Category Archives: Lungs & Breathing

Vaccination is the most effective flu prevention for seniors

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Flu shot todayBy Dr. Kory B. Fowler
Medical Director, Intermountain Region
Humana

The influenza virus– commonly known as the flu – affects up to 20 percent of Americans annually, leaving more than 200,000 people hospitalized from complications each year, according to the Centers for Disease Control and Prevention (CDC).

The flu is particularly dangerous for Washington seniors, who often have pre-existing chronic health conditions, such as diabetes or heart disease.

Last year the flu vaccine prevented 6.6 million illnesses, 3.2 million doctor visits and at least 79,000 hospitalizations.

There are many ways to reduce the risk of catching the virus, such as washing your hands often, but an annual flu shot is the most effective way to prevent the flu and reduce the risk of complications. Continue reading

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Enterovirus D-68 confirmed in two patients at Seattle Children’s Hospital

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From Seattle Children’s Hospital

Parents strongly encouraged to take precautions, seek medical attention for troubled breathing, wheezing in babies, children, teens

EV68-infographicSEATTLE – Sept. 19, 2014 – Seattle Children’s Hospital announced today that two children have tested positive for Enterovirus D-68 (EV-D68).

The children, whose names were not released, have preexisting health conditions that exacerbated their condition but were stable enough to be discharged from the hospital earlier this week.

The presence of EV-D68 in the two children was confirmed by the Centers for Disease Control (CDC) on Thursday.

Results for three other children who were tested for EV-D68 were negative. Two of those children have been discharged; one is deceased.

No children in Washington or the United States have died of EV-D68 related illness. Continue reading

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How Racism Creeps Into Medicine – The Atlantic

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Illustration of the lungs in blueIn 1864, the year before the Civil War ended, a massive study was launched to quantify the bodies of Union soldiers. One key finding in what would become a 613-page report was that soldiers classified as “White” had a higher lung capacity than those labeled “Full Blacks” or “Mulattoes.” The study relied on the spirometer—a medical instrument that measures lung capacity.

via How Racism Creeps Into Medicine – The Atlantic.

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Death with Dignity Act prescriptions rise 43 percent

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Washington MapThe number of Washington state residents who obtained prescriptions for a lethal dose of drugs under the state’s Death with Dignity Act rose from 121 in 2012 to 175 in 2013, a 43% increase over the previous year.

Of the 159 who died

  • 77 percent had cancer
  • 15 percent had a neuro-degenerative disease, including amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease).
  • 8 percent had other conditions, including heart and respiratory disease,

Their ages ranged from 29 to 95 years. Ninety-seven percent were white, and 76% had some college education. Ninety-five percent lived west of the Cascades.

Of the 159 who died, 119 ingested the medication and 26 did not. In 14 cases, it is unknown whether they took the medicines.

Reasons that patients gave for obtaining the lethal prescriptions included

  • Concerns about loss of autonomy – 91 percent
  • Concerns about loss of dignity – 79 percent
  • Concerns about loss of the ability to participate in activities that make life enjoyable – 89 percent.

Under the state’s Death with Dignity Act, terminally ill adult patients have had the right to ask their physician to prescribe a lethal dose of medication to end their life. Since the law’s enactment, 550 people have acted on that right since the law went into effect.

The 2013 Death with Dignity Act Report and information about the Washington State Death with Dignity Act are on the agency website.

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States target asthma care as number of patients grow

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Washington is one of the few states that has made the Asthma and Allergy Foundation of America honor roll of states that have adopted comprehensive public policies supporting people with asthma, food allergies, anaphylaxis risk and related allergic diseases in schools.

Illustration of the lungs in blueBy Michael Ollove
Stateline Staff Writer

April 16, 2014 

In a valley wedged between the Mississippi and Missouri rivers, St. Louis often finds itself beset by a stationary air mass that only a severe storm of some kind can dislodge.

St. Louis is also an industrial city with high humidity, so it’s no wonder it usually makes the list of worst places for asthmatics to live.

