"Pertussis claims life of Texas infant"

On April 30, Serena Gabrielle King, age 27 days, succumbed to whooping cough in Austin. She is the third person in Texas to die from the disease this year. Texas, which has one of the lowest rates of childhood immunization in the nation, has seen a startling increase in the incidence of pertussis since 2000. Travis County, where Austin is located, experienced one case in 2000, 54 in 2001, and 111 in 2002.

Infants are particularly likely to contract the disease. According to the “MMWR Summary of Notifiable Diseases,” in the years 1999, 2000, and 2001, between 22 to 27 percent of pertussis cases reported in the United States occurred in infants under 7 months of age. The increased incidence of pertussis puts newborns like Serena at considerable risk: Infants do not receive the first dose of DTaP until 6 weeks to 2 months of age, leaving them extremely vulnerable in the earliest weeks of life.

Editorial Note: Since Serena’s death, an 11-week-old boy is reported to have died from pertussis in Oregon, according to an account that appeared in the “Herald and News,” Klamath Falls, OR. Published May 16, the account states the boy died the previous week; details were not made public at the family’s request.

Following are a newspaper article as well as a letter to the editor, written by Serena’s grandfather. As both make clear, the only hope of sparing other infants from Serena’s fate lies in increasing rates of childhood immunization.

The newspaper article, written by Mary Ann Roser, was published in the “Austin American-Statesman” on May 7. We are grateful to the “Austin American-Statesman” for permission to reprint it. The letter to the editor, written by Troy Rickabaugh, was published May 27 in the newspaper “Mineral Wells Index.”

Too Young for Shot, Austin Infant Dies of Whooping Cough
By Mary Ann Roser
(Copyright “Austin American Statesman”; reprinted with permission)
May 7, 2003

A month-old infant died of whooping cough last week in Austin, the first such death in Travis County in years and a reminder that the highly contagious disease is in the community and can kill babies. Whooping cough, also known as pertussis, is on the upswing, and Travis and Burnet counties were among the hardest hit in the state last year. Officials at the Austin/Travis County Health and Human Services Department investigated people who came in contact with the baby–including students at Crockett High School, which the mother attended, and the doctor’s office where the disease went undetected–but could not find the source of the whooping cough, health department spokesman Bob Flocke said.

“We’ve exhausted all the leads and all the contacts,” Flocke said Monday. “We don’t have anywhere else to go.” The health department sent a letter to teen parents of children in day care at the high school, letting them know the pertussis exposure could have occurred there, Flocke said. Whooping cough starts with cold symptoms and often is spread by older children or adults who do not get as severe a case or the characteristic “whoop” that younger children get.

Lacee King, the baby’s mother, said she hoped the loss of her 27-day-old daughter, Serena, would educate people, including the medical community, about pertussis. Her daughter was not diagnosed until just before her death. She also wants parents to be aware of the importance of vaccinations. “I hope it can make people aware of what can happen from not being vaccinated,” said King, 16.

Serena King was too young for the vaccine, which is given at 2 months, 4 months and 6 months, with boosters at 18 months and 4 years. Someone who might not have been vaccinated could have passed the disease to her. Texas ranks near the bottom of the states in childhood vaccination rates. Some parents opt out of the pertussis vaccine because of side effects, such as fever. The vaccine is about 80 percent effective, though protection wanes as the child ages.

Serena, born April 3, developed jaundice and cold symptoms about two weeks after she was born, and King took her to Carousel Pediatrics. The baby was seen by a nurse, who told King that her child had normal nasal problems, King said.

When Serena began coughing and vomiting, King took her back and was told her daughter had gastroesophageal reflux, a digestive problem, King said. When the baby’s condition worsened April 27, King and her husband, Rickey King, rushed her to the hospital. A day later, she was diagnosed with pertussis, and on Wednesday, she was dead. “I think Carousel Pediatrics had a big part in this,” Lacee King said.

Glenn Wood, the senior physician at Carousel, said pertussis is hard to diagnose early on. Dozens of children come in every day with coughs and runny noses, and it would not be feasible to test every child for pertussis, he said. After reviewing Serena’s chart and records of her visits on April 16 and April 22, he said that while his nursing staff treated the child, “There’s not anything I would have done differently based on what I’m seeing.”

“It’s a terrible, unfortunate case, but it illustrates how important it is to get vaccinated,” he said. “There are a lot of kids behind on their vaccinations, and a lot can’t get in to see their doctor, especially kids on Medicaid and on CHIP,” the Children’s Health Insurance Program.

For a long time, pertussis was seen as virtually eradicated. But in recent years, it has made a comeback. Death rates in Texas have risen from zero or one a year to five in 2001 and four in 2002, said David Bastis, program manager in the immunization division at the Texas Department of Health. So far this year, two deaths have been reported in Texas. A check of records to 1990 showed no other pertussis deaths in Travis County.

Why the increase in deaths statewide? “There’s more pertussis out there because of low immunization coverage and waning immunity in adolescents and adults,” Bastis said. “That increases the chance that babies and infants will get pertussis.” Last year, 111 pertussis cases were reported in Travis County, up from 54 in 2001 and one in 2000. There were 235 pertussis cases in Burnet County in 2002, more than any in Texas.

Troy Rickabaugh, Lacee King’s father, called the newspaper about his granddaughter’s death in the hope of educating others about the potentially deadly consequences of pertussis. “If we can save one life,” he said, “that would be wonderful.”

Don’t Let a Child Die over Lack of Immunizations
(From the “Mineral Wells Index”)
May 27, 2003

Dear Editor,

My beautiful granddaughter is dead.

Serena’s death was totally preventable, but someone made a bad decision not to get immunized for whooping cough.

Her mother, my daughter, went to all her prenatal doctor appointments, watched her diet, took care of herself so she could take care of her baby.

Serena was too young to even begin getting vaccinations, but you can be assured she would have received all her shots on time. All the love and caring our family gave Serena ultimately made no difference because someone else chose not to be immunized.

Pertussis, or whooping cough, is a totally preventable disease. But only if everyone lives by the Golden Rule and does the right thing. No one has the right to make a decision for himself that can hurt others. And that’s what happens when all children are not immunized. Their parents make the wrong decision, and someone else’s child gets hurt!

Serena lived 27 days in the loving arms of her family. She died because someone in the community did not get immunized.

You can do something to make sure other families don’t suffer the pain we are suffering. You can get immunized. And you can ask your state senator to support two bills pending in the Texas Senate: HB 1920 and HB 1921. One bill calls for the Texas Department of Health to keep a database that doctors can use to see if a child needs to be immunized. The other provides vaccines for children who don’t have the insurance coverage to pay for the immunizations.

Please, don’t let another Serena die needlessly.

Troy Rickabaugh


Disclaimer: Immunize.org publishes Unprotected People Stories about people who have suffered or died from vaccine-preventable diseases for the purpose of making them available for our reader’s review. We have not verified the content of this report.

Date Published: May 30, 2003
Age: Infants

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