SAN JUAN COUNTY DEPARTMENT OF HEALTH

County Health official reports pertussis cases

posted 07/21/2010
San Juan County Health Official Dr. Frank James reports that the County Health Department has received reports of three local cases of Pertussis ("Whooping Cough") this month. He urges all County residents to make sure that their vaccinations are up to date and asks anyone with a cough or cold-like symptoms to take extra precautions to avoid contact with young children.

California is now dealing with a growing outbreak of the disease, reporting nearly 1,500 cases and five deaths. All of those fatal California cases were in children under three months of age - too young to be fully protected by vaccine.

Children are most susceptible to pertussis, showing symptoms of spasmodic coughing, whooping and vomiting. The disease is considered highly communicable, but a vaccine does provide protection.

A series of five vaccinations is recommended to provide protection against diphtheria, tetanus and pertussis. The first shots are given beginning at two months of age and are completed between ages 4 and 6.

Protection from those initial vaccinations fades over time, so health officials say anyone over the age of 11 who has not had a tetanus, diphtheria and pertussis booster shot, should get one as soon as possible. In recent years, San Juan County has had to deal with pertussis cases that spread from school children, to parents and then through workplaces leading to lost days from work. Some people have reported broken ribs from the spasms of coughing.

Adequate stocks of the vaccine are available from health care professionals and the San Juan County Health Department.

The incidence of pertussis has increased steadily in the U.S. since the 1980s, and epidemics have occurred every three to five years. The most recent epidemic occurred in 2005 when more than 25,000 cases were reported nationwide.

Persons with concerns about Pertussis should contact their health care provider or the San Juan County Health Department at 378-4474.

Pertussis ("Whooping Cough")

What is it?

Pertussis is a highly contagious bacterial infection that causes a severe cough.

Symptoms

• Symptoms appear 6 to 21 (average 7-10) days after exposure to an infected person.
  
  
• Pertussis may start with cold symptoms or simply a dry cough followed by episodes of severe coughing. Fever is absent or mild.
  
  
• Gagging or vomiting may occur after severe coughing spells. Cough may be worse at night.
  
  
• The person may look and feel healthy between coughing episodes.
  
  
• Immunized school children, adolescents, and adults often have milder illness than young children.
  
  
• Infants with pertussis may not develop a severe cough. They may only have a mild cough, decreased feeding, and may have difficulty breathing or turn bluish.

How is it spread?

• Pertussis is spread through droplets from the mouth and nose when a person with pertussis coughs, sneezes, or talks.
  
  
• Untreated, persons with pertussis can spread the infection for several weeks.
  
  
• Adults and older children with unrecognized pertussis often spread the infection to others, including young children.

Who gets it?

• Anyone who is exposed to the bacteria can get pertussis.
  
  
• Pertussis vaccine prevents severe disease in young infants, but even a vaccinated person can get pertussis infection.
  
  
• Pertussis occurs in older children and adults because protection from the vaccine (DTP or DTaP) lasts only 5-10 years after the last dose.

Who is at greatest risk?

• Infants less than one year old are considered at high risk for complications of pertussis, including hospitalization, pneumonia, convulsions, and rarely, brain damage or death.
  
  
• Unimmunized or partly immunized children are also at higher risk for pertussis infection and severe disease.
  
  
• Pregnant women with pertussis near the time of delivery may spread it to their newborns.
  
  
• Persons who have close contact with pregnant women, infants, or health care workers can spread pertussis to these high risk individuals.
  
  
• Health care workers with pertussis who have face-to-face patient contact can spread pertussis to their patients and other health care staff.

Treatment

• Treatment is most effective early in the disease. A health care provider must prescribe an antibiotic active against pertussis.
  
  
• Persons treated with antibiotics are no longer contagious after the first 5 days of appropriate antibiotic treatment have been completed.

Prevention

• Pertussis vaccine is included in DTaP and the new Tdap vaccine for adolescents and adults (available since 2006).
  • Before age 7, children should get 5 doses of the DTaP vaccine.
    
    
  • Doses are usually given at 2, 4, 6, and 15-18 months of age and 4 - 6 years of age.
    
    
  • The 4th dose may be given as early as 12 months of age.
    
    
  • Tdap should be given as a single booster dose to 11-64 year old individuals.
  
  
  
• Persons with cough illnesses should avoid contact with infants and expectant mothers, including visiting or working in labor, delivery, and nursery areas of hospitals and in child care settings.
  
  
• If you live or have close contact with someone who has pertussis, you should take antibiotics to prevent pertussis - contact your health care provider.

Report all cases to Public Health by calling 360-378-4474 during business hours or 360-201-2505 after hours.

Stories from previous years

More than 40 cases of whooping cough on Orcas Island

Health Department urges parents to take immediate action
to protect young children

posted 01/18/2008
All Orcas and Lopez residents with a persistent cough are urged to see their health care provider for evaluation, testing and treatment of pertussis (whooping cough).

