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Whooping cough is much more prevalent in Ontario than what is reported to public health officials, according to new study that reinforces the importance of being vaccinated against this highly contagious disease.
Researchers at Public Health Ontario and Institute for Clinical Evaluative Sciences estimate the total number of whooping cough cases among infants is about three times higher — and about eight times higher for those older than the age of 1.
“I was quite surprised by the results,” said Dr. Natasha Crowcroft, chief of applied immunization research and evaluation at Public Health Ontario and lead author of the paper, published Wednesday in the journal PLOS ONE. “I wouldn’t have guessed that (under-reporting of whooping cough) was on this kind of scale … This is much bigger than I anticipated.”
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Researchers compared various sets of data in Ontario from 2009 to 2015, including public health reportable disease surveillance data, public health laboratory data, hospitalizations, emergency room visits and OHIP data, such as physician billing clams. But the data didn’t paint a complete picture and many cases of whooping cough were missing. Researchers estimate the total number of cases among infants younger than 1 was 924, but only 337 cases were reported to public health. For those older than the age of 1, the estimated total was 12,883, compared with the 1,665 reported cases.
Health officials know that many cases get missed in the data, but this is the first study to look at how widespread the problem is here in the province. There are various reasons why whooping cough is under-reported. Doctors may have difficulty distinguishing between it and other respiratory infections, choose not to test for it, or they simply don’t notify public health, which they’re required to do by law.
Whooping cough, formally known as pertussis, is transmitted when an infected person coughs and sneezes. It progresses to a severe hacking cough with difficulty breathing, with some people making a whooping sound as they gasp for air. People of all ages are affected, but it’s especially dangerous for infants. Deaths are rare, but when it does occur, it’s typically among infants, especially those who are too young to be immunized.
Crowcroft says people should not become complacent when it comes to vaccination. The vaccine for whooping cough is highly effective during the first few years, but immunity wanes so people need to get booster shots. Under the province’s publicly-funded immunization program, the vaccine is given to infants at 2, 4 and 6 months of age, with a booster administered at 18 months. Boosters are given four to six years later, and again between the ages of 14 and 16. Adults are funded for a one-time booster. It’s important that pregnant women get vaccinated to protect their babies during those first few months of life, when newborns are especially vulnerable.
“When it comes to whooping cough, you just cannot take that risk with your children,” she says. “Because there’s a lot more (whopping cough) around than we thought there was.”
Dr. Jeffrey Pernica of McMaster University, who wasn’t involved in this research, says the study’s findings are a call to public health officials and physicians to improve accuracy, which may mean changing the way whooping cough cases are recorded in the data.
“We want to capture the most severe cases. But it’s also important to capture cases that might not be as severe, but still cause problems to Ontarians and that incur costs to the province,” says Pernica, associate professor in the department of pediatrics and head of the division of pediatric infectious disease.
He notes that it can be tough for parents to distinguish between whether their kids have the common cold or whooping cough.
“The most important thing is if they think their children have respiratory symptoms that are not gradually getting better, or are getting worse, or their children are having difficulty breathing, they should always see their physician.”