California keeps close eye on whooping cough after infant’s death

The first whooping cough death in California since 2016 was confirmed Tuesday.

An infant in San Bernardino County died after contracting pertusis, also known as whooping cough, according to a statement from the California Department of Public Health. Department Director Dr. Karen Smith called the death “a tragedy.”

“Any infant death due to pertussis is preventable through maternal vaccination,” said Dr. James Watt, chief of the department’s Division of Communicable Disease Control. For confidentiality reasons, the department is not providing any details about the case, such as the infant’s identity or whether the infant or the mother was vaccinated.

Whooping cough is a bacterial infection of the respiratory tract that is highly contagious and especially dangerous for babies, but today, vaccines can offer protection against the disease.

In general, infants who die from the disease typically have not received a vaccination for it, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

The US Centers for Disease Control and Prevention recommends vaccinating infants at 2 months of age and women in the third trimester of each pregnancy to protect the child until they are old enough to be vaccinated.

Whooping cough vaccines are effective but not perfect; those who contract the disease after having been vaccinated are less likely to develop a serious infection, according to the CDC. The whooping cough vaccine given to children is 80% to 90% effective, but effectiveness decreases over time.

The infection has early symptoms such as runny nose and fever as well as apnea, or pauses in breathing for babies, which can be life-threatening. Later-stage symptoms include vomiting and fits of rapid coughing.

The disease gets its name from the distinctive sound an infected person may make when inhaling after a coughing fit. According to the CDC, breathing in after coughing so much that all the air is gone from one’s lungs creates a high-pitched “whoop” sound.

A deadly disease for the youngest

“Young infants can have very severe disease from pertussis, as this case tragically illustrates, and they can even die,” Watt said.

Fauci said whooping cough is most dangerous for infants because of their narrow windpipes, which can leave them more susceptible to complications from restricted breathing, one of the symptoms of the infection.

According to the CDC, about half of babies younger than 1 year old who develop whooping cough will need hospital care. Watt said that in California, between 50 and 200 infants are hospitalized for whooping cough each year.

The statement released by the California Department of Public Health said infants can be vaccinated at 6 weeks of age, two weeks earlier than the CDC’s official recommendation. Watt said that the recommendation acts as a guideline and that infants can be vaccinated anywhere between 6 and 9 weeks old; however, if there were to be an outbreak of the disease, he said, the department would encourage parents to vaccinate their children closer to the 6-week mark.

Watt said that the infant’s death was not part of an outbreak but that whooping cough has periodic outbreaks every three to five years, and California’s most recent outbreak was in 2014.

“We’re watching very closely to see if there’s any suggestion of any increasing trend in pertussis,” he said.

Whooping cough on the rise

Although cases of whooping cough dropped precipitously in the mid-20th century, the disease has rebounded in recent years.

According to data from the CDC, over 100,000 cases of whooping cough were reported each year in the US until the introduction of a vaccine in the 1940s. From 1965 to 2002, the annual number of cases dropped to below 10,000, but starting in 2003, the number tended to grow. In 2016, the most recent year of available data, nearly 18,000 cases of the disease were reported, which was actually a decrease from the preceding years.

Fauci said the recent rise is due to the country’s switch in the 1990s from a whole-cell pertussis vaccine to an acellular vaccine. The acellular vaccine, although less durable than the whole-cell vaccine, caused fewer and less severe side effects in children. To compensate for the vaccine’s decreased durability, the CDC recommends that children get five doses of the vaccine.

Unvaccinated children may also account for some of the increase. According to the CDC, only 84.6% of children 19 to 35 months received four or more doses of a whooping cough vaccine in 2015, leaving millions of infants potentially susceptible to the disease.

California’s child vaccination rates soared after legislators passed a law in 2015 to ban religious and personal beliefs as reasons to exempt children from school vaccinations, including the one for whooping cough. Two years after passing the law, the California Department of Public Health announced that 96% of kindergarteners had received all their required vaccines, the highest rates the state has had since 2001.

As of July 8, there have been 1,272 cases of whooping cough reported statewide so far this year. Seventeen of those cases hve have been in San Bernardino County, which is in line with the number of cases reported in previous years, according to data from the California Department of Public Health.

“Even when we’re not having an epidemic, pertussis is always there,” Watt said. “It’s always circulating, which means that people are always at risk for pertussis, and particularly, we’re concerned about young infants, who have the most severe disease.”