{"id":930,"date":"2013-08-28T16:41:30","date_gmt":"2013-08-28T20:41:30","guid":{"rendered":"http:\/\/blogstemp2.wpengine.com\/?p=930"},"modified":"2015-06-04T14:24:46","modified_gmt":"2015-06-04T18:24:46","slug":"vaccination-against-pertussis","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2013\/08\/vaccination-against-pertussis\/","title":{"rendered":"Vaccination Against Pertussis – Is It Worth the Trouble?"},"content":{"rendered":"
\"\"

According to a study in the BMJ, the pertussis vaccine appears to be 53% effective against clinical infection in a “real world” setting.<\/em><\/p><\/div>\n

\u00a0\u201cFour out of four!\u201d exclaimed a proud PGY1 as she handed me the billing sheet for her last patient in continuity clinic.<\/p>\n

\u201cFour out of four?\u201d asked I.<\/p>\n

\u201cYes, I gave all of my patients their updated Tdap today,\u201d she boasted.<\/p>\n

As her preceptor, I commended her for her commitment to routine health maintenance\u00a0\u2014 you know, the supposedly routine tasks that, instead, routinely get pushed to the bottom of the patient\u2019s problem list. I remarked that I had only administered a total<\/strong> of four Tdap vaccines in my 3 years in resident clinic.<\/p>\n

Of course, I was exaggerating, but I admit that immunizations often got lost in the shuffle of resident continuity clinic. After an exasperating primary care encounter, the last thing I wanted to hear from my preceptor was, \u201cHas she had her tetanus shot?\u201d And I could imagine few things more defeating than quibbling with a patient over whether flu vaccines cause the flu, pneumococcal vaccines actually reduce the risk\u00a0for pneumonia, and so on.<\/p>\n

With so many competing priorities, so many new patients, and so many old dictations to scan\u00a0\u2014 maybe someone had already vaccinated Mrs. Jones and actually documented it!\u00a0\u2014 I often felt that the burden of vaccinations was too much to bear. But should I be chided for my negligence?<\/p>\n

This week Paul Mueller<\/a> of NEJM Journal Watch reported that the pertussis vaccine\u00a0is only moderately effective in adults<\/a>.\u00a0The data derive from a large case-control study of patients under the care of the Kaiser Permanente group in northern California. The vaccine was reported as \u201c53% effective\u201d against clinical pertussis infection.<\/p>\n

I actually pulled the BMJ <\/em>article<\/a>, and a few things stuck out:<\/p>\n