Increasing Whooping Cough Cases Puts Children In ECE At High Risk

Amid concern that NZ is at high risk of widespread transmission of whooping cough, the pivotal role of the Early Childhood Education (ECE) sector in safeguarding child health and curbing the spread of diseases continues to fall through a policy gap.

Dr Sarah Alexander, chief advisor to the Office of Early Childhood Education (OECE) said that there is insufficient awareness that those working at the front-line in early childhood services are at significant risk of transmitting or acquiring vaccine-preventable diseases.

Last week, Health NZ issued an urgent warning that New Zealand is on the verge of a national outbreak of whooping cough, or pertussis, and urged babies, children, and pregnant people to get vaccinated as soon as possible.

The disease is highly contagious and poses a severe threat to infants and young children. Last year, despite no spike in community case numbers, whooping cough claimed the lives of three infants in New Zealand.

In September 2024, there were 187 reported cases of whooping cough, more than double the 75 cases in August, and an exponential rise from the 22 cases recorded in April. Most people with a cough are not tested for pertussis, suggesting that the reported cases represent only a fraction of the actual figures.

To address the country's low childhood immunisation rates, the Health Minister Dr Shane Reti this month announced a plan to train the Plunket workforce as vaccinators.

With the heightened risk of a national whooping cough outbreak, Dr Alexander emphasises the immediate need for action from the Minister for Health and Minister of Education regarding the ECE sector's involvement.

Nationwide ECE services accommodate around 40,000 children under the age of two years, including 9,000 infants under 12 months. In total there are about 192,000 children in ECE under the age of six years.

Dr Alexander said that in ECE settings diseases can spread quickly and easily.

“There is much social and physical contact between children, and between children and adults.

“For ECE teachers being sneezed on is part of the job – you can’t stop children from being children.

“Many ECE centres have large numbers of children and often the indoor spaces are small for the numbers of children and adults”, said Dr Alexander.

A study reported in the New Zealand Medical Journal revealed that out of 4,000 surveyed early childhood educators, only 48 percent reported being immunised against pertussis. (see https://nzmj.org.nz/media/pages/journal/vol-135-no-1548/early-childhood-education-staff-are-falling-through-a-vaccination-policy-gap-in-new-zealand/53a25fc536-1696472896/early-childhood-education-staff-are-falling-through-a-vaccination-policy-gap-in-new-zealand.pdf)

“Given that immunity wanes over time, ECE workers really should consider receiving a booster at least every 10 years,” said Dr Alexander.

Immediate measures could include:

· Making access to a free booster readily available to all ECE teachers and workers.

· Issuing a message to every family and person working in ECE that if they have a persistent cough they should get a pertussis test and stay away from their early childhood service while awaiting the test result.

Dr Alexander said that teachers and other early childhood workers are not prompted to evaluate their vaccination status for the diseases that are of greatest risk to young children. Whereas ECE services are required by law to ask families for a copy of their child’s vaccination record and keep a child immunisation register.

The OECE advocates that vaccination is important for everyone who works with children in ECE services to consider.

Notes:

Data from September to December 2023 indicate that only 67.4% of infants had received their primary three doses of the pertussis-containing vaccine by six months of age. (see public health briefing 23 July 2024, Increasing whooping cough cases put pēpi at risk. What can be done about it? | PHCC)

The OECE drafted an “Immunisation and Vaccination Record” form for use by ECE services to support teachers to consider their vaccination status (available at https://oece.nz/public/information/resources/vaccination-immunisation-staff). But the Ministry of Education, told the OECE that it would be a matter for the Ministry for Health to implement. The OECE believes it concerns the health of teachers and children’s workers and therefore children in ECE, and the two government departments should be collaborating better to mitigate the risk of transmission of vaccine preventable diseases such as whooping cough in early childhood settings.

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