Charlie Cardus of South Portland, 11, receives a TDAP booster, which includes the pertussis vaccine, from nurse Vanessa Kearns at Maine Medical Partners South Portland Pediatrics on Thursday.

A rising rate of pertussis cases in Maine this year highlights the threat the state is trying to combat by implementing a new middle school booster shot requirement to protect against pertussis and other diseases.

Maine was one of the last states in the nation to add the booster shot requirement, even though it has had sky-high pertussis rates since 2011 and one of the highest rates of pertussis, or whooping cough, in the country.

The provision by the Maine Center for Disease Control and Prevention went into effect for students entering seventh grade in the 2017-18 school year, and health officials are hoping the booster will make a dent in pertussis rates.

Pertussis is a highly contagious, violent cough that can persist for months, and can be deadly in infants, especially those too young to be immunized.

Molly Brown, a nurse practitioner at Intermed, said she treated a case of pertussis last school year, and it’s not an easy disease to deal with. Students typically miss two months of school or more.

“It’s a nasty, nasty illness that you don’t want to get,” Brown said. “The symptoms can be quite severe. They call it the 100-day cough, and people have coughing fits to the point where they’re throwing up.”


The booster shot requirements are likely to make a difference in the number of cases, according to a Vanderbilt University study released this year. The research revealed a 53 percent decline in pertussis nationally from 2008 to 2013, after many states mandated a middle school booster shot.

“We believe that Maine is likely to see a significant decrease in pertussis over the next several years,” said Emily Spencer, spokeswoman for the Maine Department of Health and Human Services, in part because of the booster shot.


This school year, school nurses are spending extra time tracking down parents who have lagged behind in catching their middle schoolers up on the booster shot requirement, officials said. For instance, at SAD 51, which includes Greely Middle School, they are waiting for vaccine paperwork from 115 out of 167 seventh-graders, Superintendent Jeff Porter said. The school started reaching out to parents this spring.

Other schools, by contrast, have had a smoother transition. John Suttie, superintendent at Old Orchard Beach, said almost all of the vaccine documents from seventh-graders are in.

Last spring, several schools in the state reported pertussis cases in letters sent home to parents, including Greely in Cumberland, Waynflete in Portland, and schools in Yarmouth and South Portland. Students can be kept out of classes for 21 days if they have an infectious disease.


In Yarmouth, there were six confirmed cases of pertussis in March and April, five at the high school and one at the elementary school.

Andrew Dolloff, Yarmouth’s superintendent of schools, said the booster requirement is needed.

“We certainly welcome the stricter standards. I’m hopeful that the general population will be better protected. The research indicates that will be the case. We did have a few cases of pertussis last year, and I’m hopeful we can avoid seeing as many sick students this winter,” Dolloff said in an email to the Portland Press Herald.

Maine’s pertussis rate for 2016 was 18.3 cases per 100,000 population, the third-highest in the country behind Vermont and Alaska. The national average was 4.9 cases per 100,000, according to the U.S. Centers for Disease Control and Prevention. And Maine is on track to have more pertussis cases in 2017: Through July 31, the state had 252 cases, only four fewer than it had for all of 2016. Maine also had a spike in cases in 2012, when 737 people came down with pertussis.

Maine typically has one of the highest voluntary kindergarten opt-out rates for school-mandated vaccines. Although vaccines are required for entry to school, parents can opt out on philosophic or religious grounds simply by signing a form. Attempts to make it more difficult for parents to opt out were defeated in 2015 when the Legislature failed to override a veto by Gov. Paul LePage.

The TDAP vaccine – a combined shot to prevent tetanus, diptheria and pertussis – is a booster shot given in late elementary or early middle school that provides additional protection when the original vaccine’s effectiveness starts to wane. A similar vaccine protecting against the same diseases, called DTAP, is administered to children ages 7 and younger in three doses.


Maine was one of the last states to require the middle school dose as a requirement to entry, according to the Immunization Action Coalition, a Minnesota-based nonprofit. Most states have added the booster requirement over the past 12 years; the most recent states to do so were South Dakota and Maine. South Dakota introduced the requirement in 2016. Hawaii still does not have one.


Dolloff said implementing the new requirement is going “smoothly,” but it does provide some logistical challenges.

“We still have a fair number of records to chase down,” he said. “Many parents provided us with the vaccination documentation prior to the school year, as we asked for it last spring. For those who’ve not yet provided it, our health staff is contacting them directly. If we have any folks that are not in compliance after that contact, then we’ll make administrative contact to get things finalized.”

Ken Kunin, South Portland’s superintendent, said school nurses and administrators worked throughout the spring and summer to make sure the district’s two middle schools, Memorial and Mahoney, were ready for the new booster requirement.

“The effort is minimal compared to the risk and potential consequences to our students and families when pertussis outbreaks occur,” Kunin said.


The fear of vaccines and the movement against immunization have persisted since 1998, when a since-retracted study tried to link vaccines to autism. Numerous studies since have proven that vaccines are overwhelmingly safe and do not cause autism.

Dr. James Foster, an Intermed pediatrician who practices in South Portland, said he has seen an uptick in pertussis over the past two years.

Martin Sabol, medical director of Nasson Health Care in Sanford, said the facility has not noticed a rush of parents bringing in their children to comply with the new booster shot requirement. But it should help bring pertussis rates down, Sabol said.

“It brings a little bit more urgency to parents who don’t want to keep their kids out of school,” he said. Another advantage of the booster shot is giving pediatricians an opportunity to catch students up on other missed vaccines, such as the HPV vaccine, which prevents the HPV virus and can prevent many common cancers, Sabol said.


Tina Nightingale, 37, of Saco was at Intermed in Portland on Wednesday for her 10-year-old son Dominic’s TDAP booster shot. Although the state is requiring the booster for seventh grade, many pediatricians give the shot at age 10 or 11 when students are in fifth or sixth grade.


Nightingale said she doesn’t have to be persuaded about the value of vaccines. Seven years ago, her then-6-week-old daughter was at a birthday party where five children had pertussis, they later found out. Her baby developed a cough that fortunately was not pertussis.

“I am very pro-vaccine, and I’m all about kids getting all their shots,” Nightingale said. “Some kids are too young to have their vaccines, and they shouldn’t be exposed to these diseases.”

Correction: This story was updated at 10:20 a.m. on Sept. 20, 2017 to clarify the Immunization Action Coalition is a nonprofit.

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: @joelawlorph

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