tdap vaccine.  We suspect that in time, the recommendations will change and that regular boosters may be required for everybody.

ANSWERS FROM PUBLIC HEALTH -- SEATTLE & KING COUNTY


What kind of intervention are public health officials currently working on besides the media based announcements to get vaccinated.  Are they working to make vaccines more readily available to the most at risk population or sending information home from school? 

Public Health – Seattle & King County is coordinating distribution of free vaccine to pharmacies, hospital settings, and public and private health care providers, so that uninsured adults can be vaccinated. In addition, Public Health investigates reported pertussis cases and takes action to prevent spread of infection to infants, pregnant women, and other high risk persons, including recommendations on treatment and staying away from school and workplaces until no longer infectious.  Public Health is providing recommendations to King County healthcare providers regarding the status of the outbreak, and diagnosis, treatment, and infection control recommendations.  Public Health also developed information about pertussis for the public and distributed a pertussis toolkit to schools in King County with information for schools to share with families.

Is there a concerted effort to make contact with non-English speaking folks, i.e., posted in their community centers and other such gathering places?

Public Health – Seattle & King County has translated information on whooping cough into 6 languages and is reaching out to limited English proficient groups through community organizations, human service agencies, ethnic media outlets, child care providers, and community health care workers.

I worry that the adults around my infant won't get vaccinated - what are the most useful things to tell them so they will?

Infants are at the very highest risk for severe pertussis with hospitalization and death.  Household members, including adults can spread pertussis to an infant without knowing it.  Dr. Wendy Sue Swanson from Seattle Children’s has some great advice for how parents of infants can talk to their friends and family about pertussis. Check out her blog post.

I am also finding (I work in a clinic) that Medicare Advantage Plans only cover this vaccine IF the patient receives the vaccine at a pharmacy. I have had to turn countless patients away because they will be charged $124 if they get it at a clinic also Regence and Premera are not covering this vaccine People should watch for free clinics.

Insurance coverage for vaccines can be confusing.  Check with your health care provider, local pharmacy or insurance carrier for information on what is covered. Public Health's website lists the pharmacies in King County that offer the Tdap vaccine.

I am 35 weeks pregnant. My boyfriend and I went and had our boosters last week. Our parents have also gotten their boosters. I am absolutely terrified to bring a new baby into this world with this epidemic going on in our state. Should EVERYONE who comes in contact with our infant be vaccinated? 

One of the best ways to protect infants against pertussis is to be sure that adults in their environment do not get pertussis and spread it to them.  Tdap vaccine is recommended for any adult who has contact with infants or pregnant women.  It is also very important that anyone with a cold or cough stay away from the newborn – even if they have been vaccinated. 

Why can't we either keep kids out of school who are not vaccinated or require mandatory vaccinations for all school children like when I was a child.  We were just lined up and vaccinated.

Washington State has a school and child care/preschool immunization law that requires children to have documentation of vaccines, or to have a signed medical, religious, or personal/philosophical exemption on file with the school, child care, or preschool.  Excluding unvaccinated children during a large community outbreak is not likely to be an effective way to control the outbreak, because so many people are getting ill and can spreading the infection in and out of school. 
   
Are licensed daycare providers required to have their staff vaccinated for pertussis?

There is no requirement (state law or school district rule) that child care providers or school staff be vaccinated with any vaccines.

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