Published: 2 December 2020
Authors: Professor Lutz Beckert and Dr Mike Maze
This publication is intended as an educational resource for healthcare professionals. It discusses pertussis (whooping cough) infection in individuals with respiratory illnesses such as asthma and COPD, and outlines the prevention of this disease via immunisation with pertussis-containing vaccines. Vaccination against pertussis is fully-funded for children and some at-risk individuals in New Zealand as part of the National Immunisation Schedule.1 The eligibility criteria for immunisation against pertussis in New Zealand has expanded. Pharmac has announced that as of 1 July 2020 the diphtheria, tetanus and pertussis (Tdap) vaccine Boostrix will replace the adult diphtheria and tetanus vaccine (ADT™ Booster) with the current eligibility criteria for Boostrix widened to include eligibility criteria currently in place for the ADT™ Booster vaccine.2 There will be a restriction in place that tetanus booster at age 45 is given only to individuals who have not received four tetanus vaccinations in their lifetime.
EXPERTS’ CONCLUDING REMARKS
This educational resource is becoming available while the world is awaiting a vaccine for the novel coronavirus, highlighting the public health benefits of vaccination. New Zealand has a comprehensive paediatric vaccination programme and life-threatening whooping cough is rare. However, the protection seems to wane after a decade and, in the context of recurrent outbreaks, previously vaccinated individuals are at risk of infection.
As adult respiratory physicians we see many patients with a postinfectious cough. During times of a cyclic endemic, we frequently confirm pertussis via serological testing as the underlying organism. Classically, by the time the serological test is positive, treatment with a macrolide antibiotic is of little benefit as this bacterium has been cleared, however, a cough which causes significant reduction in the quality of life through sleep disturbance, chest pain, rib fractures or vomiting often continues for about 3 months. The impact of pertussis is likely to be higher among patients with chronic respiratory disease.
Given the tolerable safety profile, the cyclic nature of the illness and the impact on quality of life, it seems prudent to discuss the opportunity of a revaccination for whooping cough with our patients, particularly our patients with chronic lung conditions. The change in the immunisation schedule, from 1 July 2020 should prompt us to actively consider vaccination for those who are eligible.