The County Health Department is continuing to investigate more than 40 cases of pertussis on Orcas Island. After starting among a few childcare facilities, the outbreak has become a community-wide outbreak. When outbreaks move from focused to community-wide the CDC recommends that anyone in the community with cold like symptoms should be evaluated, tested, and treated to avoid further spread of the disease. More than forty cases have been identified on Orcas and at least two cases are being investigated on Lopez Island. For close contacts and suspected cases of any age a course of antibiotics is recommended to prevent disease and limit contagiousness.

Pertussis is most contagious during the first week when symptoms are mild, similar to a bad cold with slight fever, runny nose and a cough. The irritating cough persists and gradually develops into a series of repeated and violent coughs (many occur without an opportunity to inhale), and then may be followed by a high-pitched whoop as they inhale and/or vomiting in children. Adults often have just a moderate to severe cough. Anyone with these symptoms is urged to avoid contact with children less than one year of age, pregnant women, the immune suppressed and those with advanced lung disease until examined by a health care provider to prevent spreading the disease. The contagious period lasts until 3 weeks after the onset of the fits of coughing or until five days of treatment with an appropriate antibiotic have been completed. The illness may last for two months or longer.

Pertussis is potentially fatal in young children less than one year old, one in 200 cases in this age group die from the infection. Vaccination is possible as early as 6 weeks of age. Because pertussis is among the most lethal diseases of unimmunized infants and young children, parents should keep young infants and unimmunized children away from individuals with even mild cough and upper respiratory illness and start the series of immunizations with the DTaP vaccine. Immunization of children less than seven years of age is critical for control of pertussis.

It is known that older children and adults with mild persistent cough illness (unrecognized as pertussis) are another major source of transmission. There is now a vaccine available for those ten years of age and older, called Tdap. It provides a booster dose of pertussis vaccine along with tetanus and diphtheria vaccines. This new vaccine is recommended for adolescents getting their routine booster dose and for adults, especially those who have contact with the high risk groups mentioned above. Vaccine is available through the San Juan County Health Department and through local physicians.

Contact the Health Department at 378-4474 for information regarding pertussis disease.

Health Department urges parents to take
immediate action to protect young children

posted 01/09/2008
Parents are urged to get children fully immunized against pertussis (whooping cough). This disease is potentially fatal in young children less than one year old. Vaccination is possible as early as 6 weeks of age.

Currently the Health Department is investigating several confirmed cases of pertussis on Orcas Island. Most people who have been in contact with these cases have been notified and referred to their family physicians for preventive treatment. For close contacts and suspected cases of any age a course of antibiotics is recommended to prevent disease or limit contagiousness.

Pertussis is most contagious during the first week when symptoms are mild, similar to a bad cold. The irritating cough persists and gradually develops into a series of repeated and violent coughs (many occur without an opportunity to inhale), and then may be followed by a high-pitched whoop as they inhale and/or vomiting. Anyone with these symptoms is urged to avoid contact with small children until examined by a health care provider to prevent spreading the disease. The contagious period lasts until 3 weeks after the onset of the fits of coughing or until 5 days of treatment with an appropriate antibiotic have been completed. The illness may last for 2 months or longer.

Pertussis is among the most lethal diseases of unimmunized infants and young children. Parents should keep young infants and unimmunized children away from individuals with even mild cough and upper respiratory illness and start the series of immunizations with the DTaP vaccine. Immunization of children less than seven years of age is critical for control of pertussis.

It is known that older children and adults with mild persistent cough illness (unrecognized as pertussis) are another major source of transmission. There is now a vaccine available for those seven years of age and older. Called Tdap, it provides a booster dose of pertussis vaccine along with tetanus and diphtheria vaccines. This new vaccine is recommended for adolescents getting their routine booster dose. Vaccine is available through the San Juan County Health Department and through local physicians.

Contact the Health Department at 378-4474 for information regarding pertussis disease.

Whooping cough cases
on the rise

EDITOR's NOTE: this was first posted in 2000)

posted 10/07/2000
Several cases of pertussis (whooping cough) have been confirmed in San Juan County.

The following is a letter from Dr. Frank James, San Juan county health officer:

Pertussis (whooping cough) has been circulating in San Juan County for the past few weeks. There have been several laboratory confirmed cases and many additional clinically likely cases. These cases have occurred largely in young adolescents who attend middle and high school. Deaths from pertussis are rare with 80 percent occurring in those under one year of age and 70 percent occurring under six months of age. While pertussis can be prevented through vaccination, immunity wanes over time, with many children becoming susceptible by 10 to 15 years of age.

Symptoms of pertussis include low-grade fever, runny nose, conjunctivitis and malaise which may last one to two weeks. The initial dry cough is eventually supplanted by paroxsymal (whooping) cough. The latter is much less likely in adults than in young children. Coughing lasts for weeks, occasionally months.

Infection is from respiratory secretions and air born droplets. Covering one's mouth when coughing is an effective means of decreasing transmission of the disease. Disposable tissues should be available and in use in the school setting.

Pertussis facts:

Symptoms:

• initial dry cough eventually supplanted by paroxysmal cough
• low-grade fever
• runny nose
• conjunctivitis
• malaise
• Coughing last for weeks

Incubation period

Incubation period: six to 20 days.

