Concerted effort is needed to reverse the ongoing rise in pertussis (whooping cough) cases and deaths, especially among children and young people, experts say in a new review article.
“The battle of pertussis is winnable through education, awareness, and vaccination,” write Emily Peake, APRN, MSN, FNP-C, CLC, and Lisa K. McGuire, MSN, MBA-HCM, RN, in the Journal of Christian Nursing.
In US and Abroad, Rising Rates of Pertussis Infection and Death
Caused by infection with Bordetella pertussis bacteria, pertussis has been increasing in recent years. In the United States, average annual pertussis cases increased from less than 3,000 cases per year during the 1980s to 48,000 in 2012, including 20 deaths. Worldwide, there are an estimated 50 million cases of pertussis and 300,000 deaths. Pertussis is a major cause of death in infants worldwide.
Why is pertussis on the rise? “Ambivalence toward precautionary childhood vaccinations” is a key reason, along with the lack of well-child visits and appropriate boosters. The arrival of non-vaccinated immigrants may also be linked to new clusters of pertussis outbreaks, according to Peake and McGuire. They write, “Nurses should educate patients and the public that follow-up booster vaccinations at all ages are critical to maintain immunity to pertussis and other vaccine-preventable diseases.”
Issues including vaccine availability and cost, literacy and language barriers, and lack of information all contribute to the lack of recommended vaccinations. Fear of vaccination and religious objections also play a role. Most states allow exemptions from vaccination based on religious reasons, and there’s evidence that even non-religious parents are using these exemptions to avoid vaccinating their children (more on that in a moment).
Nurses should reassure parents that that recommended vaccines are safe. Current diphtheria-tetanus-pertussis vaccines do not contain the mercury-containing preservative thimerosal. Adverse events occur in only a small fraction of vaccinated children, and most of these are mild local reactions.
Education Is Key to Increasing Pertussis Vaccination
“Practitioners must build a trusting relationship with patients and reinforce the need for vaccinations through face-to-face contact, engaging parents to discuss concerns, and provide evidence-based research to guide recommendations and reassure patients of the safety of vaccines,” Peake and McGuire write. Waiting rooms provide a good opportunity to present videos and other educational materials.
The World Health Organization is working to increase the percentage of infants who receive at least three doses of pertussis vaccine to 90 percent or higher, especially in developing countries. The authors discuss some international efforts to fight pertussis and other vaccine-preventable diseases, such as the United Nations Foundation’s Shot@Life campaign.
Last month, another major initiative, led by the GAVI global vaccines alliance, appealed for $7.5 billion to help immunize another 300 million children against life-threatening diseases between 2016 and 2020 and save up to 6 million more lives. The additional investments, which GAVI hopes to get mainly from global health philanthropists and the governments of developed nations, could double the number of lives saved through GAVI-supported vaccines to an estimated 12 million. GAVI, which is backed by the Bill & Melinda Gates Foundation, the World Health Organization (WHO), the World Bank, UNICEF, donor governments and others, funds immunization programs for nations that cannot afford standard prices. The group targets common but deadly diseases such as pneumonia, diarrhea and cervical cancer and says it has already saved around 6 million lives since its launch in 2000.
Closer to home, partnerships should be formed with service organizations, food banks, churches, hospitals and schools. “These groups can help identify those most likely not to be vaccinated and help them find free or low cost immunizations,” the authors write. “Faith community nurses are in an ideal role to create and lead these partnerships.”
Nurses can also advocate for policies aimed at making universal vaccinations available for adolescents and adults. Peake and McGuire conclude, “By using our resources and uniting, a global battle will be waged and won against pertussis and the children of tomorrow can breathe easier for a lifetime.”
The Human Impact of the Anti-Vaccination Movement
Public health and medical scholars cite the introduction of vaccinations as one of the top ten public health accomplishments of the 20th century. Unfortunately, in recent years there has been a resurgence of the anti-vaccine movement, leading some parents to refuse immunizations for their children. Although the origins of this movement began in the mid to late 1800′s with the introduction of the smallpox vaccine, the modern anti-vaccine movement took off when researcher Andrew Wakefield claimed to have found evidence that vaccines play a role in the development of autism. His findings were later to found to be fraudulent, his study was discredited, and Wakefield was disbarred by the British General Medical Council and banned from practicing medicine for “serious misconduct,” including “repeatedly breaching the fundamental principles of research medicine.”
However, the damage was already done. Despite efforts by public health organizations and medical professionals to reassure the public that vaccines are safe and effective (and despite overwhelmingly scientific evidence to back up their safety and effectiveness), immunization rates in the U.S. and the U.K. declined for the first time in modern history. As a result, infectious diseases that were once nearly eradicated are reappearing. In the U.S., measles cases were triple the annual average last year and several major cities experienced widespread outbreaks. Whooping cough has also made a comeback, resulting in the worst epidemic of the deadly disease in 70 years.
In other parts of the world, civil war and unrest are preventing children from getting immunized. Pakistan, where the Taliban has banned aid workers from vaccinating children, is the epicenter of an unprecedented resurgence of polio that the World Health Organization recently declared a “world health emergency.” The disease is also reemerging in other countries affected by violent conflict, including Syria, Somalia and Iraq — all countries where polio was previously eradicated.
Since 1924, vaccines have prevented more than 103 million cases of eight infectious diseases in the United States alone. In just the past decade, immunizations have prevented 26 million cases of disease in America – 99 percent of which would have occurred if not for vaccinations.
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