Pertussis vaccine is safe for preemies

The pertussis epidemic in California has many new parents worried. For preemie parents, it’s just one more thing to add to the list. Pertussis, or whooping cough, has affected more than 6,000 people so far this year in California. More than 200 children have been hospitalized and 10 have died. One was a premature baby, born at 28 weeks who received the first dose of DTaP (diphtheria-tetanus-pertussis vaccine) at 2 months of age (15 days before dying – not enough time to be protected).

Children are most vulnerable to whooping cough, especially those under the age of 6 months. This is due to smaller airways and weaker immune systems. Preemies are at increased risk, especially if they have bronchopulmonary dysplasia.

While hand hygiene is important, the best defense  against pertussis is vaccination for everyone who might come into contact with your baby in addition to vaccinating your baby. Getting parents vaccinated is key as more than 50% of infants who get pertussis catch it from one of their parents. Pertussis is highly contagious – about 90% of household contacts who are susceptible will catch the infection. Basically, it spreads like wild fire.

A sad piece of  insider information is the fact that many health care workers, including NICU doctors and nurses, decline vaccination deespite all the safety studies and the proof that pertussis vaccination reduces the risk of catching the infection 23-fold. This is a major problem as pertussis starts off as the mildest runny nose, so the person handling your baby will be infectious before he or she even knows she is sick.

Despite the safety of the vaccine (millions of doses given with no increased risk of severe allergic reactions, sudden infant death syndrome, or autism) many parents wonder if it okay to give their tiny preemie shots at 2 months of age (when the first dose should be given). Many preemies are still less than 4 lbs when their first vaccines are due. Fortunately, a study published in 2008 in the journal Pediatrics (by Carbone et al.) should help put some minds at rest. This study looked at 93 preemies (average weights 1,750 g) who received the DTaP vaccine while in the NICU and compared them with preemies who did not receive the vaccine. There were the same amount of apneas and bradycardias in in both vaccinated and unvaccinated babies.

This study is VERY important because it had a control group, meaning the apneas and bradycardias in vaccinated babies were compared with the rate of in babies who had not received the vaccine. Another older study from 1997 questioned whether the pertussis vaccine DTaP might increase the rate of apneas and bradycardias; however, that study did not have a control group so it was impossible to know if the apneas and bradycardias were due to the vaccine or just plain old apneas and bradycardias of prematurity. This study tells us that 16-20% of babies who weigh 1,750 g have prolonged apneas and 56-58% have prolonged bradycardias and the rate is not affected at all with vaccination.

Apneas and bradycardias happen. They peak and trough like the roughest ocean and are truly maddening for parents. But they are not caused by the pertussis vaccine, which is safe for all kids, especially those who need it the most.

And one last thing. Ask everyone who comes in contact with your baby is they are vaccinated against pertussis. Adults should have a booster if they haven’t had one in past 10 years. Don’t be afraid to ask doctors and nurses. Your baby has a right NOT to be infected by their care provider.

Want to know more about pertussis? Check out this video:

Remember, this blog does not represent individual medical advice

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One Response to Pertussis vaccine is safe for preemies

  1. René Najera says:

    Thank you for this very valuable information, Dr. Gunter. Lack of a control group leads to analysis bias, which is not a good thing to come up with a reasonable conclusion. That’s not to say that looking at patient charts and medical histories is not valuable for building a foundation for knowledge. Thanks again.

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