Why Infants Are At High Risk of Whooping Cough—and How to Protect Them
Whooping cough, also known as pertussis, is a respiratory infection that can be mild in many cases, but deadly in others. Fortunately, death from whooping cough is fairly rare in the United States, because most Americans receive childhood vaccinations protecting against it. Before the pertussis vaccine was recommended for all infants, roughly 8,000 people in the U.S. died annually from whooping cough. Today, that number is closer to 20 people each year. However, most of the deaths related to whooping cough are in infants younger than three months old. Even infants who survive a bout of pertussis can have a prolonged, scary illness. To avoid these preventable deaths, it’s important to understand how whooping cough affects babies and how families can protect them.
Most Americans receive a vaccination called DTaP in childhood. This shot protects against diphtheria, tetanus, and whooping cough. Whooping cough is a highly contagious bacteria. Those who aren’t vaccinated against it have an 80 to 90% chance of contracting it after being exposed. Unfortunately, we’re exposed to it a lot; about 10 to 25% of people with chronic coughs in the wintertime actually have mild whooping cough. Plus, many people can carry the bacteria without experiencing symptoms. If they have been vaccinated, older children and adults can still get whooping cough because the immunity induced by the vaccine lessens over time, but it typically won’t be severe. For most people, whooping cough manifests as a long-lasting cold. If you become infected, you’ll experience a nasal discharge and other cold symptoms for a couple of weeks. Then, it’ll enter the coughing stage. Whooping cough is named for the sound people make when they cough with this condition. The cough can last a long time—even a few months—but in most older children and adults, it won’t develop into anything more serious. For some, though, the cough can be bad enough to induce vomiting or even break a rib! If it’s recognized within a week or two, you can treat it with an antibiotic, but often you have to wait for the infection to go away on its own.
We know vaccinating against whooping cough is effective; although some people still contract the infection, the symptoms are usually mild and will rarely lead to a hospital visit. The trouble is, infants don’t respond well to the whooping cough vaccine until they’re around two months old and are not fully protected until the third vaccine dose at six months old. We recommend that mothers get a whooping cough booster, called a Tdap shot, with each pregnancy between 27 and 36 weeks into the pregnancy, with the hope that the vaccine antibodies will transfer to the unborn child, providing some level of protection. However, this approach doesn’t mean the baby is 100% immune to whooping cough. They’re still quite vulnerable to contracting this very contagious bacteria. And when they do contract whooping cough, it can be severe. Infants’ lungs are quite small and they can’t cough like older children and adults can. Babies who have whooping cough may turn blue, gag, or stop breathing. About two-thirds of infants who become infected have to go to the hospital for extended periods of time, and some ultimately die from it.
That’s why it’s crucial to keep babies safe from exposure to whooping cough for the first few months of their lives. Once the baby is two months old, they’ll receive the first of several vaccinations against whooping cough. They’ll get an additional dose at 4 months old, 6 months old, 15 to 18 months old, and 4 to 6 years old. However, the vaccination is roughly 85 to 90% effective, so whooping cough is still a small risk. That’s where the concept of “cocooning” comes into play.
Studies show when an infant does become infected with whooping cough, the source tends to be someone in the immediate family, grandparents, or healthcare workers. That’s why vaccinating everyone around the baby—cocooning—is extremely important. Even if you received a whooping cough vaccination as a child, if you haven’t gotten the adult Tdap booster, it’s crucial to get one at least two weeks before coming into contact with the newborn baby. This booster is necessary because the vaccine becomes less effective over time, meaning you can contract whooping cough and, although it might be asymptomatic or mild, you still carry the infection and can spread it to an infant. It’s especially important for grandparents and other older adults to get the Tdap booster, because they won’t have an effective immune response left over from their childhood vaccines. Getting the shot not only protects them, but also could save their grandchild’s life. Because infants can get pertussis from other sources, “cocooning” alone is not totally effective so every pregnant woman should get a Tdap with each pregnancy. Every adolescent or adult should also get one dose of Tdap in their lives both to protect themselves and all others around them.