Health NW: Meningitis, pertussis and diphtheria vaccines

<center>Kathryn B. Brown, FNP</center>

In honor of National Immunization Awareness month, this week's column is about three vaccine-preventable diseases: meningitis, pertussis and diphtheria. These diseases can be fatal, but are easily prevented by safe and effective vaccines.

• Meningitis is an infection of the fluid that surrounds the brain and spinal column. The symptoms can include a high fever, headache, stiff neck, vomiting, confusion and seizures. Infants may appear irritable and listless, and may vomit and refuse to eat.

Meningitis is sometimes caused by a virus; this type is not too severe and usually resolves without treatment. Bacteria cause the more serious types of meningitis, which are fatal in 10 to 15 percent of cases. These three types of bacteria are Haemophilus influenzae type b, Neisseria meningitidis and Streptococcus pneumoniae. There are vaccines available for each of these types of bacterial meningitis.

Young children are at greatest risk of the Haemophilus influenzae type b (Hib) type of meningitis. Vaccination against Hib is now routine in childhood. It is a series of four shots, given at 2, 4, 6 and 12-15 months of age.

College students living in dormitories are at greatest risk for meningococcal meningitis caused by Neisseria meningitidis. Fifteen to 20 students die each year. Some colleges are now recommending or requiring the vaccine for incoming freshmen. Also, travelers to the "meningitis belt" of Africa - from Senegal across to Ethiopia - should consider vaccination against meningococcal meningitis, since there are frequent epidemics in that part of the world. This vaccine can be given at age 2 or older; one shot protects you for three years.

A vaccine against Streptococcus pneumoniae - the cause of pneumococcal meningitis and pneumonia - is called the pneumococcal polysaccharide vaccine (PPV) and is recommended for everyone age 65 years or older, as well as for people with certain medical conditions. A variant of this is also now part of the routine childhood vaccine series. Four shots of the pneumococcal conjugate vaccine (PCV) are given at 2, 4, 6 and 12 months of age.

• Pertussis is better known as whooping cough. The symptoms start off much like the common cold, but then a severe cough develops. At the end of a coughing attack, a high-pitched "whooping" sound is heard as the patient inhales to catch their breath. Infants are at highest risk for developing pneumonia and dying from this disease. In the 1940s - before a vaccine was developed - pertussis killed 8,000 children each year in the United States.

There were 193 pertussis cases in Oregon and 264 in Washington in 2002. It is very contagious and public health authorities must work hard to control outbreaks. A child in Jackson County, Oregon, died of pertussis this May.

• Diphtheria is a disease that can be fatal in up to 20 percent of cases. Before a vaccine was available, diphtheria killed tens of thousands of children in the United States each year. Now, it is a rare disease, with fewer than five cases reported per year.

The vaccine against both pertussis and diphtheria is given routinely as part of the DTaP (diphtheria, tetanus and pertussis) series, which is given at 2, 4, 6 and 15-18 months, and then again between age 4 and 6 years.

At age 11-12 years, children should get a Td (tetanus, diphtheria) booster. Adults should receive a Td booster every 10 years for life.

Make sure your children are fully immunized. The risk of side effects from these vaccines is much lower than the risk of disability or death from these diseases. If you can't afford a visit to a pediatrician, call your county health department and ask about free or low-cost vaccines.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to

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