Although the news and concerns about the measles are overshadowing our offices at the moment, pertussis outbreaks continue in local school districts, particularly involving middle and high school students who are likely immunized but have waning immunity due to the weaker nature of the acellular form of the vaccine. In March, there were around 80 confirmed cases in 12 schools in the West Los Angeles area. Unfortunately, in mid-April, an infant died of pertussis in Orange County. Remember, the reason for population-level pertussis immunization is to protect the babies who are either not yet immunized or under-immunized, for whom pertussis can be fatal. Also, please remember that if you have a confirmed case of pertussis, that the child must complete five (5) full days of antibiotics before going back to school in order not to spread the disease. They may continue to cough for several months after treatment, but they are no longer contagious if they complete five days of antibiotics.

 

In their article on "Effectiveness of pertussis vaccination and duration of immunity" published in 2016, Schwartz et al. examined pertussis immunity with acellular pertussis vaccine following a localized outbreak in Ontario, Canada during 2012. They used a case control study design to look at 5867 children who had been immunized between 2009 and 2013 (486 who had tested positive for pertussis and 5381 who had tested negative) and found that the vaccine conferred 84% immunity up to 3 years, but then dropped to 62% from 4-7 years, and 41% at 8 or more years (click here for a copy of the original article). In light of this and ongoing outbreaks in the county, I am hearing of pediatricians' being pressured by parents to give additional Tdap boosters to children 7-10 years and 14+ years who fall in this period of waning immunity. While this is not an official recommendation of the ACIP or AAP Red Book Committee, I can see the reasoning, particularly as pregnant women are given Tdap with every pregnancy, and parents are understandably concerned about ongoing cases of pertussis in local communities. Our chapter is partnering with LA County DPH to study this issue--please contact Tomas if you are interested in getting involved.

 

Later this month, we are hosting a Strategic Forum with First 5 Los Angeles to address the Help Me Grow initiative in Los Angeles County. In our chapter, Help Me Grow initiatives have been launched in San Luis Obispo, Ventura, Kern, San Bernardino and Riverside counties, in addition to Los Angeles (click here for a link to the Help Me Grow California website). The Help Me Grow initiative helps communities leverage existing resources to identify vulnerable children, link families to community-based services, and empower families to support their children's healthy development. Our involvement as pediatricians in Help Me Grow is crucial because we are uniquely positioned to identify developmentally vulnerable children through developmental monitoring during well-child visits. This work builds upon the efforts of Ed Curry during his time as Chapter President where he championed training pediatricians on developmental screening. Please join us for this important Strategic Forum (details below).

 

Our chapter is also getting to know our new state Surgeon General, Nadine Burke Harris. Tomas and I were invited to Chapter 4's Trauma Informed Care conference in Anaheim on April 5 and 6 and had the opportunity to meet and chat with her about her future plans for the state. I also had an opportunity to be involved in her Listening Tour, where she is meeting with community members to hear from them the struggles to provide trauma-informed care to children in low-income communities and in foster care. Dr. Burke Harris outlined her top three priorities as addressing Adverse Childhood Experiences (ACEs), toxic stress, and health equity. In our own chapter, we are launching our ACEs Committee with Adam Schickedanz from UCLA, Ruby Kalra from Kaiser Downey, Ariane Marie-Mitchell from Loma Linda, Stephanie Marcy from CHLA and Danielle Shaw from Camarillo. Please click here if you are interested in joining our ACEs Committee and being part of the Surgeon General's initiatives for California.

 

Did you know that AB 1433 (signed into law in 2005) requires that all kindergarteners in the state have an oral health exam prior to May of their kindergarten year? This law was updated in 2018 to use Prop 56 funds to provide more oversight at the state level and collect data on whether and how this is happening. Last month, I attended a Board Meeting for our local Dental Transformation Initiative, called More L.A. Smiles (details below). Please check out their website for opportunities for CME and MOC related to pediatric oral health, as well as more information on this kindergarten dental registry.