Winter Maladies: Whopping Cough


This quarter I am doing a Preceptorship in the Emergency Room at a local hospital. I’m pretty excited. I think this experience will help me refine my diagnostic skills and give me the chance to see emergency situations triaged quickly.

The process of applying for a position in the ER was tedious. It involved a long list of vaccinations. Having preceptored with a Naturopathic Pediatrician I have seen all ends of the vaccine spectrum: parents who decline every vaccine, those who choose an alternative schedule, and those who follow the CDC schedule to a tee. As a future Physician, I believe this is an area where docere is important. It is the Physician’s responsibility to educate parents around the risks and benefits of vaccinations – not to push an agenda.

Since I was born in an era when alternative schedules were not yet popularized, my parents elected to fully vaccinate my sisters and I. Thanks to them, I was well prepared for my application. I had a document from the Orange County Department of Health listing the dates of my vaccinations.

What was missing included: Varicella (or Chicken Pox), Hepatits B, one dose of MMR and Tdap (or Pertussis, Diphtheria and Tetanus). I was certain that I was immune to Varicella because I had chicken pox at the age of 6 (and it caused me to miss out on my last day of first grade and our ice cream social – quite memorable). I was also certain I had a series of Hepatitis B vaccines. I had immunity titers run by my doctor, which proved me correct. The antibodies found in my body show that I am protected from both Hepatitis B and Varicella.

I only received one dose of the MMR vaccine as a child (Measles, Mumps and Rubella) and while I showed full immunity to Rubella, I did not have immunity to Measles or Mumps. So, at the tender age of 28, I received 2 additional vaccinations: MMR and Tdap (the adult vaccination for Tetanus, Diphtheria and Pertussis).

In the ER I will be exposed to many things; and more importantly many people, both healthy and ill, will be exposed to meThe vaccines required by the ER are meant to protect both parties. While the Naturopath in me has varying views on whether or not I needed to be vaccinated for MMR again, I still consented to the vaccine. This is primarily because I feel the benefits outweigh the risk. Without the vaccine I wouldn’t be allowed into the ER, and I wasn’t willing to forgo the experience. I felt more comfortable getting the Tdap vaccine because of the implications that Pertussis (or Whooping Cough) could have on the patients I will be seeing in the Emergency Room.

Whooping Cough has made the news quite a bit in the last few years and is especially scary to parents of young children. It can be carried by adults who exhibit minor to no symptoms, and can create a deadly situation in a young child. It is highly contagious and is spread through respiratory droplets (sneezing and coughing). If someone with the infection comes in contact with an unprotected infant, the child has the potential to develop pneumonia, severe breathing difficulties and seizures. According to the CDC, more than half the infants who get Pertussis must be hospitalized.

A recent study by Kaiser Permanente found that even after the recommended 5 doses of DTaP (the childhood vaccine for Pertussis, Diphtheria and Tetanus) immunity wanes upwards of 42% after five years. The CDC recommends a Tdap booster in adolescents (age 11 or 12) and for adults who need a Tetanus booster and have not yet had a Pertussis booster.

It is of utmost importance that anyone who might come in regular contact with infants to consider the risk and benefits of the Tdap vaccine. In this case, for the safety of others rather than yourself. Even a person with an innocent cough should be aware of the dangers that this could potentially pose to an infant.

This season, be aware and mindful of those around you. Especially the little ones.

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