Cases of whooping cough growing, but knowledge about it is lacking
Annenberg Public Policy Center of the University of Pennsylvania
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Half of the public (50%) knows that Tdap protects against tetanus, 47% know it protects against diphtheria, 44% against whooping cough. Source: Annenberg Public Policy Center's ASAPH survey, November 2024.
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PHILADELPHIA – Following a several-year lull during the pandemic, cases of whooping cough are increasing across the United States. As of Nov. 30, early U.S. data show over 28,000 cases reported this year, or six times as many as in the same period in 2023, according to the Centers for Disease Control and Prevention (CDC).
Whooping cough or pertussis, a highly contagious bacterial infection of the respiratory tract, was one of the most common childhood diseases in the 20th century and a major cause of childhood mortality, according to the CDC. Until a pertussis vaccine became available in the 1940s, over 200,000 cases were reported annually, the CDC says.
As cases rise, a nationally representative panel survey by the Annenberg Public Policy Center of the University of Pennsylvania finds that many in the public are not familiar with symptoms of the disease. Almost a third of respondents (30%) are not sure if pertussis is the same as whooping cough (it is) and not sure (30%) whether a vaccine exists to prevent it (it does).
The CDC recommends vaccination for everyone against whooping cough, which is spread by coughing or sneezing. The illness may first resemble a common cold but can produce “rapid, violent, and uncontrolled coughing fits” a week to two weeks after symptoms appear. People who are vaccinated may still get whooping cough but generally have a milder illness.
Safety reviews of two main types of whooping cough vaccines – Tdap (tetanus, diphtheria, acellular pertussis), for those 7 years and older, and DTaP (diphtheria, tetanus, and acellular pertussis) for infants and young children – show both to be safe and effective, the CDC reports.
“The MMR vaccine, which covers measles, mumps and rubella, is colloquially referred to as the measles vaccine,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center (APPC). “Instead of speaking about the DTaP and Tdap vaccines and using the unfamiliar term ‘pertussis,’ public health communicators should reiterate that our best defense against whooping cough is the whooping cough vaccine.”
What does Tdap protect against?
The Tdap vaccine (tetanus, diphtheria, pertussis) is recommended by the CDC to be given to everyone age 7 and older, including those who are pregnant to protect their newborn.
Yet only half or less of Americans know which diseases the Tdap vaccine protects against. According to the latest Annenberg Public Policy Center health survey, when a nationally representative sample of U.S. adults is provided with a list of diseases and asked which of these diseases the Tdap vaccine protects against, a third of respondents (34%) say they are not sure.
Just 44% selected pertussis or whooping cough, 47% selected diphtheria, and 50% selected tetanus, all correct. The vast majority of respondents rightly rejected several incorrect choices – just 13% said Tdap protects against polio, 10% said pneumococcal disease such as pneumonia or meningitis, 3% selected dengue, and 1% chose Zika.
In total, almost 3 in 10 people (29%) knew all three diseases that the Tdap vaccine protects against and chose none of the incorrect ones.
The survey finds that 85% of respondents say they would be likely to recommend that a child aged 11 to 12 years old in their household or an adult in their family who is due for their 10-year booster get a Tdap vaccine. And 80% indicated that they think the Tdap vaccine is effective at offering protection against tetanus, diphtheria, and pertussis, although 15% were unsure.
Knowing the symptoms of whooping cough
Many in the public lack familiarity with the symptoms of whooping cough – in fact, when the survey respondents are shown a list of symptoms and asked which are for whooping cough, the only one almost universally recognized (83%) is coughing fits. These fits are often followed by a distinctive “whoop” sound when someone gasps for air. Low-grade fever is correctly selected as a symptom by 44%; vomiting after coughing fits by 33%; and runny nose by 30%. Under a third of respondents selected symptoms that are not associated with whooping cough: 30% incorrectly chose headache and 28% incorrectly chose chills. Only 14% said they were not sure of the symptoms.
About half of those surveyed (49%) think that a healthy adult who got whooping cough would be likely to experience moderate (34%) or severe (15%) symptoms, while 21% think the adult would experience mild symptoms, 1% think no symptoms, and 29% are not sure.