But the state has also pioneered advances in addressing asthma treatment and costs. Two years ago, the Missouri legislature became the first to allow schools to stock quick-relief asthma medications for emergencies.  Continue reading

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Antibiotics don’t prevent complications of kids’ respiratory infections

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Three red and white capsulesBy Milly Dawson
HBNS Contributing Writer
FEB 18, 2014

Antibiotics are often prescribed for young children who have upper respiratory tract infections (URIs) in order to prevent complications, such as ear infections and pneumonia, however, a new evidence review in The Cochrane Library found no evidence to support this practice.  Continue reading

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App lets you determine your neighborhood’s radon risk

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Screen Shot 2014-01-21 at 11.28.29From the Washington State Department of Health

Olympia, January 21, 2014 – Washington residents now have a new online map to check and see if their neighborhood has a geological risk for the cancer-causing gas, radon, using a new state app. The new app is offered by the state Department of Health’s Washington Tracking Network.

Some areas of the state, such as Spokane and Clark counties, are well-known for having higher levels of radon, but the new online map shows that there are some areas around the Puget Sound such as Pierce and King counties that might come as a surprise.  Continue reading

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Something odd about your cigarette? FDA wants to hear about it

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Consumer Update from the FDA

Cigarette SmokeAre you using a tobacco product that you believe is defective or is causing an unexpected health problem?

Are you using a tobacco product that has a strange taste or smell?

The Food and Drug Administration (FDA) wants to hear from you and has a new online tool you can use to report your problem. Continue reading

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lesson one

Oregon schools use ‘behavioral vaccine’ to reduce smoking

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Blackboard with "Lesson one" written on it.

Photo: Krzysztof “Kriss” Szkurlatowski

By Kristian Foden-Vencil
Oregon Public Broadcasting

Behaving well in elementary school could reduce smoking in later life. At least, that’s what Trillium Community Health Plan hopes, and it’s putting money behind the idea.

Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the “Good Behavior Game.”

Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the “s” sound and the “a” sound. But first, as she does every day, she goes over the rules.

“You’re going to earn your stars today by sitting in the learning position,” she says. “That means your bottom is on your seat, backs on the back of your seat. Excellent job, just like that.”

For good learning behavior, like sitting quietly, keeping their eyes on the teacher and working hard, kids get a star and some stickers.

Railey says the game keeps the kids plugged in and therefore learning more. That in turn makes them better educated teens and adults who’re less likely to pick up a dangerous habit, like smoking.

The Washington, D.C., nonprofit Coalition for Evidence Based Policy says it works. It did a study that found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent — and reduced the number of kids who had started to take hard drugs by more than half.

The fact that a teacher is playing the Good Behavior Game isn’t unusual. What is unusual is that Trillium is paying for it. Part of the Affordable Care Act involves the federal government giving money to states to figure out new ways to prevent people from getting sick in the first place.

So Trillium is setting aside nearly $900,000 a year for disease prevention strategies, like this one. Jennifer Webster is the disease prevention coordinator for Trillium Community Health, and she thinks it’s a good investment.

“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” she says. “This is really what needs to be done. What we really need to focus on is prevention.”

Trillium is paying the poorer schools of Eugene’s Bethel School District to adopt the strategy in 50 classrooms.

Trillium CEO Terry Coplin says changes to Oregon and federal law mean that instead of paying for each Medicaid recipient to get treatment, Trillium gets a fixed amount of money for each of its 56,000 Medicaid recipients. That way Trillium can pay for disease prevention efforts that benefit the whole Medicaid population, not just person by person as they need it.

“I think the return on investment for the Good Behavior Game is going to be somewhere in the neighborhood of 10 to one,” Coplin says.

So, for each dollar spent on playing the game, the health agency expects to save $10 by not having to pay to treat these kids later in life for lung cancer because they took up smoking.

Coplin concedes that some of Trillium’s Medicaid recipients will leave the system each year. But he says prevention still makes medical and financial sense.

“All the incentives are really aligned in the right direction. The healthier that we can make the population, the bigger the financial reward,” he says.

The Oregon Health Authority estimates that each pack of cigarettes smoked costs Oregonians about $13 in medical expenses and productivity losses.

Not all the money Trillium is spending goes for the Good Behavior Game. Some of it is earmarked to pay pregnant smokers cold, hard cash to give up the habit. There’s also a plan to have kids try to buy cigarettes at local stores, then give money to store owners who refuse to sell.

