GUEST OPINION: The risks of whooping cough and pregnancy

<p>As obstetricians, we have a special stake in ensuring that Sonoma County is adequately prepared for the current whooping cough epidemic declared by the California Department of Public Health.</p><p>We have noticed that patients seem to be only mildly aware or concerned about this. However, we vividly remember that a previously healthy 2-month-old baby died from pertussis within the last few years despite aggressive and appropriate treatment at one of our Sonoma County hospitals.</p><p>Whooping cough, or pertussis, is a highly contagious respiratory disease — with an infection rate of 80 percent to 90 percent for household contacts. The infection has a varied course and severity, but the symptoms may last for up to three months.</p><p>In children, the classic symptoms are more than 2 weeks of uncontrollable fits of cough, inspiratory “whooping” sound or vomiting after cough. Infants under 1 year of age are especially susceptible to severe disease and complications including hospitalization. This is especially concerning for infants under two months of age, as vaccination is not recommended prior to that (90 percent of all deaths are reported in infants under 4 months of age).</p><p>The pertussis vaccine is highly effective, but immunity decreases over time. The old pertussis vaccine (that we both received as kids) caused such side effects (including common fevers) that it was not used in children over the age of 6. In 1991, an acellular vaccine became available that has been used since and does not cause these side effects. A new formulation in 2005 was approved for use in adolescents and adults to the age of 65. This is called Tdap. The “ap” stands for acellular pertussis. This vaccine also includes tetanus and diphtheria protection.</p><p>Current recommendations include a five-dose childhood regimen followed by a booster dose as early as possible between 11 and 18, then every 10 years. If a tetanus shot without the pertussis protection has been given more than two years previously, then the Tdap booster is still recommended.</p><p>Dr. Mary Maddux-Gonzalez of the Sonoma County Health Department recently reported 55 confirmed and probable cases of whooping cough this year, compared to only six at this time last year. She notes that more than 50 percent of infants are infected by their parents and that cases typically peak from August to September.</p><p>California had reported 1,337 cases as of June 30 — a fourfold increase over last year. Eighty-nine percent of cases were among infants aged less than 6 months, who are too young to be fully immunized. Five deaths were reported, all of previously healthy Latino infants under 3 months of age. We are in the midst of a statewide and countrywide epidemic.</p><p>The best approach for prevention of infection in newborns seems to be to surround the baby with a protective “cocoon” with recommendation of booster vaccines for mothers of newborns and all family members.</p><p>Because vaccination during pregnancy is controversial, the Centers for Disease Control recommends that all women considering pregnancy receive the Tdap vaccine at their routine annual exams, if their vaccination is not current. Otherwise, vaccination is recommended prior to discharge from the hospital after delivery (although the American College of OB/GYN states that it may also be given the last two months of pregnancy). The CDC also encourages vaccination of all adolescents and adults who anticipate contact with an infant under age 12 months (including all family contacts, child-care workers, and health care workers). </p><p>For all of these reasons, we urge vaccinations for everyone who is not current but especially for all women who are planning pregnancy, all adolescents and anyone who will be in close contact with children under 1 year old.</p><p>Vaccination is easy. Most primary care and OB/GYN offices offer the vaccine, and the county is also offering free vaccinations at the Downtown Santa Rosa Market on Wednesdays, July 14 and 28, between 5 p.m. and 8:30 p.m.</p><p><i>Dr. Brad Drexler is an OB/GYN with offices in Healdsburg and Santa Rosa. Dr. Ashley Weinert is an OB/GYN in Santa Rosa and ACOG representative on the California Immunization Committee.</p>