ShareThisSACRAMENTO, Calif. - With California's whooping cough outbreak escalating, 75-year-old Gloria Coleman asked her doctor for the adult booster shot, a new vaccine that public health doctors hope will break the cycle of a sometimes-fatal disease.
A nurse told her she didn't qualify; she was too old, Coleman said.
Whether Coleman, who volunteers at a hospital front desk where infants and ill people pass regularly, should get the shot despite her age is one of the puzzles complicating the fight against pertussis, better known as whooping cough.
The booster shot is not being given widely, even in hospital maternity wards, where doctors long have advised that each new mother get it. Getting fathers, sisters, brothers and others in the household immunized before their first contact with a vulnerable newborn is proving even tougher.
Whooping cough is a boom-bust disease, and 2010 is shaping up as an "epidemic" year, said Dr. John Talarico, chief of the Immunization Branch at the California Department of Public Health. As of June 15, the state knew of 910 reported cases and another 600 probable ones. Five infants have died, all under 3 months old.
Little babies are most vulnerable because their airways are immature and they haven't gotten the full series of childhood shots that begin when they are 2 months old. Public health officials would like to see those infants "cocooned" in a circle of family safety: a household in which every sibling and adult has a current immunization as soon as the baby is born.
Adults get whooping cough far more often than they realize, because it often feels just like a cold with a lingering cough. Doctors now believe immunity from childhood vaccinations wears off over time, and that adolescents and adults have been unwittingly spreading the disease.
The booster shot -- called Tdap, for tetanus, diphtheria and acellular pertussis -- might put an end to that. Different versions were licensed by the Food and Drug Administration in 2005 for people ages 10 to 64.
"This is a safe vaccine. ... The more people who get it, the better off everyone is," said Stacey Martin, an epidemiologist who works on pertussis for the federal Centers for Disease Control and Prevention. "By vaccinating yourself, you're not just protecting yourself, you're protecting those around you."
But what about a grandmother or grandfather, 65 or up, who might cuddle or rock a newborn?
Doctors can give them a shot, too. It's called an "off-license" use of a vaccine. Just as doctors prescribe drugs "off label" for diseases the FDA didn't originally license the drug for, they are free to give vaccines to people outside the license ages.
"If you're in close contact with an infant, no matter what age you are, you need to talk to your doctor about the benefits of vaccination," said Talarico.
Vaccine manufacturers are studying older populations, which already get the booster in some European countries. Those studies have made it clear the booster shot is safe in older people, Talarico said, and he expects the age limit to be changed once more data are in.
Until then, seniors asking their doctors for a Tdap booster might have rough going. Coleman said that in her Kaiser doctor's office, she was flatly told she was too old.
"I would like that shot because I work with the public," volunteering at the information desk at a Kaiser hospital, Coleman said. "All kinds of babies come by me and they cough right into my face."
The whooping cough epidemic has worsened so quickly that any Kaiser patient turned down for the booster because of age should feel comfortable asking again now, said Dr. Stephen Parodi, regional chief of infectious disease for Kaiser Permanente Northern California.
"The clinical context has changed," he said, and a fresh conversation with the doctor "would be entirely reasonable."
Dr. James Cherry, a UCLA professor who specializes in pediatric infectious diseases, said denying the booster to seniors is foolish and dangerous.
"It's a funny thing. We do a lot of things off label. ... but for some reason, with vaccines, people sort of stick to rules that don't make a lot of sense," said Cherry. He made sure he got the booster shot himself, even though he's now 80.
His sentiment is not universal.
Dr. Dean Blumberg, a UC Davis professor of pediatric infectious diseases who considers Cherry a mentor, said he would not usually recommend an off-label Tdap shot for a senior.
And Dr. Ted Epperly, board chairman of the American Academy of Family Physicians, believes most family doctors would not give people over 64 the Tdap booster. Not even during an epidemic, not even if they asked, and not even if there were a newborn in the house.
Instead, Epperly said, he would tell those seniors "to be extremely careful" by washing their hands, wearing a face mask and staying away from the baby, even if it's a grandchild.
(E-mail reporter Carrie Peyton Dahlberg at cpeytondahlberg(at)sacbee.com.)
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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