This story is part of a reporting partnership that includes NPROregon Public Broadcasting and Kaiser Health News

Photo courtesy of Krzysztof “Kriss” Szkurlatowski

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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As Washington delays, states move on e-cigarettes

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eBy Jake Grovum
Stateline Staff Writer

Money grab, health concerns, or both? Absent guidance from Washington, states are pressing ahead with their own agendas on electronic cigarettes.

Heading into legislative sessions next year, policymakers, industry representatives, health advocates and tax wonks expect electronic cigarettes — or e-cigarettes for short — to be among the top issues at state capitols.

Legislatures are expected to tackle how to classify, regulate and, perhaps most importantly, tax the relatively new products.

The debates in states come as the federal government considers its own answers to similar questions. The Food and Drug Administration is considering classifying e-cigarettes as “tobacco products,” which would extend its reach and potentially subject e-cigarettes to a host of rules and regulations that apply to tobacco cigarettes.

“States are scrambling to figure out how to deal with this,” Ohio Attorney General Mike DeWine said in an interview. “It’s going to be fought out in 50 states; it’s going to be fought out in one jurisdiction after another.”

DeWine was a lead author of an Oct. 23 letter sent by 40 attorneys general to the FDA pushing for federal rules and for e-cigarettes to be treated as “tobacco products” for regulatory purposes.

So far, Washington hasn’t decided how to proceed with e-cigarettes. A proposed rule, expected to be released for public comment in November, was delayed by the government shutdown and is still pending.

That has left a patchwork of rules, regulations and product definitions across the nation, often at the urging of anti-tobacco advocates. “We think it’s really important that states act,” said Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.

More than half the states, for example, have banned the sale of e-cigarettes to minors, but others have no restrictions. Currently four states — Utah, North Dakota, Arkansas and New Jersey — have lumped the products in with tobacco under indoor smoking bans, even as research about possible ill-effects from second-hand vapor smoke, if there even are any, remains limited.

Some local governments have taken similar steps on their own, enacting rules for e-cigarettes that sometimes go beyond those in place at the state level.

The intensity of the debate illustrates both the lack of good research on e-cigarettes as well as the money at stake. Often, those considering limits don’t even agree on whether applying tobacco regulations is appropriate, given how different the products are. Like tobacco cigarettes, nicotine levels in the “cartridges” that are loaded into the e-cigarette device can vary widely, complicating efforts to agree on a standard approach to regulation and taxation.

E-cigarettes first appeared about a decade ago, and sales have grown exponentially in recent years. The number of American adults who said they have tried them doubled to one in five in just one year (from 2010 to 2011), according to a Centers for Disease Control survey.

Use among middle and high school students also doubled from 2011 to 2012, according to the CDC, with nearly 1.8 million students saying they’ve used them.

E-Cig Revenue

In an era of revenue-hungry state governments — some still dealing with declining revenue from traditional tobacco taxes and recovering from the Great Recession — taxing e-cigarettes seems likely to get the most attention from state lawmakers in 2014. Questions of advertising limits, health claims and ingredient disclosure will likely remain federal issues.

So far, only Minnesota has put in place a specific state tax policy for e-cigarettes, a decision reached in 2012. The products are subject to a 95 percent tax that functions like a sales tax, tacked onto the wholesale cost of the product.

That generally means they are taxed at a higher rate than traditional cigarettes, which are subject to a $1.29-per-pack levy. The state expects to collect $1.16 billion from all tobacco taxes in the 2014-2015 fiscal year.

For now, most other states apply only a sales tax – if they have one – to e-cigarettes. But at least 30 others are considering e-cigarette taxes of some kind next year.

“I will be watching to see if more proposals like Minnesota are replicated in the states,” said Scott Drenkard of the Tax Foundation, an anti-tax research group, “But I hope they are not.”

What this is is a money grab.

As tax experts see it, there’s little rationale aside from simply raising revenue for taxing e-cigarettes as traditional cigarettes. Tobacco, they say, is taxed because it produces negative health consequences that cost the public. For now, there’s little research that shows similar effects from e-cigarettes.

