August is National Immunization Awareness Month

Spotlight on whooping cough in Oregon

When Jill Evans gave birth to a baby girl in mid-January 2009, she was elated, yet concerned. Baby Grace had arrived a few weeks early and was on the small side, but she thrived until she was about four weeks old. "She suddenly seemed sort of lethargic, sleeping a lot," says Jill, a mother and schoolteacher who lives in Winston, outside of Roseburg. "Then she started coughing; it almost sounded like she was choking."

The coughing and vomiting continued to the point where Grace couldn't eat-she woke only to cough and choke. Jill and her husband Scott grew gravely concerned for their tiny baby. "We were scared," says Jill. "I finally got a pediatrician on the phone who said, 'Take her to the ER and have them test her for pertussis."

Pertussis, also known as whooping cough, is a highly contagious respiratory infection that causes a strangling cough, which can last for months. It is particularly dangerous for tiny newborns who are too young to be vaccinated and have a very tough time getting through the wracking cough.

At the ER, they tested Grace for pertussis with a nasal swab. "By this point she was pretty limp and seemed almost lifeless," Jill says. "We didn't feel safe having her at home. She was struggling to breathe." At 2 a.m., the nurses were trying to put oxygen over Grace's face so she could get air. At 3 a.m., Grace's heart rate was elevated to 215. They Life-Flighted the baby to Doernbecher Children's Hospital in Portland and put her in the Intensive Care Unit (ICU). Grace had pertussis.

Jill says it was horrible waiting for the antibiotics to work. "She had coughing spells all night long. We had to hold her tiny body up with our hands under her armpits while lifting her arms high in the air and allowing her body to hang down to try to relieve her chest," Jill says. "The first couple of nights and days seemed like that's all we were doing. She was put on oxygen and had a feeding tube along with multiple IVs for antibiotics and hydration." After six days in ICU, Grace finally began to get better. Her brother Noah, two years older, received antibiotics as well. Today, they are both happy, healthy, fully immunized children.

Thinking back, Jill believes Grace caught whooping cough from her. "I didn't realize the whooping cough vaccine wears off and adults need to get a booster," she says. "I worked around sick kids right up to the time Grace was born," she says, "and I had a bad cough myself when she was about two weeks old. Some people around us were getting tested for pertussis." If she had known, Jill would have made sure both she and her husband were vaccinated against whooping cough when Grace was born.

She hopes people will learn from her experience. "I've never been part of the vaccination debate," Jill says, "but even if you're questioning getting your children fully immunized, at least get the booster yourself to avoid passing whooping cough on to your kids."

August is National Immunization Awareness Month, and Oregon Public Health officials are taking this opportunity to implore everyone, especially expecting and new parents and siblings as well as health care providers, to make sure they are up-to-date on their pertussis vaccine. Infants cannot receive their first pertussis vaccination until they are 2 months old, but if everyone around a new baby is immunized, they can cocoon that newborn and protect him or her from going through what Grace went through, or worse. Individuals age 2 months and older should receive regular DTaP vaccinations (for children through age 6) as well as one routine Tdap booster (starting at age 11) to protect themselves and those around them from whooping cough.

Since 2003, four infants under three months of age have died from pertussis in Oregon. So far this year, there have been nearly 200 cases of whooping cough reported in our state. California declared a pertussis epidemic in June; seven babies have died, and there have been over 1,500 cases there. Southern Oregon reports more cases of pertussis than usual this year-the peak season for whooping cough is summer.

Jill may have felt alone and frightened when Grace caught whooping cough, but there were scores of people across the state addressing her baby's illness. Juventila Liko, an Oregon Public Health epidemiologist in the immunization program, studies pertussis and other vaccine-preventable diseases in Oregon.

When a baby catches whooping cough, Liko takes note and watches carefully in case there is an outbreak. If necessary, she participates in the Urgent Epidemiology Response Team, working with county and state health officials to collect and analyze data; assist with testing, recommend diagnostic techniques, treatment, prophylaxis and intervention measures; and support illness surveillance across the state. Liko also designs studies to identify risk factors for vaccine-preventable disease in Oregon, and reports those findings to local, state and federal health officials.

But for Liko, pertussis isn't all science and data and surveillance. She knows that each pertussis statistic represents a child. "Reading a chart and seeing the handwritten notes is hard," Liko says, "especially if you're a parent. Seeing the words 'baby passed away peacefully,' from a vaccine-preventable disease, is just heartbreaking."

For more information on immunization and vaccine-preventable diseases, visit www.oregon.gov/DHS/ph/imm. Read an open letter about immunization, endorsed by more than 140 individuals and groups: www.oregon.gov/DHS/ph/imm/openletter.shtml. The Oregon Immunization Program invites you to follow immunization news online: www.facebook.com/OregonImmunize and www.twitter.com/OregonImmunize.