Background and Symptoms
Pertussis (also known as whooping cough) is a highly communicable, vaccine-preventable disease that lasts for many weeks and is typically manifested in children with spasms of severe coughing, whooping, and associated vomiting. It is caused by Bordetella Pertussis, a bacteria that is transmitted through direct contact with mucous, saliva and other discharge from the nose and mouth. Major complications are most common among infants and young children, and include hypoxia, apnea, pneumonia, seizures, encephalopathy, and malnutrition. Young children can die from pertussis.
In 2010, California had the highest number of pertussis cases–9,143, including 10 infant deaths–since 1947. According to the CDC, the 2014 pertussis outbreak in California reported incidence more than five time greater than baseline levels.1
The pertussis vaccination series can begin when an infant is 6 weeks of age. Infants are not protected until the initial series of three shots is complete. Neither vaccination nor illness from pertussis provides lifetime immunity. The series of shots that most young children receive wears off by the time they finish middle school.
The California Department of Public Health (CDPH) recommends that all patients indicated for immunization against tetanus, diphtheria or pertussis be immunized with DTaP if aged 6 weeks through 6 years and Tdap if aged 7 years and older. (Tdap is now required for school entry in grades 7-12; more on the new requirement is included below.)
CDPH recommends that all patients without documentation of full immunization against pertussis be immunized at the earliest opportunity. The following groups are of particularly high priority for pertussis immunization:
- Women of childbearing age (especially adolescents);
- Other people in close contact with infants;
- Health care personnel; and
- Patients with wounds.
New Tdap Immunization Requirement
All students entering or advancing to grades 7 through 12 in the 2011-12 school year are now required to be immunized with a pertussis (whooping cough) vaccine booster called Tdap. School-based health centers can play a lead role in ensuring all targeted students in their school district have received the Tdap booster on or after their 7th birthday, and that they have submitted the required proof to their school.
Resources for Providers
For provider information and educational materials for families and schools, go to www.ShotsForSchool.org.
Key Steps for Providers
Take these steps to ensure adolescent patients are protected against pertussis and are ready for school entry:
- Send reminder and recall phone calls and notices NOW to your patients who have not yet received a Tdap booster, including those who have received a dose of Td but not Tdap.
- If you use the California Immunization Registry, check out its new reports that provide rosters of patients who have and have not received Tdap to assist you with reminders.
- Immunize with Tdap at every opportunity, including sports physicals and visits for mild illness or injury, and give other recommended immunizations: meningococcal conjugate, HPV, influenza, and any catch-up doses of varicella, MMR, and hepatitis B.
- Provide clear and accurate documentation about Tdap immunization for your patients and your partner schools. Vaccines have similar names and abbreviations (e.g., Tdap, Td, DTaP, DT, etc.), which can be confusing to the school staff who will be keeping records for the new law.
- Post downloadable electronic banners on your school health center website and in electronic newsletters to help notify your patients.
- View the free 1-hour CME webcast: Shots For School: Clinicians’ Role in California’s New Tdap Requirement for 7th – 12th Graders.
(1) Centers for Disease Control and Prevention. (2014). Pertussis Epidemic – California, 2014. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6348a2.htm