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Posts for tag: Tdap

August 26, 2019
Category: Immunizations
Tags: DTaP   Tdap   tetanus   spores   Diseases  
July 3, 2019 from AAP News

Tetanus spores lie in wait for unvaccinated children

Satoshi KamidaniM.D., FAAP and Larry K. PickeringM.D., FIDSA, FPIDS, FAAP

Tetanus is caused by a neurotoxin called tetanospasmin produced by the anaerobic, spore-forming, gram-positive bacillus Clostridium tetani. Tetanospasmin affects the nerve endings at the nerve-muscle junction, leading to severe skeletal muscle spasms and convulsions.

The dormant spores are everywhere in soil and intestinal tracts of mammals and can survive for months to years. The spores germinate and begin to produce the neurotoxin under favorable conditions, which include contaminated wounds due to traumatic injury, deep puncture wounds caused by dirty nails or animal bites, inappropriate umbilical cord care in the neonate or a foreign body in the skin.

Pediatric tetanus case

In 2017, an unvaccinated 6-year-old boy developed tetanus following a forehead cut he sustained while playing outdoors on a farm. It was the first pediatric tetanus case reported in more than 30 years in Oregon.

The patient had jaw spasms and involuntary arm muscle spasms and subsequently developed body stiffness and difficulty breathing due to diaphragm and voice box spasms.

He was air-transported to a pediatric medical center where he received intensive care, including sedation, analgesia, endotracheal intubation (followed by tracheostomy), mechanical ventilation and neuromuscular blockage in an environment with minimal stimulation (a darkened room and ear plugs). He also developed nervous system (hypertension, tachycardia and body temperature instability).

Antibiotics, tetanus immune globulin and diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) were administered. The wound was irrigated and debrided. He required approximately eight weeks of inpatient care (including six weeks of intensive care), followed by one month of rehabilitation before he fully recovered. The inpatient charges were $811,929.

Although physicians discussed the risks and benefits of tetanus vaccination with his parents, they declined any recommended immunizations, including the second dose of DTaP.

Tetanus worldwide

Although the tetanus toxoid vaccination has contributed significantly to dramatic reduction of the incidence of tetanus, the disease remains a public health problem worldwide. The World Health Organization (WHO) reported that approximately 34,000 newborns died worldwide from neonatal tetanus in 2015, while 86% of infants worldwide were vaccinated with three doses of diphtheria-tetanus-pertussis (DTP) vaccine in 2016.

According to Centers for Disease Control and Prevention (CDC) surveillance, 197 cases and 16 deaths from tetanus were reported in the United States from 2009-’15. While most cases were adults and all tetanus-related deaths occurred in elderly adults, 24 (12%) cases were in patients younger than 20 years of age, including two cases of neonatal tetanus (see figure).



Based on National Immunization Surveys, estimated DTaP vaccination coverage with at least three doses among U.S. children ages 19-35 months was 94% in 2017, whereas coverage with at least four doses was as low as 83%. Importantly, the coverage among uninsured children 19-35 months of age was significantly lower (78% with at least three doses and 62% with at least four doses, which is below the average worldwide) than insured children.

It is crucial to inform caregivers that uninsured or underinsured eligible children can receive vaccines at no cost through the Vaccines for Children (VFC) program ( 

Tetanus vaccination and safety

One of the striking facts about tetanus is that people cannot naturally acquire immunity to tetanus even after recovery from tetanus disease. This is likely because people can develop tetanus from a small amount of toxin production, which usually is not sufficient to elicit an immune response. In addition, there is no herd protection against tetanus since this is not a communicable disease. Therefore, tetanus vaccination of each child is the only way to provide protective tetanus immunity.

The Recommended Child and Adolescent Immunization Schedule calls for children to receive a five-dose series of DTaP at 2, 4, 6 and 15-18 months and 4-6 years of age. Adolescents should receive a single dose of Tdap at 11-12 years of age.

In addition, adults should receive a Td booster every 10 years, and pregnant women should receive a single dose of Tdap during every pregnancy, preferably during the early part of gestational weeks 27-36.

Information on use of Tdap or Td as tetanus prophylaxis in wound management is available at

Tetanus toxoid-containing vaccines are highly effective and safe. Mild local reactions or fevers are commonly seen, but severe reactions including neurologic or anaphylactic reactions are rare.