APPC’s Annenberg Science and Public Health knowledge survey
The survey data come from the 22nd wave of a nationally representative panel of 1,771 U.S. adults conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. Most have been empaneled since April 2021. To account for attrition, small replenishment samples have been added over time using a random probability sampling design. The most recent replenishment, in September 2024, added 360 respondents to the sample. This wave of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded Nov. 14-24, 2024. The margin of sampling error (MOE) is ± 3.3 percentage points at the 95% confidence level. All figures are rounded to the nearest whole number and may not add to 100%. Combined subcategories may not add to totals in the topline and text due to rounding.
Download the topline and the methods report.
The policy center has been tracking the American public’s knowledge, beliefs, and behaviors regarding vaccination, Covid-19, flu, RSV, and other consequential health issues through this survey panel over the past two-and-a-half years. In addition to APPC director Kathleen Hall Jamieson, APPC’s team on the survey includes research analysts Laura A. Gibson and Shawn Patterson Jr.; Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute; and Ken Winneg, managing director of survey research.HomeLoginRegister
Survey: What are the symptoms of whooping cough
Although most Americans (83%) know that coughing fits are a symptom of whooping cough, other symptoms such as low-grade fever and runny nose are less well known. Source: Annenberg Public Policy Center's ASAPH survey, November 2024.
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Annenberg Public Policy Center
The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about communication’s role in advancing public understanding of political, science, and health issues at the local, state, and federal levels.
Method of Research
Survey
Study shows drop in use of antiviral medications in young children with influenza
Despite national medical guidelines supporting the use of antiviral medications in young children diagnosed with influenza, a recent study reports an underuse of the treatment.
“Antiviral Use Among Children Hospitalized with Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study” was published in Clinical Infectious Diseases, the flagship journal of the Infectious Diseases Society of America.
Flu illness accounts for up to 10% of all pediatric hospitalizations during the winter season in the United States.
While guidelines recommend all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals regardless of symptom duration or vaccination, study results show adherence to guidelines fall short.
“Our findings of limited use of antivirals in hospitalized children with influenza illness is concerning,” said James Antoon, MD, PhD, MPH, assistant professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “We found that almost half of hospitalized children did not receive antiviral therapy despite widely endorsed recommendations by the Centers for Disease Control (CDC), Infectious Diseases Society of America and American Academy of Pediatrics. Use of these antivirals reduce how long children have symptoms and prevent influenza complication.”
Antoon, along with Justin Amarin, MD, co-led a multicenter study of a cohort of children hospitalized with confirmed flu diagnosis at seven pediatric medical centers in the CDC New Vaccine Surveillance Network (NVSN) between Dec. 1, 2016 and March 31, 2020. A total of 1,213 children with lab-confirmed flu were included.
Among those with research or clinical influenza testing, only half received antiviral treatment and among those with clinical influenza testing by a physician, almost two-thirds received an antiviral.
Study findings also saw almost 37% of hospitalized infants younger than 6 months old, who are not eligible for flu vaccination, did not receive an antiviral.
“The low use of influenza antivirals shows the need for additional efforts to understand the barriers to treatment and improving clinical testing. Improved antiviral treatment is critical for optimizing care in this population of patients,” said Antoon.
Natasha Halasa, MD, PhD, Craig Weaver Professor of Pediatrics in the Division of Pediatric Infectious Diseases at Monroe Carell, served as the site principal investigator.
“Data from two national influenza surveillance networks indicate that antiviral treatment of hospitalized children and adolescents with influenza has declined from 70%– 86% during the 2017–2018 season to less than 60% in 2023–2024,” noted Halasa.
“Only 30% of children and adolescents at higher risk for influenza complications were prescribed antivirals during outpatient visits.”
These findings mentioned by Halasa were published in the CDC digest Morbidity and Mortality Weekly Report (MMWR) on Nov. 14.
Antoon said that antiviral treatment results in shorter symptom duration, lower risk of developing subsequent pneumonia and sinusitis and otitis media infections. Some data suggests that use of antivirals is associated with decreases in hospital length of stay, use of mechanical ventilation and intensive care unit admissions.
“Future studies should also focus on improving influenza testing and prompt antiviral treatment for children with influenza-associated hospitalizations as well as standardizing care both within and across institutions,” he said.
Journal
Clinical Infectious Diseases
Article Title
Antiviral Use Among Children Hospitalized with Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study
Article Publication Date
17-Dec-2024
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