It comes after a nationwide surge in whooping cough infections during 2010. Lakendria Ross of Nashville didn't let her newborn leave the house last December. "I was on pins and needles because she was a December baby," Ross said. People who wanted to see the baby had to come to her home and promptly wash their hands. She also told friends and family members not to touch the infant's face. Being a "pit bull" for your baby is the right thing to do, according to Dr. Eric Scott Palmer, a Nashville neonatologist . "Not only is there pertussis or whooping cough, but we are entering the influenza and respiratory syncytial virus seasons," Palmer said.

 "These are some viral illnesses and bacterial illnesses, such as whooping cough, that can and do kill infants, particularly former premature infants. At family gatherings, while everyone loves babies, the infection control during those times is of critical importance -- particularly as it relates to hand-washing." Many adults mistakenly believe they are protected against pertussis because they've had whooping cough before, while others walk around with the virus without realizing it, said Dr. Kelly Moore, who directs immunization programs for the Tennessee Department of Health. Also, the vaccine wears off over time, so a booster shot is needed about every 10 years. "People may assume it's like measles, where you get it once and you never get it again," Moore said. "Unfortunately, this is something you can get many times. The problem is the symptoms aren't as classic as measles or chicken pox. People might not even realize they have it because it is not as obvious.

" Pertussis is most infectious before people think they may have it, Moore said, because the cough gets progressively worse. It is highly communicable. Eighty percent of those in a household where someone has the disease also will get it, she said. Doctors start vaccinating infants for pertussis at two months old, but protection requires booster shots. Children need five doses of the vaccine, and three of those occur before the age of 1. Another new recommendation from the CDC is that pregnant women get the shot after the 20th week of gestation if they have not been previously vaccinated. "What is frightening is that people with an ordinary cough illness might not think they have pertussis and might expose a newborn or infant unknowingly," Moore said. "Small infants or newborns can stop breathing when they have pertussis." Last year's outbreak hit California the worst. The 9,143 cases in that state were the highest incidence in 63 years. Michigan and Ohio also had high rates of infection. In Tennessee, 226 cases were reported last year.

 Activity appears to be down this year, with 84 cases reported through early December. "The vast majority of pertussis cases are never diagnosed or confirmed," Moore said, noting that it takes a more sophisticated lab test than a blood check to detect the bacterium. Protection is provided by the Tdap vaccine, the same shot that wards off tetanus and diphtheria. The Metro Public Health Department charges $50 for the adult vaccine, and Medicare will not reimburse for it. However, state guidelines allow the charge to be dropped if an infant lives in the household. Whooping cough is one of several winter illnesses that can cause serious complications for infants and people with compromised immune systems. Health officials also recommend that people who have not gotten flu shots get that vaccination. "The stoic family member who shows up sick at the family Christmas party is probably not doing anyone any favors," Moore said.