Rise of vaccine hesitancy

Vaccine hesitancy and refusal are growing rapidly and are considered one of the major threats to global health by the WHO. Most cases of tetanus in the United States occur in unvaccinated people.

Since vaccine-preventable diseases (VPDs) are uncommon, it is important for health care professionals and the public to be reminded of how devastating VPDs are and that vaccinations are the best way to prevent them. Infants and children are susceptible to all diseases in the immunization schedule if not properly immunized.

Dr. Kamidani is a pediatric infectious diseases fellow at Emory University School of Medicine. Dr. Pickering is adjunct professor of pediatrics at Emory University School of Medicine.

August 23, 2018
Tags: Cough   Influenza   immunizations   Vaccines   DTaP   Tdap   Pertussis   Whooping Cough   DTP  

Whooping Cough, Claimed the Life of a San Bernardino County Infant


The California Department of Public Health (CDPH) announced [Tue 17 Jul 2018] pertussis, better known as whooping cough, claimed the life of a San Bernardino county infant. This is the 1st confirmed infant death from the disease since 2016, when 2 deaths occurred.


"This baby's death is a tragedy for the family and for California as a community, as this is a preventable disease," said Dr Karen Smith, CDPH director and state public health officer. "This serves as a grim reminder that whooping cough is always present in our communities, and immunizations are the 1st line of defense."

What whooping Cough looks and sounds like:


Akron's Children's Hospital Video about Pertussis:


Each year, 50-200 California infants are hospitalized with pertussis. CDPH and the Centers for Disease Control and Prevention (CDC) recommend that expectant mothers receive the whooping cough booster shot (also called Tdap, or tetanus, diphtheria and acellular pertussis vaccine) at the earliest opportunity between 27 and 36 weeks of every pregnancy, even if previously immunized. Getting immunized during pregnancy boosts a mother's immunity and passes on protective antibodies directly to their babies before birth. This helps protect newborns until they are old enough to begin receiving their own whooping cough immunizations at 6 to 8 weeks of age.


"No baby should have to be hospitalized due to a vaccine-preventable disease, and certainly no baby should die," said Dr Smith. "To give babies the best protection, I urge all pregnant women to get vaccinated against whooping cough as early as possible during the 3rd trimester of every pregnancy."


To avoid the spread of whooping cough, CDPH also recommends that:

- parents immunize their babies against whooping cough as soon as possible. The 1st dose is recommended at 2 months of age, but can be given as early as 6 weeks of age;

- California 7th grade students [should] receive the whooping cough booster, Tdap;

- adults should receive a whooping cough booster once in their lives.



Dominican Republic

Source: Hoy Digital [in Spanish, machine trans, edited

Two children under 2 [years of age] died in the last week at the Robert Reid Cabral Children's Hospital because of whooping cough, a contagious and vaccine-preventable disease. The dead are a girl aged 15 months from the community of Cambita, San Cristóbal and another one of 3 months, who lived in La Romana.


Also, another 28 children have been admitted with this disease, which calls the attention of the pediatricians of the hospital, since the vaccine that immunizes is included in the Expanded Program of Immunizations (PAI).


The official website of the Ministry of Health, in the epidemiology component, defines pertussis as an endemic respiratory disease that commonly affects children under the age of 5, with infants under 6 months of age at the highest risk of complications, but also it can affect teenagers and adults. The use of the vaccination scheme with DPT [diphtheria, pertussis, tetanus] or pentavalent [diphtheria, tetanus, pertussis, hepatitis B, and _Haemophilus influenzae_ type b (Hib)] is the main prevention measure, while pertussis outbreaks tend to occur every 3 to 4 years, according to official information.


So far this year [2018], 29 probable cases of whooping cough have been reported, 7 in the last 4 epidemiological weeks. As many as 9 out of 10 cases correspond to children under 1 year of age. Santo Domingo Norte and Santiago are the demarcations that register the highest number of cases.


Faced with this situation, the Ministry of Health instructed the provincial directorates and corresponding health areas to ensure adequate research and response to preventable diseases.



