Cough & Cold Watch

Experts Revise Guidelines for Whooping Cough Vaccination

In September, the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention released revised recommendations for the use of Tdap vaccine to protect against pertussis in older children and adults.

According to the AAP, pertussis is easily transmitted and causes severe, uncontrollable coughing. Although it primarily affects adolescents and adults, it can be a serious threat to infants who are too young to be immunized. Pertussis is often transmitted by older, unvaccinated family members, friends, and relatives.

Recommendations from the policy statement, published in the October 2011 issue of Pediatrics, are as follows:

• There is no minimum interval required between receipt of a tetanus toxoid or diphtheria toxoid containing vaccine and Tdap when Tdap is otherwise indicated.

• A single dose of Tdap should be given to children aged 7 to 10 years who have incomplete or unknown pertussis vaccine history.

• A single dose of Tdap should be given to adults of any age who have not received Tdap previously, who are health care workers, or who have or anticipate having close contact with an infant younger than 12 months.

• A single dose of Tdap may be given in place of the tetanus and diphtheria toxoid vaccine to any person aged 65 years or older who has not previously received Tdap.

To access the guidelines, visit http://pediatrics.aappublications.org/content/128/4/809.

Some Parents Still Hesitant to Follow Recommended Vaccine Schedule

More than 1 in 10 parents of young children use an alternative vaccination schedule, according to a new study, which also found that a significant number of parents who use the recommended schedule are likely to switch to an alternative schedule.

In the study, which is published in the October 2011 issue of Pediatrics, researchers from the University of Michigan interviewed 771 parents of children aged 6 months to 9 years. Of those parents, 13% reported deviating from the recommendations, and 2% refused all vaccines. Of those who used an alternative schedule, 41% said they developed the schedule, 15% used a schedule developed by a friend, and 8% reported using a well-known alternative schedule.

The researchers found that using an alternative vaccine schedule was strongly associated with not having a regular health care provider for the child, and that the vaccines most commonly delayed were the measles-mumps-rubella (45%) and diphtheria-tetanus-acellular pertussis (43%) vaccines.

A large minority (30%) of parents using an alternative schedule said they had initially followed the recommended vaccination schedule, with most switching because it “seemed safer.” Additionally, 1 in 4 parents who followed the regular vaccination schedule said they believed delaying vaccination was still safer.

These results, according to the authors, highlight the need to develop strategies to prevent the spread of attitudes and beliefs that counter vaccination.

“Small decreases in vaccine coverage are known to lead to dramatic increases in the risk of vaccine preventable disease outbreaks,” said Amanda Dempsey, MD, PhD, MPH, of the University of Michigan. “Not following the recommended schedule leaves kids at risk for these diseases unnecessarily.”

Cold and Flu Season Poses Risks for Children with Asthma

Having a cold or the flu can exacerbate symptoms of asthma, according to researchers from Nationwide Children’s Hospital in Columbus, Ohio, who found that 30% of children admitted to the hospital with the flu have asthma, and are at an increased risk for developing pneumonia.

Triggers such as common cold, a change in the weather, allergens that children are exposed to, and cigarette smoke can cause already irritated airways to become even more agitated, said Beth Allen, MD, a physician of pulmonary medicine. “Colds are the number one thing that lands kids with asthma in the hospital. They’ll come down with a cold, start having a cough on day two, and by day three, they’re pretty sick and can experience a severe asthma flare-up.”

Dr. Allen and colleagues have witnessed a surge in the number of children who visit the emergency department during cold and flu season at Nationwide Children’s Hospital. To help reverse this trend, she suggests that parents make sure that children are caught up on flu shots and get a checkup during the fall. She also recommends that parents closely monitor children who are prescribed a daily asthma controller, and work with their child’s physician to develop a written asthma action plan to help prepare for different situations that could affect children’s health.

“Parents should be able to recognize the symptoms, know which medicines to use if they develop, and know when to call the doctor if that medicine is failing,” she said.