“There is zero, emphasis on zero, justification for taxing e-cigarettes right now,” said David Brunori of the group Tax Analysts, a nonprofit tax analysis group that provides insight to private firms and government agencies. “What this is is a money grab. It’s a way of trying to find revenue to replace lost tobacco taxes.”

According to the nonpartisan Tax Policy Center, state and local tax revenues have somewhat leveled off in recent years as smoking has declined. Collections grew from $7.7 billion in 1997 to $15.8 billion in 2007, but reached just $17.6 billion in 2011, the most recent year available.

Tobacco companies that don’t produce e-cigarettes have often pushed tax parity so their own products are not at a disadvantage. In Minnesota’s case, the state simply said that under its laws, the tax must apply.

But the most popular argument is deterrence—higher taxes might make the product less attractive and less affordable to young people looking for nicotine.

“It has nothing to do with revenue,” Ohio’s DeWine said. “It has everything to do with discouraging use.”

An Alternative to Tobacco

Discouraging use, however, is exactly the opposite goal lawmakers should have, said Ray Story of the Tobacco Vapor Electronic Cigarette Association. It’s an opinion shared by some outside of the industry as well, especially with regard to those already smoking.

“Cigarettes are sold everywhere in the world, and we want to make sure that the e-cigarette is sold as a less-harmful alternative right there next to it,” Story said.

“We should expand the use, not restrict it,” he added, saying that if e-cigarettes can greatly reduce cigarette use the industry “will have made the greatest impact on humanity ever.”

The contrasting approach reflects two key differences in thinking about e-cigarettes: as a new recreational product similar to tobacco cigarettes, or as a potentially less-unhealthy alternative that could even help smokers quit entirely.

E-cigarette producers themselves are divided. Some welcome traditional cigarette-style regulations to a degree, content to play by similar rules as tobacco producers, especially if it saves them from more onerous limits applied to drug manufacturers, for example. Others argue that even thinking about e-cigarettes through the same frame of reference as tobacco is a flawed approach.

Federal officials in Washington will likely be the ones to eventually settle the dispute, and that decision could still be months away. Meanwhile, debates in the states over two key issues within their control – taxes and sales to minors – are likely to rage in 2014.

But the eventual decision from the FDA is sure to affect those debates. “If the FDA says these are essentially tobacco products,” said Brunori of Tax Analysts, “that will give all kinds of cover to state politicians.”

Stateline logo

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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When temperatures dip, air quality often does as well

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Illustration of the lungs in blueFrom the Washington State Department of Health

You may have noticed spectacular evening skies this winter, yet those sunsets frequently are a sign of air quality problems that occur this time of year. Winter weather patterns can trap air pollution – especially from wood stoves and fireplaces – near the ground, where it can build-up and may threaten people’s health.

The state Department of Health is reminding people air pollution can be harmful to their health. It can be especially harmful for people who have a lung condition like asthma, chronic obstructive pulmonary disorder (COPD), or with heart disease.

Air pollution has fine particles that can cause immediate and long-term health effects when inhaled. It’s a good idea to check local air conditions and limit outdoor activities when air quality conditions are poor.

The amount of air pollution that causes immediate health problems varies from person-to-person. For people who are sensitive to air pollution, even a short outdoor stroll can cause wheezing or shortness of breath.

Others may not have problems until they do more strenuous activities like yard work, running, or shoveling snow. Kids and adults over 65 are among those who should limit their activity during periods of poor air quality.

Air pollution often can’t be seen or smelled, but the state Department of Ecology monitors air conditions and posts them online across the state. More information and statistics on air quality in your community can be found on our website.

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Seattle hookah bars violating laws banning public smoking, King County health officials say

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Public Health – Seattle & King County has found that six Seattle hookah bars are violating the state’s law banning public smoking and ordered them to stop allowing smoking on their premises.

Here’s the announcement from Public Health – Seattle & King County

Six Seattle hookah bars receive order for violating public smoking law

Six hookah bars in Seattle are on notice for violating Washington’s Smoking in Public Places law. Public Health – Seattle & King County sent each of the establishments a Notice and Order on Tuesday, October 1, requiring them to stop allowing smoking.