Dr. T comments:

For every case of reported Whooping Cough, 100 cases go unreported and unrecognized. Teens and adults are usually not as sick as children under age one year, but they are highly contagious. Whooping Cough is called the 100 day cough. Sometimes the cough is so bad, that one can break a rib or two. Women who are pregnant are antibody factories. That is why pregnant women are encouraged to have the Tdap vaccine shot every pregnancy in their last trimester even if they have had it before. The antibodies against Pertussis that they produce because of the Tdap vaccine passes through the placenta to their babies offering them some protection until their babies are old enough to receive immunizations to stimulate their own immune systems to produce their own protective antibodies. 


The same reasoning applies to pregnant women getting the influenza shot in their last trimester as well. Babies can not get a flu shot until they are six months old. So in addition to the gift of life, mothers who get the flu shot (in season) and a Tdap also give the gifts of antibody protection to their newborn infants. Not a bad way to start a healthy life!


The Wrong way to Cover Your Mouth when coughing!


If a person has had the disease, Whooping Cough, this disease does not convey life-long immunity as many other illnesses do. Appropriate immunizations against Whooping Cough also do not convey life-long immunity to the disease. All teens and adults should have at least one Tdap vaccine. Right now there is no recommendation for adults to have Tdap booster, however we know that Whooping Cough antibody protection from a Tdap only lasts 3-5 years. Even though we depend on a mother's Tdap antibodies passing through the placenta to protect her baby, even though it is not Public health Policy, it still seems wise to me that all adults who are going to be around a newborn in the baby's first year of life should have a current Tdap "booster" if it has been more than 3 or 4 years since the adult's last Tdap. Perhaps National Policy will eventually change to this recommendation. Don't know! But I do know that Pertussis antibodies from a Tdap only last 3-5 years and then are gone.


All forms of Whooping Cough immunizations are effective and safe and can be given with any other vaccine that is needed, e.g. influenza vaccine, etc. As a community we depend on each other for many things. This includes protection from serious disease. We expect restaurant employees to wash hands before they leave the restroom. We expect each other to not drink and drive, to not text and drive, to cover our face appropriately when we cough. Similarly, we should expect each other to get safe and effective immunizations to protect each other, our children and our families from preventable contafious disease. 


Ask your doctors about your current immunizations status and that of your children. If you've not had a Tdap, get one. If you've not had a flu shot, plan to get one. The flu shot is now so purified, that even people with egg allergy can get one. September and October are perfect months for a flu shot. The flu shot is preferred this year, 2018, over the nasal spray influenza vaccine. 

December 23, 2014
Category: Immunizations
Tags: immunizations   Vaccines   DTaP   Tdap   Pertussis   Whooping Cough   Polio  

Are Vaccines on our New Year’s Resolution List? Fodder for Thought!


The following are some NBC news items from this past year about vaccine preventable diseases.  As this year comes to an end, my New Year’s Hope for our community is that we will not suffer these diseases and their sad consequences because all of us will do our part to protect ourselves and our families, friends and neighbors by keeping our immunizations current and up to date. Some of us can not get immunizations due to true medical conditions and depend on the grace and good-will of others to be protected from these diseases.


Every adolescent and adult should have at least one Tdap vaccine to remain protected from Whooping Cough (Pertussis). The outbreak of Pertussis in California can occur in Georgia and every other State in the U.S. when the community proportion of immunized persons falls below an important threshold of protection.


The Tdap vaccine should be given to every pregnant woman with every pregnancy in the last trimester of her pregnancy to boost her antibody level against Whooping Cough. This antibody boost flows into her fetus prior to delivery and protects her baby from Whooping Cough through the first 6 months of life until the baby’s own immunizations provide adequate protection. Whooping Cough (Pertussis) kills babies under 3-6 months of age. This vaccine is safe for all mothers-to-be and is their first gift of love and protection to their unborn child. Her second gift is asking her family and friends to get their Tdap vaccines before the baby is born in preparation for their first visit.


Parental decisions about immunizing or not immunizing their children are not always easy or straightforward. The science of the safety and effectiveness of childhood and adult immunizations is not always believed. As one of my physician teachers pointed out to me, “Fear Trumps Science.” Fear does not always respond to reassuring factual information. While we live in a democratic pluralistic society and we must respect the rights of others, we all have a duty to make rational decisions that benefit ourselves and the common good. Remember the parable of the man who while drowning refuses help and assistance from three boats passing by while waiting for G-d to save him. After drowning on presenting himself at the pearly gates, he asks G-d, “Why did you not save me as I knew that you would?” G-d answered, “What did you want from me? I sent three boats to save you.” G-d gave us minds to improve and perfect the world, and with these minds, man created vaccines to prevent the scourge of disease. Get on the boat when it passes by.


