Time to Expand Definition of a Travel Vaccine

Pertussis is the other vaccine-preventable disease that has been popping up lately and for which we need to consider vaccinating patients who may be traveling to affected areas, even within the United States. As of April 13, the California Department of Public Health reported ongoing pertussis activity, with 733 cases in 2011 for a rate of 6.5/100,000 population. There were 9,273 cases with onset in 2010, or 2.37/100,000, the highest incidence reported in the state since 1958.

Of the 755 hospitalized cases in 2010, more than half (55%) were infants younger than 3 months of age and nearly three-quarters (72%) were infants less than 6 months of age. Of the 10 deaths, 9 were infants.

So far in 2011, the highest rates of pertussis in California have been in the counties of Amador (86/100,000), Sonoma (32.5), and Santa Clara (23.5). Have a patient traveling to California who hasn't received a DTaP within 10 years and never received a Tdap booster? There is no longer a duration limit since the last Td dose. Just go ahead and give the Tdap.

And while we're on the subject, I wanted to mention that I chaired a committee for the Pediatric Infectious Diseases Society that has just published a position statement regarding personal belief exemption from immunization mandates. This document is aimed at helping pediatricians and family physicians who live in states that have laws allowing such exemptions, by providing a resource to support you medicolegally when facing parents who attempt to use misguided laws to avoid immunizing their children. It is available at www.pids.org/news/238-pid-position-statement-on-pbes.html