How Advanced Practice Nurses Can Help Combat Pertussis

A recent article published in the Journal of Pediatric Health Care discusses initial advocacy steps that advanced practice registered nurses (APRNs) can take to address the rising number of cases of pertussis in children.

“Advanced practice nurses can play a significant role in protecting infants younger than 12 months old through initiating and supporting advocacy efforts at the state level for childcare employee Tdap [tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis] vaccination,” wrote Jeanette L. H. Parker, DNP, APRN, NP-C, from the Medical University of South Carolina, Charleston, and colleagues.

Pertussis (whooping cough) is a vaccine-preventable respiratory disease caused predominantly by the bacterium Bordetella pertussis. The condition is highly contagious and spreads through the air by infectious droplets. Initially, it causes cold-like symptoms, but after about 1 to 2 weeks, the disease progresses, and the classic symptoms of pertussis develop—paroxysmal cough with an inspiratory whoop, vomiting after paroxysmal coughing, and exhaustion. Although pertussis can infect persons of all ages, it is most serious in children, particularly those younger than 1-year old who have not yet been fully vaccinated against the disease.

According to the authors, “[o]nce infected, infants may experience severe respiratory symptoms and incur high rates of hospitalization, and they account for the vast majority of pertussis-related deaths each year.” The authors also noted that incidence rates of pertussis have been higher over the past 5 years than at any time since the first pertussis vaccine became available. In the United States, pertussis infection is cyclical, with peaks in disease every 3 to 5 years. Incidence rates reached a high in 2012, and the next cycle is therefore estimated to peak between 2015 and 2017.

To reduce the risk of pertussis infection in infants younger than 12 months, the Global Pertussis Initiative (GPI) and the Centers for Disease Control and Prevention (CDC) recommend a strategy known as cocooning; this involves appropriate, one-time Tdap vaccination of all individuals in close contact with these infants, including parents, family members, and childcare providers. However, despite these recommendations, only 11 states discuss the issue of employee Tdap vaccination in their childcare licensing regulations.

Because APRNs play a role in protecting this vulnerable population of infants, they should take advantage of their influence in the community to reduce pertussis infection rates. In particular, APRNs can address the issue through legislative action, by advocating for one-time Tdap vaccine boosters for childcare employees—a strategy that would protect employees against pertussis as well as young infants who are too young to be fully vaccinated against the disease. If the APRN’s state childcare regulations already support Tdap vaccination for employees, the APRN can work to ensure vaccination compliance by educating childcare facility directors and employees, as well as their communities, about the benefits of vaccination. However, if the state regulations do not address this issue, the APRN should develop a strategy for addressing the regulatory gap. This strategy may involve contacting key stakeholders (such as government personnel, professional organizations, parent and community representatives, and childcare directors and employees) to help guide an approach to regulatory changes.

“APRNs play a vital role in framing policy conversations to improve care for at-risk populations,” the authors concluded.

​Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.