" Whooping cough ? Pertussis ? What is that ? How do I protect my children from it ?" Well, the good news is, vaccination against petussis is part of the 6 in 1 vaccine that they receive at 2,3,5, and 18 months. By the time a child turns 2, he would have received 4 doses of the pertussis vaccine. And this vaccine is part of the free vaccination program by the government of Malaysia.
"If our children are vaccinated, why is there an outbreak?" There are several reasons.
In order to mantain herd immunity, the majority of children must be vaccinated. A drop in the number of vaccinated babies can lead to breakthrough infections.
Under the immunisation program, a baby receives his first dose at 2 months. Based on the manufacturer's recommendations, the earliest age it can be given is at 6 weeeks. This means that babies under the age of 2 months are at risk of contracting the disease should they become exposed .
Neither vaccination nor natural infection confers lifelong immunity. Protection lasts 5 -10 years after the last dose, while antibodies from natural infection lasts 7-20 years. However, natural infection carries the risk of multi organ involvement, and death.
Complications of pertussis infections are more common in babies under 1 year if age. One in 3 of those infected under the age of 1 year will require admission. Of these, 68% will have apnoea ( stop breathing intermittently) , 22% get pneumonia ,2. % will have seizures ( fits), 0.6% will have encephalopathy ( inflammation of the brain), 1% will die. Source : CDC
https://www.cdc.gov/pertussis/about/complications.html
While complications are less common in teenagers and adults, they can get fractured ribs from the vigorous coughing. These teenagers and adults too can spread it to their classmates and peers, some of whom may have babies and older people at home.
While high grade fever used to be a problem with the old whole cell vaccines, today's pertussis vaccines are acellular vaccines. This means that instead of incorporating the whole bacteria in the vaccine, only bits and pieces are used, thus making it impossible for the vaccine to cause disease. The incidence of fever is also very much reduced, and very rarely is it high. Compared to getting natural imunity, vaccination is a much safer option in protecting our babies.
When should we vaccinate?
The national immunisation program gives DTaP at 2,3,5 and 18 months, while 7 year olds receive td ( tetanus and diphtheria) while pregnant mothers and 15 year old teenagers receive the tetanus vaccine. Replacing the tetanus vaccine with adult tdaP ( tetanus, diphtheria and pertussis but at a lower dose compared to children), will extend the protection. Pregnant mothers who receive the tdaP between 27-36 weeks of pregnancy will pass the antibodies to their unborn babies via the placenta. This will protect the babies until they are old enough to be vaccinated. Replacing the tetanus jab at 15 with tdaP and tetanus and diphteria at 7, will extend the protection until they are at least 20 years of age. Administering the tdaP at regular intervals will not only protect against whooping cough, but also tetanus, and diphtheria.
At the moment, the tdaP vaccine is only available in private clinics and hospitals. My advice to my patients is to take it in place of the td in school.I normally tell them ahead of time as I am unable to give the vaccine once they have takjen the td in school, and there are no standalone pertussis vaccines in the market.
