Often viewed as an affliction of a bygone era, whooping cough is making a modern-day comeback—and two Robert Wood Johnson Foundation (RWJF) Clinical Scholars are working to put a stop to it.
Deepa Camenga, MD, (2009-2012), a third-year Clinical Scholar at Yale University, and Kelly Kyanko, MD, (2008-2011), a Clinical Scholars program alumna who is now an instructor of medicine at New York University, are researching ways to vaccinate new parents and caregivers against whooping cough (the common name for pertussis).
One way to increase the adult vaccination rate is to offer free pertussis vaccinations to mothers and caregivers during infant pediatric visits, Camenga, Kyanko and their colleagues find in a study published in the January, 2012 issue of Academic Pediatrics. Adult vaccinations are a key way to protect newborn infants from the deadly disease, Camenga and Kyanko say. If parents and caregivers are vaccinated against the disease, then infants will be less likely to contract and die from it.
“Physicians know that parents and caregivers of new babies should get vaccinated against pertussis, but the system isn’t delivering,” Camenga says.
Indeed, getting post-partum parents and caregivers to get an expensive shot for an obscure disease that poses little threat to adults is easier said than done.
To get vaccinated, parents and caregivers must first learn about the dangers of the disease for infants—a tall order given its euphemistic name and relatively low profile. Then, they have to come up with the time, energy and money to get the vaccination—three often scarce resources in households with young infants.
Hurdles to receiving the vaccine can be especially high in low-income areas, where parents and caregivers are less likely to have health insurance or receive routine health care. Caregivers in particular may face the highest hurdles, since they are more likely than mothers to report having no insurance and no source of routine care, according to Camenga and Kyanko.
To ease the vaccination burden, Camenga and Kyanko devised a study in partnership with the Hospital of St. Raphael in New Haven, Conn., to measure whether giving adults the opportunity to get vaccinated against pertussis during pediatric clinic visits would increase adult vaccination rates.
Under the study, 60 mothers and 42 caregivers attending pediatric visits for two-week old infants were offered the vaccine at no charge. The study took place from June to December of 2010 at a hospital-based health clinic serving low-income families in New Haven.
Results show that of the 102 people who participated in the study, 70—or 69 percent—received the vaccination. That represents an enormous increase over the average 5 percent of adults who receive the Tdap (Tetanus, diphtheria, and pertussis) vaccine nationwide.
“The initiative is a success,” Camenga says. “By providing the vaccine free of charge and in a convenient location, we have really improved vaccination rates in our community.”
Study Targets Post-Partum Mothers and Caregivers
Camenga and Kyanko came up with the idea in collaboration with clinicians at a local hospital in New Haven, where they served as RWJF Clinical Scholars at Yale University.
Their team targeted post-partum mothers and infant caregivers because newborns are particularly susceptible to pertussis, which causes violent coughing spasms that can produce the disease’s signature whooping sound as carriers struggle to breathe. Infants are more likely than adults to die from the disease because of their immature respiratory and neurological systems and small body size. They do not receive the first of five pertussis vaccination shots until they are two months old and do not become immune until they are four months old.
One of the best ways to protect new babies is to ensure that caregivers are properly immunized, medical experts say. Although the pertussis vaccination rate among children is high, immunity fades over time. To recover immunity, adolescents and adults need to be revaccinated.
The incidence of pertussis has dropped precipitously since the vaccine was introduced in the first half of the 19th century, but rates have surged nationwide in the last two decades. In 2009 there were nearly 17,000 reported cases of pertussis, 14 of which were fatal. During the summer of 2010, a pertussis epidemic in California killed 10 infants.
The resurgence of pertussis prompted the study participants to more readily accept the vaccination, Kyanko said. “People were concerned about their infants’ health and felt that this was something they could do for their infants.”
Camenga and Kyanko hope the project—which was paid for by government subsidies and hospital donations—can be replicated in other pediatric clinics and perhaps broadened to incorporate adult vaccines for other diseases such as influenza.
“We hope that local, state and federal officials would consider incorporating this adult vaccine into a subsidized vaccination program,” Kyanko said.