While the National Advisory Committee for Immunization recommends vaccinating adults to protect against the bacterial disease pertussis (also known as whooping cough), accessing that vaccine as an adult in Newfoundland and Labrador is not an easy task.
Margot Mayo at JEMA International Travel Clinic in St. John’s most often deals with grandparents who want to take the vaccine before they travel to visit a newborn baby.
Pertussis is highly contagious and can result in serious complications for infants, including death. According to the Public Health Agency of Canada, death is estimated to occur once in every 200 cases involving children less than a year old.
Mayo has not been able to get the vaccine at her clinic, and doesn’t expect to have it in stock until the spring.
“A lot of times people are going off to Western Canada or some parts of the States, and they’ve been calling looking for the pertussis vaccine,” said Mayo, a registered nurse who is the owner and CEO of JEMA International.
Immunizations for babies and young children cover the early risk of transmitting pertussis, and Grade 9 students in Newfoundland and Labrador also receive the tetanus-diphtheria-pertussis (Tdap) vaccine.
But according to Dr. David Allison, Eastern Health’s medical officer of health, immunity does wane as one gets older.
“As an adult, you become susceptible again. You pick it up and then because your symptoms aren’t particularly severe, you don’t necessarily feel the need to go see a doctor or get some treatment. Then, that individual can be a source of infection for children.”
Mayo said supply issues often crop up in the vaccination industry, which can be frustrating. In the case of pertussis, she has noticed an increase in demand for adult vaccinations.
“Unfortunately, we probably had a sense of false security in thinking that once we had the vaccine as a child, it was going to cover us and give us immunity or protection for longevity or lifetime, but unfortunately that’s not the case, and we’re starting to see a lot of severe cases of adult whooping cough occurring all over the world.”
In Canada, incidences of pertussis have fallen dramatically in comparison to rates from decades ago. According to data compiled by the Canadian Notifiable Disease Surveillance System, there were on average 165 cases per 100,000 people from 1935 to 1939. From 2005 to 2009, that figure declined to six cases.
However, there have been some reported outbreaks of whooping cough in recent years. In 2012, New Brunswick was dealing with 1,100 confirmed cases, with the majority of those cases affecting children. The provincial government launched an aggressive immunization program targeting all junior high school students.
“We’ve certainly seen some cases here,” said Allison, “but it’s not as problematic as it has been in other provinces.”
Last year, Eastern Health dealt with 14 reported cases of whooping cough. Of those, none were for people older than 65. Five covered ages 20 to 64. Of the nine remaining cases, five involved children less than a year old. There were no deaths.
“In the long run, I think adult immunization is going to help protect the broader population,” said Allison.
The disease can be difficult to diagnose. It may start as a chronic cough before persisting for several weeks. Symptoms can be confused with chronic lung conditions like bronchitis.
“It can be difficult to confirm with laboratory cultures, and that’s probably part of why we’re not seeing as large a number (of cases) as elsewhere,” said Allison.
He would not attribute the small number of pertussis cases within Eastern Health’s region to Newfoundland’s geographic isolation as an island, noting there are enough people travelling outside the province to risk exposure.
A wait list has been established for the vaccine at JEMA International. Mayo said those looking for the pertussis vaccine will be contacted once a new supply comes in.