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Some elderly patients can't get whooping cough vaccine

Whooping cough shot wasn't tested on older people, but state says they should get it.

October 25, 2010|By Rong-Gong Lin II, Los Angeles Times

Some doctors are erroneously telling elderly patients that they cannot receive an inoculation for whooping cough, despite recommendations issued this summer by state health officials urging senior citizens to get vaccinated.

David Manuel Hernandez, 43, a Chicano studies assistant professor at UCLA, said his elderly parents, who are in their early 70s, had for weeks been unable to get the vaccines from their La Mirada physician. "My wife and I just had a baby and we are so worried about this," Hernandez said.

But senior citizens can and should be vaccinated for whooping cough, also known as pertussis according to the California Department of Public Health and the U.S. Centers for Medicare and Medicaid Services. California is entrenched in an outbreak of whooping cough, which has infected nearly 6,000 Californians the highest number since 1950, and has killed 10 newborn babies so far this year.

A state health official confirmed last week that he had heard of anecdotal cases of physicians having given patients outdated information.

"It is a challenge to reach all providers who have busy practices," Dr. Rob Schechter, chief pediatrician of the Immunization Branch of the California Department of Public Health, said Thursday.

The incorrect information rankled Hernandez, whose wife, Iyko Day, gave birth to daughter Tei Luz Hernandez-Day on Oct. 19.

Hernandez said he had been following news accounts of the pertussis epidemic for months. He and his wife were vaccinated with the Tdap shot weeks ago.

Hernandez's wife's parents, who are from Canada, got the shots at home. But Hernandez's parents were turned away from their La Mirada clinic repeatedly.

"They're caught, and they don't know what to do. They're getting into the idea that they're not going to see the baby for two months," Hernandez said.

After speaking with The Times, Hernandez said, his father found another healthcare provider that administers the vaccine to seniors.

For months, state health officials have been urging adolescents and adults — particularly those who are in contact with newborn babies — to get the Tdap vaccination, which protects against tetanus, diphtheria and pertussis.

Newborns are at the highest risk for death from whooping cough.

The Tdap shot was licensed for use in adolescents and adults up to age 64 in 2005 by the U.S. Food and Drug Administration.

But in light of the accelerating outbreak, and with evidence that the inoculation is safe for the elderly, California officials in July said anyone above 65 years of age should also receive the Tdap vaccine.

In August, Medicare issued a statement backing the California recommendation and confirmed that Medicare covers Tdap for seniors. "Vaccination of those over the age of 64 is important because neither prior vaccination nor natural disease confers lifelong immunity and those over 64 years of age have increasingly become primary caregivers for their grandchildren.

"Studies have demonstrated that pertussis is under-diagnosed in adults and may present with milder symptoms. In addition, the source of infection for infants under 3 months of age — those most likely to be hospitalized and die — is most commonly a household member or primary caregiver."

Schechter said any senior citizens having problems getting the vaccine should contact their local public health department for inoculations many of them offer free or discounted immunizations for the needy.

FDA spokeswoman Shelly Burgess said clinicians have the ability to prescribe a product for "off-label" uses "based on the clinicians' assessment of the risk and benefits of doing so, while taking into consideration recommendations such as those being made in California."

Burgess said the age limit was set at 64 not because the Tdap shot is unsafe for seniors but because there weren't enough seniors included in a clinical study presented to the FDA.

Schechter said that the federal Advisory Committee on Immunization Practices is to meet in Atlanta this week to address the question of immunizing senior citizens with Tdap.

If the committee endorses the California recommendation, some private insurers that have previously not covered Tdap vaccines in seniors may start to do so.

ron.lin@latimes.com

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