One has to wonder how big an epidemic and how much preventable suffering must occur in a community before those who fear vaccines fear the scourge of disease more, and will rush to the end of the line to get immunized.


No vaccine is 100% effective. Whooping Cough is called the 100 day cough. Although it’s not usually fatal to older children and adults, it is no fun and it is highly contagious! It’s not children who give infants and children Whooping Cough (Pertussis), it’s adults (often parents and family) who spread it to others. Pertussis can be fatal to infants under 3-6 months of age. The improved DTaP vaccine that children have gotten for decades is safer than it has ever been, but there is growing evidence that its protection against Whooping Cough wears off sooner than hoped for, 3-5 years instead of 10 years or longer. The old whole cell DTP vaccine was very effective providing 10 year plus immunity to Whooping Cough, but the vaccine had more troublesome side-effects. Even though the newer DTaP and Tdap is far safer though less long lasting, it is more effective than NO vaccine at all. Until a safe and longer lasting “P” component of DTaP & Tdap is developed, children and adults should get the current “P” vaccine to protect against Whooping Cough. Please encourage pregnant women to get their “P” vaccine (Tdap) in their last trimester, even if they have had Tdap previously prior to pregnancy. And if you plan to visit a household where there is an infant under age one year, have the consideration to have had your Tdap (as an adult) at least once in the past decade or a few weeks before you enter their household if you have not yet had Tdap.


Atlanta is one of the nation’s Metropolitan areas where there is a growing number of school children whose parents have chosen to delay or defer immunization in part or in whole. We are prime for an outbreak of preventable childhood diseases, such as Measles, Mumps, Whooping Cough, etc. This is a dangerous situation. Don’t wait until the news media report disease in Atlanta or Georgia; keep up with your immunizations now. Let that be among your New Year’s Resolutions.


It doesn’t take an Amish Community to have a significant number of unimmunized or under immunized children and adults. Just look down your neighborhood street to the right and to the left. Odds are most of your adult neighbors have not had a Tdap vaccine and many of their children are missing necessary vaccines to protect themselves and the community. If your community has a homeowner's association (HOA), why not create an educational program to inform and remind everyone about preventable diseases and important immunizations? This program won’t convince everyone to act, but it will many. There is no need to embarrass anyone by asking them to reveal their vaccine status or philosophy; simply present information and let people make their own rational choices. Perhaps your doctors or your County Public Health Department will provide information or speakers for your HOA program. If you do not have an HOA, perhaps your church, synagogue, or mosque will sponsor a similar educational program for their membership.


Who would have thought we might be thinking of a polio epidemic in the USA in the 21st century? This has not happened YET, but the only protection against a polio epidemic is the polio vaccine. We only use IPV (inactivated polio vaccine) in the U.S.  IPV cannot cause polio. It is NOT a live vaccine. It is safe. We have military in countries where polio is occurring and although our soldiers are immunized against polio, of course, there is no 100% effective vaccine. It is not beyond the realm of possibility that a healthy soldier could bring polio back to the US where the virus might spread. If not the military, then perhaps polio might be imported into the U.S. by international travelers. After all Atlanta does have an international airport. When parents choose to delay or defer childhood vaccines, polio is often the vaccine saved to last if it is given at all. Parents feel that polio presents no real risk to their children. But we don’t live in a bubble. International travelers and returning military interact with us daily in Metropolitan Atlanta. We watch movies in cinemas and shop in grocery stores and malls with international travelers whether we know it or not. We all handle the same currency and hold on to the same escalator handrails. And this is as it should be. Make a New Year’s Resolution to be sure your children are current with their polio vaccines. If you plan to travel abroad, seek out current vaccine recommendations from for the country or countries to which you are traveling.


Our Public Health Authorities and the CDC continuously monitor our public health. Vaccine recommendations are an ongoing dynamic reality. We will look to them to keep us abreast of current risks and what we can do to prevent and respond to preventable disease.


Best wishes for a Merry Christmas, Happy Hanukkah, Happy Quanza and a Healthy New Year!


Dr. T