This commentary was adapted from episode 147 of the Health & Veritas podcast. Subscribe for weekly doses of expert insight on health and the healthcare industry.
For most of the 21st century, there have been 10,000 to 50,000 pertussis cases every year in the U.S. Pertussis, also known as whooping cough for its characteristic hacking cough followed by a whooping sound, is a vaccine-preventable illness that causes its most severe effects in infants under one year of age, for whom it results in hospitalization in one third of patients and of which between 1 in 100 and 1 in 200 will die after infection.
Starting during the pandemic year, pertussis cases fell dramatically—to 6,000 in 2020, then 2,000 in 2021, 3,000 in 2022, and 5,600 in 2023. Some of this drop may reflect underdiagnosis, but some is likely due to the social distancing and other non-pharmacologic measures undertaken during the pandemic. Because immunity wanes considerably over time, adults are the natural reservoir for the bacterium and it is likely that their reduced exposures resulted in less risk to infants around them.
It should not be terribly surprising that there has been a broad rebound this year, with 18,506 cases so far, with 11 weeks to go. If it tracks as I suspect, we will end the year with somewhere around 24,000 to 25,000 cases. That would be high, but not extremely so; six times in the last two decades prior to covid, we had higher figures.
So why do I bring this up? Because this is an extremely preventable illness. Whooping cough is a tough disease on infants and even young kids—and it is avoidable through vaccination. Compared to many of our other vaccines, there is much less of a herd effect: my vaccination does not necessarily protect you from pertussis. So there is every good reason for parents to get their children caught up on their vaccinations. Because immunity wanes over time, we give a five-shot sequence, from two months of age to six years of age. It is also recommended that pregnant women get vaccinated, since that is the only way to protect one of the highest-risk groups: infants below two months of age. And yet, more than 40% of pregnant women do not get vaccinated, according to the most recent study, from last month. Only 80% of children appear to be up to date on pertussis vaccinations—substantially lower than the polio and measles, mumps, and rubella vaccines.
This is a reminder that our vaccination programs only work if people use them. These are not minor diseases: your decision may be life or death. Choose wisely.
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