To protect public health, state law requires that all places of employment and public places are smoke-free.

Health inspectors visited the hookah bars multiple times. They found patrons smoking and each of the bars operating as a public place and/or place of employment.

“Our investigation shows that these hookah bars are violating the law, and endangering the health of their workers and patrons. We are forced to take this enforcement action because they haven’t been responsive to our previous warnings,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “Secondhand smoke is a proven killer, and state law works to protect everyone from this health threat.”

Hookah bars have claimed that they are exempt from the indoor smoking law because they are private clubs. However, smoking is prohibited by law if a club has employees and/or the club is open to the public.

The investigation found that these six bars are all open to the public, operating similarly to night clubs that charge a cover for admission.

Each of the establishments received multiple warnings from inspectors, but they have not complied with Washington law. The Notice and Orders require immediate compliance plus payment of fines and fees.

The fine for each violation is $100, in addition to escalating re-inspection fees after the first warning. Subsequent violations will result in additional steps to ensure that state law is followed, including possible court action.

Hookah is a water pipe commonly used to smoke tobacco. Research shows that hookah smoking is at least as harmful as cigarette smoke, even when mixed with sweet fruit and candy flavors.

The establishments have ten days from receipt of the Notice and Order if they wish to appeal or 30 days to pay the fines and re-inspection fees.

Hookah bars receiving a Notice and Order this week include:

 

Lounge Address
Casablanca Shisha Lounge 1221 S Main St

Da Spot Hookah Lounge

1914 Minor Ave
Medina Hookah Lounge 700 S Dearborn St
The Night Owl 4745 University Way NE
Sahara Hookah Lounge 7523 Lake City Way NE
Seattle Hookah Lounge 4701 Roosevelt Way NE

 

Hookah health threat

Tobacco use remains the number one cause of preventable death and disease in King County, costing nearly 2,000 lives and $343 million dollars in health costs and lost wages locally every year.

  • Tobacco is placed inside the bowl at the top of the hookah.

    Tobacco is placed inside the bowl at the top of the hookah.

    Hookah is a water-pipe commonly used to smoke tobacco, often mixed with sweet fruit and candy flavors.

  • Research shows that hookah smoking is not a safe alternative to cigarettes and that hookah smoke is at least as harmful as cigarette smoke.
  • During a typical 45-minute session of hookah use, a person may inhale as much smoke as smoking 100 cigarettes or more.
  • Hookah smoke contains the addictive drug nicotine, along with tar, carcinogens, and heavy metals.
  • Hookah smoking has been associated with lung cancer, oral cancer, heart disease, respiratory illness, periodontal disease, and low birthweight.
  • Sharing a hookah mouthpiece can transmit infectious diseases, including tuberculosis.

Hookah and youth

Hookah use has seen a rise in popularity, especially among youth. According to the 2012 Healthy Youth Survey, hookah use among King County high school seniors is higher than cigarette use (15% and 12%, respectively).

‘We are very concerned about the high hookah use rates among youth,” said Scott Neal, Tobacco Prevention Program Manager for Public Health – Seattle & King County. “Sweet fruit and candy flavors lure youth and help fuel the misperception that hookah smoking is safer than cigarettes.”

Report smoking law violations

To report violations, visit the Tobacco Prevention Program page for an online form; or text the establishment’s name, date of violation, and brief description of the violation to  206-745-2548.

 

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tacuin women

Women’s Health – Week 3: Asthma

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From the NIH Office of Research on Women’s Health

tacuin womenAsthma is a chronic (long-term) lung disease that inflames and narrows the bronchioles or airways. People of all ages have asthma, but it most often starts in childhood.

Asthma causes recurring periods of wheezing (a whistling sound when you breathe),  chest tightness,  shortness of breath,  and coughing. The coughing often occurs at night or early in the morning.

Many people with asthma are allergic to airborne allergens. It is believed that allergens (mostly those found indoors),  when inhaled, cause inflammation in the airways in the lungs. Inflamed airways are more sensitive to allergens,  but also extremely sensitive to irritants and to some viral infections.

Allergens,  irritants,  and viral infections can trigger asthma attacks. During an asthma attack,  the muscles surrounding the walls of the airways in the lungs constrict and narrow the airways.

