Whooping Cough and Newborns: How to Set Boundaries

Dec. 6, 2024 — Whooping cough is making a dangerous comeback across the US, with cases soaring to 4.5 times more this year than last, according to the CDC. For parents of newborns, this highly contagious respiratory illness poses a serious threat — and protecting your baby starts with setting clear boundaries.

That might mean asking grandparents, friends, and other loved ones to follow precautions before meeting your little one. If the pandemic taught us anything, asking people to take medical precautions doesn’t always go over well. Still, it’s necessary.

“Babies are very vulnerable in the first 6 months of life,” said Rachel C. Orscheln, MD, medical director of ambulatory pediatric infectious diseases at St. Louis Children’s Hospital. “So, we try to have multiple layers of protection around them.”

The stakes are high: Bordetella pertussis, the bacteria behind whooping cough, spreads easily through airborne droplets, often hiding behind symptoms that look like a common cold. But with the right strategies, parents and caregivers can work together to keep infants safe. Here’s what you need to know.

Set Limits, Enforce Them, and Explain Why

The CDC and American Academy of Pediatrics recommend that parents, relatives (including kids and teens), and caregivers who will be in close contact with a new baby get the pertussis vaccine shots and boosters. Immunity to pertussis develops over about 2 weeks after the shot.

“Since pertussis is most serious in those less than 1 year of age, anyone who has close contact with infants should be up to date with their vaccine,” said Dean Blumberg, MD, chief of the Division of Pediatric Infectious Diseases at the University of California, Davis, and a spokesperson for the American Academy of Pediatrics. “This protects the infant by decreasing the risk that a contact will potentially infect them. About one third of babies with pertussis need to be hospitalized. And almost all deaths due to pertussis occur in those less than 1 year of age.”

Asking visitors with cold-like symptoms to postpone their visit is critical. “Pertussis is generally transmitted by close contact, being within 6 feet of an infant,” Blumberg said. “Symptom screening — excluding visitors who have symptoms such as fever, cough, sneezing — is always a good strategy to protect infants against pertussis and other respiratory infections.”

Ultimately, it is up to the parents to decide what measures they would like in place to protect their baby, the experts said. But in general, stricter measures are often better for younger babies, as that’s when pertussis is most serious, Blumberg said.

Orscheln agrees. “I tend to be more restrictive with visitors overall, especially in the first month of life,” she said. “After that, if you have any symptoms or are sick, stay away from a newborn. If you have to be around a baby and have symptoms or think you could develop them or aren’t sure you were vaccinated, wear a mask, use good hand hygiene, and stay back.”

Don’t assume friends and relatives are already vaccinated against pertussis. Don’t assume people will even know if they’re up to date. Adults, preteens, and teens should have one Tdap (short for tetanus, diphtheria, and pertussis) shot followed by a booster every 10 years. Children should have all recommended DTaP (short for diphtheria, tetanus, and pertussis) shots. But just 28% of US adults are covered, according to CDC statistics from 2022. And vaccination rates in children have fallen slightly in recent years, according to a study published in October in the CDC’s Morbidity and Mortality Monthly Report.

Blumberg urges parents to set limits firmly but politely.

“It can be challenging to explain what rules you are following to protect your newborn, since we do not all share the same values regarding health, risk of infection, and protection against infection,” he said. “However, parents are responsible for protecting their babies, so I hope that they are comfortable with making decisions that make sense and are reasonable for them and expect others to respect their roles as parents.”

Questions and Answers

Potential visitors may have questions about pertussis and vaccines against it. Here’s what to know and share:

Don’t mothers and babies get vaccinated against pertussis? Isn’t that enough? Parents can explain that infants receive their first DTaP vaccines at 2, 4, and 6 months of age, but their own immunity to pertussis is very low before 6 months; vulnerability is high until they’re a year old. Mothers who get a Tdap booster during pregnancy lower their baby’s risk of infection by 78% and for hospitalization by 91%.

“But that doesn’t fully protect an infant against infection,” Orscheln said.

Do adults even get whooping cough? Yes — and risk is four times higher for those with lung conditions like asthma and chronic obstructive pulmonary disease. After age 45, the odds of hospitalization for severe pertussis go up, too. But lack of awareness about whooping cough in adults is a top reason Americans aren’t vaccinated, according to a CDC study.

“Older people can be infected with pertussis, which can cause severe and prolonged symptoms,” Orscheln said. “Being vaccinated isn’t just altruistic. It protects your health, too.”

My doctor never suggested the vaccine, do I need it? Don’t wait for their doctor to bring it up first. In a recent University of Pittsburgh study, published last month in the journal BMC Primary Care, of 800 doctors in the US, Germany, and France, just 65% said universal pertussis vaccination was a priority. More named vaccination against COVID-19, the flu, and pneumonia. But new parents can suggest relatives ask their doctor about the vaccine’s benefits and safety.

“In studies, the one thing that moves the needle is a recommendation from a trusted health care provider,” Orscheln said.

I think I got a tetanus vaccine a few years ago, did it cover pertussis? Adults may not remember when they last got a Tdap booster or know whether their last shot was “Td” or an older type called “DT” just for diphtheria and tetanus — or a “Tdap” shot that includes pertussis. CDC statistics show that for about 31% of US adults who have gotten a tetanus/diphtheria shot in the past 10 years, it did not cover pertussis. Check your vaccine status with your primary care doctor, Blumberg suggested.

“Some adults may have received the Td vaccine, which protects against tetanus and diphtheria but not pertussis,” he said. “They can still receive the Tdap vaccine after the Td vaccine, with no minimum interval needed between doses.”

I’ve got a little cough; can I assume it’s not pertussis? Loud gasps for breath that sound like a whoop, between violent coughs, are a hallmark of childhood pertussis that may be mild or missing in infected adults. Ask visitors who are coughing, sneezing, or who have a fever to stay home, Orscheln and Blumberg said.

“Almost all cases are transmitted by people who are symptomatic, by coughing or sneezing. However, they may not know that they have pertussis at the beginning of the illness, because it usually starts with mild symptoms similar to having a cold,” Blumberg said.

When in doubt, just let loved ones know that the baby will still be there, smiling and waiting to meet them, when they feel better — and that will help everyone feel better.

SOURCES:

Rachel C. Orscheln, MD, Medical Director of Ambulatory Pediatric Infectious Diseases, St. Louis Children’s Hospital.

CDC: “Vaccines for Family and Caregivers,” “Vaccination Coverage Among Adults in the United States, National Health Interview Survey, 2022,” “Coverage With Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2023-24 School Year,” “Diphtheria Vaccine Recommendations.”

HealthyChildren.org: “Whooping Cough (Pertussis): Symptoms, Treatment & Prevention.”

Dean Blumberg, MD, Chief, Division of Pediatric Infectious Diseases, University of California, Davis; Spokesperson, American Academy of Pediatrics.

Human Vaccines & Immunotherapeutics: “Public Health Management of Pertussis in Adults: Practical Challenges and Future Strategies.”

Vaccine: “Barriers to Early Uptake of Tetanus, Diphtheria and Acellular Pertussis Vaccine (Tdap) Among Adults — United States, 2005-2007.”

BMC Primary Care: “Pertussis Vaccination in Adults: A Behavioral Study of Physicians From the US, France, and Germany.”

Aging Clinical and Experimental Research: “Improving Vaccination Rates in Older Adults and At-Risk Groups: Focus on Pertussis.”