When Katie welcomed her baby girl, Callie Grace, into the world after five long years of struggling to conceive, it felt like a miracle. Her tiny bundle was healthy and strong. But four weeks later, Callie developed a soft, dry cough. Then suddenly, while waiting at the doctor’s office, baby Callie stopped breathing. “Nurses and doctors flocked to our room,” Katie said. “It was truly overwhelming. I was scared.”
Katie could only be a bystander as her tiny baby was rushed to the Pediatric Intensive Care Unit, hooked up to monitors, and tested for a host of potential causes. When Callie stopped breathing again, her parents watched helplessly from behind a glass wall as doctors tried for 45 minutes to revive her. “We never dreamed we’d lose her,” Katie says. “Callie was a more loved, more wanted baby than you’d ever find.”
Baby Callie died that day.
It wasn’t until a few days later that the cause of her death was discovered: whooping cough. “We could not believe it,” Katie says, “We were so careful to not expose her to a lot of people. She never left the house except to go to the pediatrician.”
Callie was too young to have even received the vaccine to prevent whooping cough. The bacteria Bordetella pertussis, which causes whooping cough, is included in the DTaP vaccine for babies and children and in the Tdap booster shot for teens and adults.
How can parents protect younger infants, who have no defense against the bacteria and are too young to get the vaccine? The strategy is called cocooning, and it has become critical in the control of whooping-cough epidemics.
Cocooning protects newborn infants by the administration of pertussis booster vaccines to parents, family, caregivers, and anyone else in close contact with an infant younger than 12 months. By surrounding the infant with a circle of protection, a safe cocoon is created for the vulnerable little one. It is the medical equivalent of circling the wagons.
As Katie and other parents now know, in infants and young children whooping cough can be deadly. The bacteria is highly contagious and spread person-to-person by coughing or sneezing. Because adults and teens often have milder symptoms, they can unknowingly infect vulnerable infants who will then experience the more severe form. In infants, the cough is minimal or not present at all – instead, they just stop breathing (a dangerous phenomenon called apnea). Almost all of the U.S. deaths recently have been in infants younger than three months, a fact which points out the importance of cocooning. It also points to the importance of pregnant women getting a Tdap booster shot during each pregnancy.
Whooping cough got its name from the unique whooping sound made by gasping for air after a severe coughing fit. Although the initial cough is mild, it classically develops into coughing fits which persist up to 10 weeks, and has thus been called “The One Hundred Day Cough.”
In 2010 an epidemic of whooping cough emerged in the United States, with over 27,000 cases reported in that year. It was the highest number of cases in our country since 1959 and had public health officials scrambling to develop a strategic approach to rapidly address it. At the height of the 2010 epidemic, ten infants in California alone died of whooping cough. An aggressive course of action was needed.
Assembly Bill 354 was signed into law by Governor Schwarzenegger in September 2010 in direct response to the pertussis epidemic. Immediately implemented across the state, this law requires that all students entering 7-12th grade first show proof of a Tdap booster shot. Public health officials renewed the emphasis on cocooning and Tdap shots for pregnant mothers. Vaccination clinics expanded throughout our community as we partnered with medical providers to make the vaccine more accessible for everyone. The Centers for Disease Control and Prevention enhanced its surveillance for whooping cough and supported local public health endeavors in a multi-faceted approach.
Swift public health interventions (or lack of them) have real-time consequences in our communities. After those 10 infants died in California in 2010, and subsequent changes to the law were passed to increase vaccinations, no further deaths have been reported in our state. Undeniably, public health is a sure return on investment.
National Infant Immunization Week, April 20-27, is an annual observance by public health to raise awareness about vaccine-preventable diseases. I could recite a laundry list of vaccination statistics, or cite the numbers of 7th graders who have received the shot since 2010, or even draw the epidemiology curve reported by the CDC for the pertussis epidemic. But the truth is, after all the biostatistics and data, and graphs and figures depicting lives saved – after all of that is done, for me, it comes down to just one child. Because I don’t count public health’s successes or failures in the magnitude of millions; I count them one by one.
A well-known African proverb says, “It takes a village to raise a child.” I propose a public health version of that proverb: “It takes a village to protect a child.” Immunization is a shared responsibility. Let’s do our part.
The personal story in this article, and more information on pertussis, can be found on CDC’s website.
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Charity Thoman, M.D., is a deputy health officer in Santa Barbara County's Public Health Department.