A new pertussis vaccine requirement for junior high school students will set a precedent in Iowa and also will make school nurses happy because of the protection it offers adolescents, experts say.

The Iowa Department of Public Health has begun to discuss the requirement that pre-teens have the TDaP booster vaccine to guard them against pertussis — better known as whooping cough. The regulation, which is expected to be enacted no sooner than August 2013, will put Iowa in line with 40 other states that already have the “secondary-level” vaccine requirement. 

Except for South Dakota, all of Iowa’s neighboring states, including Illinois, have the secondary-level TDaP requirement.

Students who are 11 or 12 years old and in the sixth or seventh grades would be required to have proof of receiving the TDaP booster before they could continue to attend school in Iowa.

“We continue to see pertussis cases occur in Iowa schools,” Don Callaghan said. “There’s waning immunity to the disease, and that’s behind the suggestion to get a booster at about 11 to 12 years old.”

Callaghan, the bureau chief of immunizations with the Iowa Department of Public Health, pointed out there is a national recommendation 

for older students to get the booster shot. Children get the original vaccination during infancy.

“School nurses will cheer for joy when this happens,” predicted Carol Harris, the head of nurses in the Davenport Community School District.

The nurses will have an extra workload when the requirement is enacted, but they think it will lessen the number of pertussis cases they see in the schools every year. 

Children at the age level in question travel a good deal, so they can spread the virus to many people, Harris said. When a case of pertussis is confirmed in a student, the school district and county health department have to track down all who are exposed, distribute letters of warning and instructions for care and then monitor the ongoing illness.

The workload that results from actual pertussis care is why nurses will welcome the vaccine requirement, Harris said.

In Scott County, 15 cases of pertussis have been confirmed since July. In the same time period the year before, there were 197 cases, and that is when the county had what was termed an “outbreak,” with many of the cases occurring in the schools.

Pertussis is a respiratory illness that causes severe coughing spells, which may be followed by vomiting.  The disease begins like a cold, with a runny nose and an irritating cough. It is characterized by severe coughing spells that end in a “whooping” sound when the person breathes in. Pertussis is spread through the air when infected people cough or sneeze and others inhale the infected droplets.


Illinois requiring vaccinations this year

Illinois began the secondary-level requirement this year, said Sally O’Donnell, the director of school health programs for the Rock Island County Public Health Department. Students entering the sixth and ninth grades need to show proof that they have received a TDaP booster before they can attend classes.

“I think all physicians’ offices, pediatric and others, are encouraging parents to do this,” O’Donnell said.

But the requirement will not necessarily protect against an outbreak, especially as it is being introduced to an area. For example, pertussis cases were reported around Christmas in the Riverdale School District, she said.

Pertussis is a miserable condition that anyone would want to avoid.

“You cough, up from your toes, and the cough can last for weeks,” Harris said. 

Students lose time out of school and parents miss work, O’Donnell said. If one athlete on a sports team gets the illness, all of the others on the team have to be notified and monitored for pertussis.


‘Cocooning effect’ recommended

Pertussis is especially dangerous to infants, who have not built up immunity with the vaccination process.

“That’s why we encourage parents, siblings, caregivers, grandparents and any others around a newborn to be vaccinated to protect the infants,” said Bethany Kintigh, the program manager for Iowa’s immunization program.

The vaccination process for family members is called “cocooning,” and it is being promoted to obstetricians and physicians who treat families with small babies, O’Donnell said.

Reasons behind recent pertussis outbreaks in the United States are not fully understood, but there is agreement that the vaccine effectiveness wears off, Juliette Tinker said. A native of Iowa City, Tinker earned her doctorate in microbiology at the University of Iowa, and now she researches and writes on pathogenic bacteriology and vaccinology at Boise State University in Idaho.

Idaho adopted the TDaP booster at the secondary level this year and enforces it for seventh-graders, she said. 

Iowa is still investigating to determine at what grade level it should make the recommendation, said Callaghan of the state health department.

Tinker — who is working on a vaccine against staph infection — said the pertussis vaccine is highly effective when issued at the proper time. Outbreaks still will happen in schools, she said, because not all students will be completely and effectively immunized.

In Iowa, students will have to be vaccinated unless they have medical reasons to opt out, such as a compromised immune system, Callaghan said. There also are religious exemptions to vaccination, but no philosophical exemptions are allowed.