New vaccine requirement a step in prevention, not a cure-all

State has expanded number of students getting Tdap shot

University of Iowa nursing student Wallis Higley of Kenilworth, Ill., gives a tetanus, diphtheria and pertussis immuniza
University of Iowa nursing student Wallis Higley of Kenilworth, Ill., gives a tetanus, diphtheria and pertussis immunization or (Tdap) to Iowa City West High sophomore Ben Sommers of Hills during an immunization clinic sponsored by Johnson County Public Health Tuesday, April 9, 2013 at Iowa City West High School in Iowa City. The vaccine was offered free of charge to any West High student who had parental consent and had not received the Tdap vaccine after the age of 7 years. Iowa law has changed to require all students entering 7th grade and born on or after September 15, 2000, to get the Tdap vaccine before the 2013-14 school year. (Brian Ray/The Gazette)

In one week, students in the Mount Vernon Community School District will go back to school. Other Eastern Iowa students have an extra week or two of summer left, but it’s still time for families to get ready for the academic year.

For incoming seventh-graders, that process now includes at least one new task: getting a tetanus, diphtheria and pertussis vaccination or Tdap.

In November 2012, Iowa was one of nine states the Immunization Action Coalition identified as not requiring the one-time Tdap booster for secondary-school students. A few months later, in January, Iowa adopted the mandate effective with the 2013-14 school year.

“We also really wanted to align with what the (Advisory Committee on Immunization Practices) recommends for 11 to 12 years old, which is that Tdap vaccine,” said Bethany Kintigh, immunization program manager for the Iowa Department of Public Health. “What we also knew was in 2012, we had about 417 percent more people with pertussis disease compared to the average of the last five years and we knew a lot of them fell into that teenage age group.”

During Iowa’s 2012 outbreak of pertussis, also known as whooping cough, the Iowa Department of Public Health recorded 1,736 instances of the illness, more than seven times the 232 cases in 2011. Linn County led the state in 2012 with 288 reported cases of pertussis.

“If you’re looking at trends, usually pertussis kind of cycles,” said Barbara Chadwick, clinical services division manager for Linn County Public Health. “It’s like the flu and everything else, it runs its course through the population from west to east.”

Thick mucus builds up in the lungs of pertussis sufferers, resulting in a persistent cough, and the disease can even be fatal. Infants, who are too young to be vaccinated, and the elderly are among the groups who are most vulnerable to the disease.

Melissa Hauser, district nurse for the Mount Vernon Community School District, said students who test positive for pertussis can miss as many as five days of school as they complete a course of antibiotics. She saw that firsthand in 2012, when Mount Vernon the pertussis outbreak hit the district’s students early and hard.

“I think it’s great,” she said of the new Tdap requirement. “Anytime we can have another immunization for kids, it’s a benefit.”

Getting the shot

The Tdap booster shot, which the Centers for Disease Control and Prevention recommends for children ages 11 and 12, was first licensed in 2005 and ACIP began recommending it in 2006.

Kintigh said that mandating the booster dose for seventh-graders provides a way to phase the requirement in without burdening school nurses, who have to audit students’ vaccination records. This year’s seventh-graders are next year’s eighth-graders and, should the requirement remain in place, eventually the majority of all secondary students will have the vaccination because they’ve been subject to the mandate.

“We hope that we will see a decrease in cases in this age population, however we will have breakthrough. We will always have people who cannot be immunized,” she said. “For us to say pertussis is going away, that will never happen.”

Iowa mandates that incoming kindergartners receive a series of five vaccinations known as DTaP — which protects against diphtheria, tetanus and pertussis — but studies show that the effectiveness wanes by the time these students reach middle school, hence the need for the booster.

Kintigh cited National Immunization Survey data which shows that 75 percent of Iowa’s 13- to 17-year-olds have already received the Tdap booster. That mandate is an effort to reach that final quarter.

Area public and private health professionals said they have not seen a rush of families this summer asking about or getting the Tdap vaccination for their students despite the new requirement this year.

“More commonly it’s something we bring up in review of their routine vaccines,” said Dr. P.C. Thomas, who specializes in family practice at MercyCare Center Point. “I’d say we’ve administered over the last three to four years more than what we had over the prior three to four years.”

One reason for that may be because of the state’s response to the 2012 pertussis outbreak. Beginning in that fall, the Iowa Department of Public Health sent an estimated 16,000 doses of the vaccine to local public health agencies for students in grades seven through 12. Linn County Public Health and Johnson County Public Health were among the recipients and chose to host school-based clinics, where the vaccine was available free of charge.

“I don’t think we’re going to see a huge influx,” Chadwick said. “The reason I think I can comfortably say that is because at least in the Cedar Rapids (Community School) District, they have been giving that Tdap at the end of the last school year to the kids who needed it because they knew that legislation was coming down the pike.”

Neither Linn County Public Health nor Johnson County Public Health have plans to host additional clinics at this time, though both continue to offer the vaccine to eligible students who need to meet the Tdap requirement.

Doug Beardsley, director of Johnson County Public Health, said that department projections showed that 450 to 460 sixth-graders would need the booster for the 2012-13 clinics. The department only administered 225 doses, which he called “a little underwhelming.”

“It will remain to be seen if there’s a big rush of students trying to get their booster before school starts this fall,” he said. “We really have not seen a huge demand here at the health department. It’s hard to know if they’ve gone to their regular pediatrician or family doctor for the shot or if they’ve already had the Tdap booster.”

No magic bullet

The Tdap booster is not a panacea though, as Dr. Manisha Patel, a medical officer with the U.S. Centers for Disease Control and Prevention’s Meningitis and Vaccine-Preventable Diseases Branch, noted.

“That’s the big question,” said Linda See, middle- and high-school nurse for the Mount Vernon district. “I don’t know when this booster starts to wane.”

In addition, both See and Hauser acknowledged that even with the requirement, there may still be families who don’t comply.

“All we can do is educate and encourage,” See said.

Vaccinated people, should they get pertussis, will have less severe symptoms and illness than those without protection, Patel said.

“There is definitely waning,” Patel said about the Tdap booster, though she said Centers for Disease Control professionals are studying how much and over what time. “A lot of vaccines wane. The idea is to make sure as whole you can protect the population as best you can.”

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