Written Testimony: House Bill 3336 by Rep. Garnet Coleman (D-Houston)
House Public Health Committee
By: The Texas Medical Association, Texas Academy of Family Physicians, and Texas Pediatric Society
March 30, 2011
The Texas Medical Association, Texas Academy of Family Physicians, and Texas Pediatric Society support House Bill 3336 by Rep. Garnet Coleman, requiring information on pertussis (commonly called whooping cough) and the availability of the Tdap vaccine be provided to a postpartum woman. Our physician members appreciate Representative Coleman’s efforts to protect Texas children from pertussis by ensuring families have information on the serious, yet preventable disease.
Texas physicians are on the front lines of preventing and treating infectious diseases, including pertussis. We firmly believe that informing mothers and families in a hospital setting is an effective way to make sure families know they can protect their newborns from pertussis. HB 3336 provides an efficient way to share information. And it fits in well with the postpartum education system already required in state statute. Hospitals are well-positioned to deliver this information before a mother is discharged from the hospital.
Even though vaccination for pertussis has been available for decades, pertussis cases and outbreaks are still occurring in Texas. In 2009, there were more than 3,000 pertussis cases. Five hundred of those cases were just north of Austin in Williamson County. Fortunately, none of the patients died who contacted pertussis during this period. However, moving forward, we must take precautions to ensure no Texas baby or child dies from preventable disease. That’s why Texas physicians believe HB 3336 is an important step to help build a solid groundwork for pertussis prevention in our state.
Pertussis affects infants who are too young to be vaccinated. Even though most adults and adolescents were vaccinated during their childhood for pertussis, their immunity fades. Adults and older siblings of an infant can contract this highly contagious disease and then unknowingly pass it to others in the family. This includes young babies who are too young to be completely vaccinated. And while a young teen may experience only mild illness, pertussis in a baby leads to severe illness and sometimes even death. In 75 percent of cases, infants get pertussis from someone in their household; more than half of the pertussis cases are transmitted by a newborn’s mother or sibling.
The acellular pertussis or Tdap vaccine (includes tetanus and diphtheria toxoids) has been available for adolescents and adults as a pertussis booster since 2005. But coverage rates remain low. Tdap coverage is only 56 percent among adolescents [1] and about 6 percent among self-reporting adults. [2]
Our physicians have been so concerned about continued pertussis outbreaks in Texas that in 2009 TMA conducted its own pilot project to reduce the incidence of pertussis. Physicians made a concerted effort to educate new mothers about the importance of protecting their babies from pertussis. Building on the experience of pertussis programs conducted at Ben Taub Hospital in Houston and in other states, TMA worked with St. David’s Round Rock Hospital in Williamson County to provide information about pertussis to postpartum women. With support from a small grant from the Department of State Health Services, 286 new mothers were given information on the disease before they were discharged from the hospital. Of these, fewer than 12 percent reported that they had been vaccinated for pertussis — even though many had heard that there was an outbreak of pertussis in the county. TMA developed a handout on pertussis that was given to the postpartum mothers. This provided basic information on pertussis and listed places where the mothers and other family members could get a Tdap vaccination. Mothers were eager to learn about how to protect their newborns from pertussis.
We found that providing information in the hospital setting before a mother is discharged is an effective educational vehicle. This also directly involves the family in helping to keep their newborn safe. Mothers get a lot of information on how to care for and protect their newborn from diseases before they are discharged from a hospital. Most mothers want to learn as much as possible and appreciate having a physician and health care staff available to answer their questions.
Our physicians also have four other recommendations to help the state address pertussis:
- Ask the state to distribute more timely information to physicians and the public on potential pertussis outbreaks (as has been done in California),
- Plan for the rapid allocation of vaccine to local health departments when outbreaks are identified,
- Promote vaccination in emergency rooms when vaccination for tetanus is indicated, and
- At the core of this issue — having strong local health officials who can work with the public and physicians to address pertussis.
Pertussis likely will continue to threaten Texas given the state’s diverse population, geography, and continued population growth. We thank Representative Coleman for bringing attention to this serious preventable disease and for identifying an effective way to inform families how to protect their babies from pertussis.
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[1] Centers for Disease Control and Prevention. National, state, and local area vaccination coverage among adolescents aged 13-17 years — United States, 2009. MMWR 2010;59;1018-
[2] Centers for Disease Control and Prevention. Tetanus and pertussis vaccination coverage among adults aged ≥18 years — United States, 1999 and 2008. MMWR 2010;59:1302-6.