Most contagious during early stage before cough becomes paroxysmal.

Not contagious after five days of anti-biotic treatment.

Tests

DFA and culture tests for pertussis are available through the public health department. Call 360.378.4474 for more information.

The incubation period is six to 20 days with the highest communicability in the early stage before the cough becomes paroxysmal. Communicability eventuarlly becomes negligible after about three weeks. When treated with antibiotics the period of infectiousness is five days after starting treatment.

Individuals who have been significantly exposed should receive prophylactic antibiotic treatment. This would include students who have intimate contact with classmates (best friends, share car pool to school, spend a lot of time together outside of school). Simply riding on the bus with or being in the same classroom with a diagnosed person would generally not be considered a reason to take preventive antibiotics.

Students who develop symptoms of early pertussis and who are classmoates of, or who ride on the bus to school with a clinically diagnosed case or a lab confirmed case, should be referred for medical evaluation with their primary care provider. These children should at a minimum be given a "DFA" and a culture test for pertussis. Some of these children and their parents will choose to receive preventive antibiotics as well as have tests performed. A negative DFA test is not adequate evaluation by itself (it is the quickest way to get a positive result, but sometimes can be negative when the culture is actually positive, as has been the case with several local cases). DFA and culture should be done on all suspected cases.

If you have questions about the diagnosis, treatment or management of pertussis do not hesitate to contact the health department at 360.378.4474.

PREVIOUS STORIES ON WHOOPING COUGH

Whooping cough in county

posted 06/29/05
PRESS RELEASE: The county Health Department is investigating one confirmed case of pertussis (whooping cough) and another related case is probable. Many contacts have been notified and referred to their family physicians for preventive treatment. Pertussis has been identified in neighboring counties so exposure is likely as people travel.

Pertussis is most contagious during the first week when symptoms are mild like a bad cold. The irritating cough persists and gradually develops into a series of repeated and violent coughs (many occur without an opportunity to inhale), and then may be followed by a high-pitched inspiratory whoop and/or vomiting. The contagious period lasts until three weeks after the onset of the fits of coughing. The illness may last for one to two months or longer.

Pertussis is among the most lethal diseases of unimmunized infants and young children. Parents should keep young infants and unimmunized children away from individuals with even mild cough and upper respiratory illness and start the immunization series. Immunization of susceptible children less than seven years of age is critical for control of pertussis. Vaccine is available through the San Juan County Health Department and through local physicians.

It is known that older children and adults with mild persistent cough illness (unrecognized as pertussis) are a major source of transmission. There is no vaccine available yet for those seven years of age and older. However, for close contacts and suspected cases of any age a course of antibiotics is recommended to prevent disease or limit contagiousness.

Contact the Health Department at 378-4474 or your physician for information regarding pertussis disease or DTaP vaccinations.

Third pertussis outbreak in county

posted 08/27/03
"We have now had three separate outbreaks - clusters - of pertussis in San Juan County," County Public Health Director Dr. Frank James told the BOCC August 26, 2003. The first was on Orcas Island with two cases. The second case involved three cases on San Juan Island. The third case involves 15 confirmed cases with 130 additional people to be treated as a precaution.

"For adults pertussis is not a big deal," said James. "For kids in school it is not a big deal. But one in 100 children under two years of age who contract the disease die. Infants under six months of age drown in their own secretions. "Even In the best medical care, there is sometimes nothing we can do," said James. "Our goal is to prevent very young children from getting it."

The symptoms and recommendations to prevent the disease are posted in the article at the bottom of this page. For more information call the county health dept at 360.378.4474.

Whooping cough in county

posted 07/22/03
One case of pertussis (whooping cough) has been diagnosed through preliminary laboratory tests and two other related cases are suspected. The county Health Department is conducting a separate investigation around three suspected cases unrelated to the diagnosed case.

Many contacts have been notified and referred for preventive treatment. Pertussis has been identified in neighboring counties, so exposure is likely with so many people traveling this summer.

Pertussis is most contagious during the first week when symptoms are mild like a bad cold. The irritating cough persists and gradually develops into a series of repeated and violent coughs (many occur without an opportunity to inhale), and then may be followed by a high-pitched inspiratory whoop and/or vomiting. The contagious period lasts until three weeks after the onset of the fits of coughing. The illness may last for one or two months or longer.

Pertussis is among the most lethal diseases of unimmunized infants and young children. Parents should keep young infants and unimmunized children away from individuals with even mild cough and upper respiratory illness and start the immunization series. Immunization of susceptible children less than seven years of age is critical for control of pertussis. Vaccine is available through the San Juan County Health Department and through local physicians.

It is known that older children and adults with mild persistent cough illness that may not be recognized as pertussis can be a major source of transmission. There is no vaccine for those seven years of age and older. However, for close contacts and suspected cases a course of antibiotics is recommended to prevent disease or limit contagiousness.

Contact the Health Department at 378-4474 or your physician for information regarding pertussis disease or DTaP immunizations.

SAN JUAN ISLANDER © 2010

editor@sanjuanislander.com

About Us | Advertising Info | Contact Us | Privacy Policy