Canadians! Vaccinate before you go to … California?

I guess it was inevitable. The Public Health Agency of Canada issued a travel advisory today. Advisories themselves aren’t surprising, they’re issued all the time for travellers to countries like China, Angola and Tajikistan. But today’s warning is for travellers to California:

An increased number of pertussis cases (also called whooping cough) has been reported this year in California in the United States.

As of August 24, 2010, the California Department of Public Health has reported 3,311 cases of pertussis. This number is seven times higher than what was reported in 2009. Cases include 8 deaths, 7 of whom were infants under two months of age who had not received any doses of the pertussis vaccine.

Other states in the Unites States have reported an increase in localized cases of pertussis while others are reporting similar rates to last year. No state other than California, however, is reporting state-wide disease.

Pertussis cases occur around the world, including Canada. Pertussis is a highly contagious disease that causes coughing spells which can last for four to six weeks. It is spread through droplets in the air from coughing or sneezing. This disease can affect people of any age however it is more serious among young infants.

The Public Health Agency of Canada (PHAC) reminds travellers to make sure their pertussis vaccination is up-to-date.

The outbreak seems the consequence of adults whose immunity has lapsed. In this group, pertussis resembles a cold – but it’s easily passed on to children, where it can be much more serious. In most kids, vaccinations offer good protection. But no vaccine offers 100% protection, and there are always kids who aren’t vaccinated, or aren’t fully protected. And pertussis in young children can kill.

Why are we seeing a large increase in pertussis in California? The reasons aren’t clear yet. It’s easy to jump to blaming anti-vaccination sentiment. But the true cause has not yet been established.

There are four different vaccines in Canada that contain the pertussis vaccine, bundled in with other vaccines. For those of you unsure about the efficacy of the pertussis vaccine, the Public Health Agency of Canada’s data are instructive:

The vaccine has reduced the incidence by 90%, but hasn’t eliminated it completely. :

Pertussis (whooping cough) is a highly communicable infection of the respiratory tract caused by Bordetella pertussis. The disease can affect individuals of any age; however, severity is greatest among young infants. One to three deaths occur each year in Canada, particularly in infants too young to have begun their immunization and in partially immunized infants (e.g., one or two doses). The number of affected adolescents and adults has steadily increased, and the morbidity in these cases is not insignificant. The goal of pertussis control is to decrease the morbidity and mortality of pertussis across the entire lifespan. Protection of adolescents and adults is a worthy goal for the benefit of these individuals themselves, notwithstanding the added indirect protection that it may provide to infants.

Prevention of pertussis is simple. Ensure your vaccination schedule is up-to-date. By vaccinating, you can help prevent children from ending up like this:

How coincidental that this very weekend, the Hug Me, I’m Vaccinated campaign is kicking off at the Dragon*Con conference in Atlanta. An initiative of Skepchick.org and the Women Thinking Free Foundation, the Hug Me campaign is offering free vaccinations to anyone that wants one. But you Canadians don’t need to go to Atlanta to get a free vaccine. And it doesn’t matter if you’re not heading to California. If you’re an adult with regular contact with infants, you should ensure you’re protected. These vaccines are covered by your provincial medicare program, so it’s at no cost to you. Make an appointment with your family doctor, get your vaccinations up-to-date, and help protect those that can’t protect themselves.

4 Responses to “Canadians! Vaccinate before you go to … California?”

  1. Brian Hoyt says:

    By all means get vaccinated. I had the misfortune of contracting pertussis about eight years ago through a series of circumstances. 1. My vaccinations were probably a little old (mea culpa)
    2. I was in the ER being treated for a severe allergic reaction
    3. In the next bed were two children from a strict religous community that did not vaccinate who were infected with…
    4. A particularly virulent strain that happened to be circulating at the time.

