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Thursday January 23, 2014 MYT 12:00:00 AM
Monday April 14, 2014 MYT 7:02:59 PM
by datuk dr zulkifli ismail
Tdap (tetanus, lower doses of diphtheria and acellular pertussis) vaccination is recommended for children 11 years and older whose immunity would have declined, or if they have missed one or more childhood DTaP doses, as well as teenagers, adults and the elderly (those above 65 years of age). – AFP
While your child’s vaccinations should be up to date, you should also make sure that you’re keeping current on booster shots.
PERTUSSIS (whooping cough) is an “old” disease that has resurfaced despite effective triple antigen (diphtheria, tetanus, acellular pertussis, or DTaP) vaccination that is available nationwide.
It is a highly-contagious disease caused by the bacterium Bordetella pertussis (B. pertussis).
It can be very dangerous for babies and young children, as it can cause pneumonia, seizures, brain damage, and even death.
Before the pertussis vaccine was developed in the 1930s, this disease was responsible for thousands of deaths and disability in the US every year.
The introduction of the pertussis vaccine has reduced this figure substantially to below a hundred deaths a year.
However, in recent years, there have been numerous outbreaks all over the world, and even an “advanced” nation like the US has not been spared.
This resurgence is attributed to waning immunity after the completion of childhood immunisation and booster at 18 months.
With this decreased immunity, adults
can be infected and act as reservoirs for the
bacteria, transmiting the infection to younger, unvaccinated, or partially-vaccinated infants.
A recent publication in the US revealed that the incidence of pertussis has increased substantially in children between the ages of seven and 10 years old, and mortality associated with pertussis was highest among those aged three months and below.
However, in spite of this situation, vaccines are still the best form of protection, as kids who have been vaccinated and get pertussis usually suffer a milder form of the disease.
Untangling DTaP and Tdap
DTaP is the vaccine that is given to infants or young children.
The Health Ministry currently provides mandatory vaccinations to infants at two, three, five, and 18 months of age with the DTaP vaccine.
Tdap (tetanus, lower doses of diphtheria and acellular pertussis) vaccination is
recommended for children 11 years and older whose immunity would have declined, or if they have missed one or more childhood DTaP doses, as well as teenagers, adults and the elderly (those above 65 years of age).
Tdap is also recommended for adults who are in close contact with infants below 12 months of age and pregnant women who have never received a dose of Tdap (they should receive a dose after the 29th week
of gestation, preferably during the 3rd
trimester, or as soon as possible after delivery).
Despite the characteristic “whoop” sound it is named after, this does not occur in all cases of pertussis.
Unlike a regular cough/cold, this disease causes severe, almost uncontrollable coughing.
There is nothing typical in the cough except that they come in paroxysms or bouts without the typical “whoop”, thus resulting in difficulty in diagnosis.
Infants in particular will not cough or “whoop” like older children.
Instead, they may look as if they are gasping for air.
This may be accompanied with a red/purple face and also a temporary cessation in breathing (called apnoea) for a short time during particularly bad bouts of coughing.
Teens and adults who have pertussis may exhibit milder symptoms, such as a prolonged cough instead of bouts of coughing, or coughing without the “whoop” sound.
Pertussis in Malaysia
According to the immunisation profile of Malaysia from the World Health Organization (WHO), from 1980 to 2007, the number of reported pertussis cases in Malaysia dropped from 97 to 15 cases.
However, Malaysia has seen an increase in pertussis cases in recent years.
The number of cases rose from 46 cases in 2010, to 249 cases in 2011, the Health Ministry reports.
This increase was mainly contributed by the availability of polymerase chain reaction (PCR) as a confirmatory test.
PCR is a more sensitive test compared to detection of bacteria through culture.
Sadly, many cases of pertussis go undiagnosed here, despite the fact that it is a disease that has to be notified to the Health Ministry.
This is mainly due to under-diagnosis, as doctors may not recognise the cough as being due to pertussis.
Doctors also don’t generally send the nasopharyngeal swabs for PCR detection of B. pertussis for confirmation.
Other possible reasons include the hassle involved in notifying the disease to the authorities (for some doctors) and the lack of definitive case definitions, amongst other reasons.
Pertussis spreads easily, as anyone who has it can infect others just by coughing or sneezing near them.
Studies have shown that between 75%-83% of infant pertussis were infected by their family members (e.g. parents, older siblings, etc.), with as many as 55% being linked to an infected parent.
There have also been many cases of caregivers who were unaware that they were infected passing it on to infants or younger children.
Even healthcare professionals can be a source.
Make sure that your child completes his primary vaccine series against pertussis (DTaP) and his booster shot (Tdap) once he is older.
Make sure you and other adults get the booster (Tdap) too.
If you have an older child who will be going overseas, especially if he is going to the US to continue his studies, he will be required to get the Tdap vaccine.
Doing so will protect not only your older child, but also you and any younger children that you may have.
We hope that the Health Ministry will also switch from Td (tetanus and diphtheria only) to Tdap vaccine as a booster at school age.
Tdap is recommended for adolescents and adults, and should be given especially to parents and caregivers, or anyone who comes in constant contact with young children.
> Datuk Dr Zulkifli Ismail is a consultant paediatrician and paediatric cardiologist. This article is courtesy of Malaysian Paediatric Association’s Positive Parenting programme. The opinion expressed in the article is the view of the author. For further information, please visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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Health, child health, pertussis, children, Datuk Dr Zulkifli Ismail
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