By Juliet Wilkinson, RN, BSN, contributor
July 27, 2012 - Contagious. Bacterial. Deadly. Preventable. It’s called pertussis, but most of the U.S. population knows it by the descriptive term, whooping cough. This infectious disease is responsible for an increasing number of deaths each year, and this year’s trend is looking especially dangerous.
Just ask Anne Schuchat, MD, (RADM, USPHS), assistant surgeon general, United States Public Health Service (USPHS), and director of the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention (CDC).
“2012 has been a huge year for pertussis around the country, and more reports are coming in each day,” Schuchat reported. “Nurses are on the frontline of patient care--and I strongly urge all health care providers to get a DTaP booster vaccination to protect themselves from getting or spreading pertussis.”
According to the CDC, the country currently has more than twice as many reported cases of pertussis as we did at the same time last year.
The disease progression
Pertussis is often diagnosed long after onset, because it starts off like the common cold. A runny nose here, a little cough there, and a low-grade fever may be the only signs you or your patients notice as the bacterium Bordetella pertussis invades the tissues of your respiratory tract. About two weeks later, the cold-like symptoms disappear leaving a seemingly innocuous dry cough behind. You are contagious and possibly spreading this airborne droplet disease the entire time.
As the disease progresses, the coughing fits increase in severity and you may hear the trademark “whoop” sound as you inhale, but the characteristic noise is not always present. Babies and young children don’t always make the sound, but instead can turn red in the face, gasp for air and may even suffer periods of apnea as the disease progresses.
“Pertussis is a very difficult to control disease. We have seen outbreaks in many communities around the country. We also regularly get reports of outbreaks in hospitals, particularly in newborn nurseries. It is so important for nurses and doctors on the front line of patient care to protect themselves against getting or spreading whooping cough,” said Schuchat.
Tracking the disease and increasing awareness
Estelle Schwarz, RN, BSN, MBA, who held the position of emergency department director at Northside Hospital in St. Petersburg, Fla., stated, "As an ED director, we were made aware of--and conscious of--the increase in the number of reported cases of pertussis.”
CDC trends show that pertussis is cyclical; dips and peaks in confirmed cases have been occurring for years. As patient educators and advocators, nurses can raise awareness about the disease and teach about vaccination.
“Nurses have a key role in helping the public stay on top of current trends, especially in the realm of infectious disease. We are responsible for educating ourselves, our staff, our peers and the public," said Schwarz.
Why the increase in reported cases?
Before the DTaP (diptheria, tetanus and acellular pertussis) vaccine, infectious diseases such as whooping cough caused many fatalities, especially in infants and young children. In recent years, some groups have united efforts encouraging parents to resist getting their children immunized, leaving the child unprotected from whooping cough and other potentially fatal diseases.
Most health experts argue that the platform of this anti-vaccination movement is flawed, because it’s based upon the belief that the pertussis vaccination can cause neurological problems in children. In fact, the whole-cell pertussis vaccine, which the United States stopped using in 1977 according to the CDC, was the vaccination linked with rare cases of neurological disorders in children. The vaccine currently in use, the acellular pertussis vaccine, has no scientific evidence or support of neurological side effects after administration.
How nurses can help
Immunization is the key step in prevention. Once a nurse has been vaccinated and become immune, he or she cannot spread the whooping cough to patients, family or associates. “The local health department sends out information regarding confirmed local cases of pertussis. This helps us to be mindful of the trend and react accordingly. As a result, my facility opted to offer the pertussis vaccine to all ED staff and offered patients DTaP vaccines opposed to the tetanus vaccine when one was needed," said Schwarz.
Patient education is necessary to spread the word about pertussis prevention. Nurses need to remind their patients, both young and old, that there is no such thing as life-long immunity to pertussis. Whether someone actually suffered the disease or had a vaccination, immunity from both will wear off over a period of 10 years.
The current DTaP recommendations include a series of five shots, the first to be given at 2 months of age. The remaining injections are given at 4 months, 6 months, between 15 – 18 months and between 4 and 6 years. Since immunity wanes, it is recommended that a booster be given at age 11 or 12. The CDC also recommends that any grown adult who has not received a booster recently and caregivers for babies and young children get a DTaP booster.
“More and more health care providers are being vaccinated against influenza each year, but we still have a way to go in getting the word out about how important it is for clinicians to be vaccinated against pertussis. Only 8.2 percent of adults 19 - 64 years of age have gotten a DTaP vaccination,” said Schuchat.
Centers for Disease Control and Prevention. (July 2012). Accessed July 24, 2012 from http://www.cdc.gov/media/releases/2012/t0719_pertussis_epidemic.html.
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