Also, the inside walls of the airways become swollen, making the airways even narrower. The constricting and swelling of the airways prevent air from flowing freely through the lungs.

In a severe asthma attack,  the airways can close so much that not enough oxygen gets to vital organs like the heart and brain. These severe attacks are considered medical emergencies.

If your asthma is not well controlled, then you may miss school, work, and other activities.

asthma_v01

A diagram of the lungs showing the difference between normal airways, or bronchioles, and asthmatic bronchioles.

Symptoms of asthma include:

  • Difficulty breathing.
  • Wheezing.
  • Coughing.
  • Tightness in the chest.

Even when you feel fine,  you still have the disease and it can flare up,  especially when you breathe in allergens or irritants from the environment. These are called triggers.

Some common asthma triggers include:

  • Allergens such as animal dander from the skin,  hair,  or feathers of animals;  dust mites (contained in house dust);  cockroaches;  pollen from trees and grass;  and mold (indoor and outdoor).
  • Airborne irritants including smoke,  strong odors or scents,  and pollution.
  • Cold air,  changes in weather,  and exercise.
  • Workplace chemicals or allergens.
Asthma and pregnancy
Pregnant women who have asthma need to control the disease to ensure their fetus gets enough oxygen. Poor asthma control raises the chance that a baby will be born early,  have a low birth weight,  and be at risk of death. Studies show that it is safer to take asthma medicines while pregnant than to risk having an asthma attack. But you need to carefully review these medicines with your health care provider.

Asthma cannot be cured. With proper treatment,  most people who have asthma can control their asthma and be active all day and sleep well at night. You can control your asthma with these key actions:

  • Work with your health care provider to make a written action plan that describes how you can manage your asthma day-to-day. Be sure to ask questions and discuss any concerns about your asthma treatment. This way,  you and your health care provider can work together on a plan that is best for you.
  • Take your medications as directed. Everyone with asthma needs a quick relief medication for symptoms. Many patients need daily long-term control medication. Most of these patients use inhaled corticosteroids,  but some may need additional medications.
  • Avoid or control allergens or irritants that make your asthma worse. Your health care provider will help you learn which triggers affect you the most and how to avoid or control them.
  • Get regular asthma checkups to monitor your asthma control and see if your treatment should stay the same or be changed. Visits at least every 6 months are recommended because asthma varies from season to season and can change over time (for example,  as a child grows older or if a woman is pregnant).
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Protect babies from whooping cough – CDC infographic

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protect-babies-from-whooping-cough

Protect Babies from Whooping Cough (Text Version)

If you’re pregnant get a Tdap shot!

Whooping cough is deadly for babies

[Picture of a nurse holding a baby beside a hospital]
Whooping cough (pertussis) is a respiratory infection that can cause severe coughing or trouble breathing.
About half of infants who get whooping cough are hospitalized!
[picture of arrow saying “1 out of 2” pointing to hospital]
Whooping cough cases across the U.S. have been on the rise since the 1980s.

Pregnant women need to get a Tdap shot

[Picture of a pregnant woman talking to a mother holding a baby]
Pregnant woman: I got my whooping cough vaccine and will encourage everyone caring for my baby to get a shot, too!
Mom: This vaccine helps protect you from whooping cough and passes some protection to your baby.

Create a circle of protection around your baby

4 out of 5 babies who get whooping cough catch it from someone at home*
[Picture of a baby surrounded by his parents, brother and sister, grandparents, and childcare providers]
Everyone needs whooping cough vaccine:

  • Parents
  • Brothers & sisters
  • Childcare providers
  • Grandparents

* When source was identified

Make sure your baby gets all 5 doses of whooping cough vaccine on time

Your baby needs whooping cough vaccine at:

  • 2 months
  • 4 months
  • 6 months
  • 15 thru 18 months
  • 4 thru 6 years

You can get whooping cough vaccines at a doctor’s office, local health department, or pharmacy

[Picture of a nurse and a doctor]
Like it? Tell a friend! It’s important! Pinit! Tweet it! Share it on Facebook!
[Picture of parents with a newborn baby and young daughter]
www.cdc.gov/whoopingcough

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention

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