Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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FDA Approves Boostrix Vaccine for Elders

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BoostrixMost of us are familiar with the need to achieve immunization against tetanus (“lockjaw”) and diphtheria. Fewer are familiar with the need to immunize against pertussis (“whooping cough”). Boostrix is a vaccine used to achieve immunity against all three. Until recently, there had not been a vaccine approved by the Food and Drug Administration (FDA) against pertussis intended for use in elders (ages 65 years and older). On July 8, 2011, the FDA approved Boostrix for use in this population of seniors.

The link to the FDA announcement is http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm262390.htm

Whooping cough is not a trivial disease. It is a highly communicable infectious disease caused by the bacterium Bordetella pertussis. It is transmitted by respiratory secretions or large droplets from the respiratory tract of an infected person. In children, whooping cough is typified by coughing episodes that are sudden, intense, and sometimes accompanied by vomiting and inspiratory “whoops,” indicating throat spasms on inhalation. It is not uncommon for the victim to cough in severe spells and to have gagging or vomiting after a coughing spell.

In adults, it most commonly presents like a common cold for a week or two (this is the most infectious period), followed by a mild cough that becomes progressively severe. The cough is as described in children and may also involve difficulty breathing. Untreated, the cough may last for six to 10 weeks in children and for more than 10 weeks in adults. 

If this diagnosis is made, the victim should be treated with azithromycin (10 mg/kg of body weight [not to exceed 250 mg] by mouth once a day on day one, then 5 mg/kg on days two through five for children; 500 mg day one, then 250 mg on days two through five for adults); erythromycin (40 to 50 mg/kg per day in four divided doses [not to exceed 2 g per day] for 14 days for children; 500 mg four times a day for 14 days for adults); clarithromycin (15 mg/kg per day in two divided does [not to exceed 1 g per day] for seven days for children; 500 mg twice a day for seven days for adults); or with trimethoprim-sulfamethoxazole (8 mg/40 mg per kilogram per day in two divided doses for 14 days for children; 160 mg/800 mg twice daily for 14 days for adults). 

The protective effect of the DTaP (diphtheria-tetanus-pertussis) vaccine wanes rapidly three to four years after the last dose, so adults remain vulnerable to the disease.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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