How to Protect a Newborn from Whooping Cough

Between 2008 and 2012, incidents of whooping cough increased four to five fold. For expectant mothers, this is a concerning statistic, as we want to do everything we can to protect our families, and particularly vulnerable newborns. RESCU spoke to paediatrician and vaccines expert Dr Tom Snelling of the Telethon Kids Institute to find out how to protect a newborn from whooping cough.

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RESCU: To what extent has the number of Whooping Cough cases increased in recent years?
Dr Tom Snelling: Whooping cough cases increased 4-5-fold across Australia from 2008-2012. Since then the number of cases has declined again.

RESCU: How dangerous is Whooping Cough for newborns?
Dr Tom Snelling: For newborns who have never been immunised, whooping cough usually results in severe symptoms, usually requires admission to hospital, sometimes requires admission for intensive care, and occasionally results in death – even in countries like Australia with good health facilities.

RESCU: What are the biggest risk factors that may cause newborns to contract Whooping Cough?
Dr Tom Snelling: By far the biggest risk factor for an infant is not being immunised. Because it takes at least two vaccine doses to be highly protected, infants are at greatest risk before they are 4 months old. We also know that most newborns who have been infected have acquired the infection from a household member, usually a parent or an older sibling. Sometimes the infection is so mild in that family member that they may not realise they are infected.

RESCU: What is cocooning? And how thorough do we need to be in this process?
Dr Tom Snelling: Cocooning is the strategy of protecting newborn infants by vaccinating other family members. The idea is that if you can prevent infection in household members then you effectively create a shield or ‘cocoon’ for the infant, protecting him or her even before they are old enough to be vaccinated themselves. Our work has shown that this not only works in theory, it works in practice. Immunizing both parents halves the risk of infection in their newborn infants. Our work suggests immunising mothers is most important, but booster vaccinating other family members and ensuring older siblings are fully immunised is also beneficial.

RESCU: Are there different kinds of Whooping Cough vaccinations available, and if so which is the most effective?
Dr Tom Snelling: In Australia we use acellular pertussis vaccines. In most countries they use whole cell pertussis vaccines which are more likely to cause fever and local swelling. Our work has shown that 2 doses of acellular vaccine is very effective for protecting infants against severe disease.

RESCU: Is it safe for expectant mothers to vaccinate during pregnancy, or should we preparing before we fall pregnant?
Dr Tom Snelling: All evidence we have is that vaccinating with non-live vaccines like pertussis vaccine is safe in pregnancy, and for some vaccines like influenza vaccine there is good evidence that this is beneficial to mother and baby. Our work has shown that when mothers are vaccinated against pertussis before pregnancy, their babies are less likely to develop whooping cough. We also know that vaccinating in pregnancy is safe so women should be vaccinated in pregnancy if they haven’t received a pertussis vaccine dose in the 5 years before pregnancy.

RESCU: What are other key vaccinations that a mother should consider during pregnancy?
Dr Tom Snelling: There is very good evidence that women should be vaccinated against influenza if they are going to be pregnant during the winter months. Any woman who did not receive all of their routine childhood vaccinations should discuss with their GP or obstetrician whether they need any catch-up vaccinations before or during pregnancy.

RESCU: Are there any risks associated with Whooping Cough vaccinations?
Dr Tom Snelling: We know from the millions of infants who have received pertussis vaccines that they are very safe. Like all vaccinations, short term reactions like fever and pain at the injection site is fairly common after pertussis vaccine. Many infants are also more irritable after vaccination, and this peaks between 6 and 24 hours after immunisation. The worst short term reaction is called a hypotonic hyporesponsive episode which occurs in about 1 in 30,000 vaccinated infants. In these rare episodes, the infant becomes very sleepy and difficult to wake up some time after vaccination. The episodes usually last a number of minutes and afterward the infant is back to normal. Although this can be frightening, we know that these episodes do not cause any long term problems.

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