    The cough was so severe and relentless that I coughed myself right out of breath and would black out. I spent several days in hospital on assisted breathing. I developed a secondary pneumonia, was off of work for two months and was a long time recovering. As a reminder of that time, whenever I get a respirator infection now that coughing fit finishing up with the “whoop” comes back, but thankfully in a milder form. At the time I got sick I was an otherwise healthy and fit man in his 30′s. I cannot imagine the suffering a child or infant having this would go through.

    I started watching this video but couldn’t finish. It was too upsetting. Get vaccinated.

  2. AshleyZ says:

    I haven’t been immunized since I was a kid (I’m 30 now) so I went to the clinic today, but they could only give me Tetanus and Diphtheria boosters. I requested the pertussis vaccine specifically, because DTaP (Diph, Tet, acellular pertussis) is the recommended immunization for someone in my situation according to the Public Health Agency of Canada website, but apparently it’s not on Alberta’s vaccine schedule. The idea of giving DTaP to an adult seemed completely foreign to the nurse, so there must not be a lot of people asking. Her (paper) reference book said that it’s only recommended for a few adults with really uncommon conditions, like liver stem-cell transplant recipients.

    I e-mailed Alberta Health & Wellness a question about this policy.

    • Scott Gavura says:

      Please post the response you receive. Alberta Health and Wellness says the following:

      Who should receive the DTap vaccine?

      This vaccine replaces the tetanus and diphtheria booster previously offered to grade nine students. An additional dose for tetanus and diphtheria will be required in 10 years. At this time, it is not known if a dose of pertussis vaccine will be required in 10 years as well.

      The Alberta immunization schedule is here.

  3. AshleyZ says:

    I sent in this question:
    “I would like to know if Alberta Health and Wellness has any plan to harmonize their immunization schedule with the Public Health Agency of Canada. For instance, the PHAC recommends that people receive a Tetanus, Diphtheria, and acellular Pertussis booster once in adulthood, but Alberta clinics only offer Tetanus and Diphtheria. There has been a recent Pertussis epidemic in California that has infected about 4,000 people and killed 9 infants, in part due to low adult vaccination rates. Newborns cannot be vaccinated, so they rely on the herd immunity of the adults around them.”

    I got the following answer from AH&W a few days later:
    “In Canada, the National Advisory Committee on Immunization (NACI) is charged with providing medical and scientific advice on immunization for Canadians, focusing on scientific evidence on the need for vaccines and to evaluate vaccine safety and efficacy. The planning and delivery of healthcare services, including immunization programs in Canada, falls under the jurisdiction of each province/territory.

    Immunization policy and programs are developed by each province/territory based on the NACI recommendations, and on disease that is circulating in each jurisdiction. The number of cases of disease, such as pertussis, varies from country-to-country, and from province-to-province, and as such, immunization programs will vary. Within Canada, each province and territory has developed their own immunization program, and at the same time attempting to align each program as closely as possible.

    Immunization programs in Alberta are offered based upon the national NACI and the provincial Alberta Advisory Committee on Immunizations recommendations. In Alberta, adolescents 12 years up to and including 17 years of age are offered diphtheria, tetanus and accelular pertussis combined vaccine (dTap) routinely given as a reinforcing dose. The Alberta Advisory Committee on Immunizations (AACI) regularly reviews vaccine information and the cases of diseases circulating, recommending changes to vaccine schedules and programs as appropriate, including the need for pertussis immunization in adults. Review of the adult pertussis vaccine is on the work plan, and may be considered in the next six months to one year.”

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  • Scott Gavura

    Scott is passionate about improving the way drugs are used. A pharmacist by background, Scott has a professional interest in improving the cost-effective use of drugs at the population level, while helping consumers make more informed decisions about their health. He blogs about pharmacy practice and questionable science at Science-Based Pharmacy and Science-Based Medicine. All views expressed by Scott are his personal views alone, and do not represent the opinions of any current or former employers, or any organizations or associations that he may be affiliated with. All information is provided for discussion purposes only, and should not be used as a replacement for consultation with a licensed and accredited health professional.