*** Health and Safety Alert Bulletin ***
Pertussis (Whooping Cough)
A number of states, including New Mexico, Oregon and Washington are reporting an alarming number of whooping cough cases. In the case of Washington there are a reported 1,100 reported cases which is ten times the number of cases from a year ago. Health officials are urging adults and teens, especially those who come in contact with small children, to get vaccinated. Whooping cough is highly contagious and can be fatal to infants.
Here’s what you need to know about whooping cough.
Real name: Pertussis
Also Known as (AKA): Whoopie Doopies
Known aliases: Bordetella pertussis (the bacteria that causes pertussis illness); whooping cough (for the “whoop” sound of someone gasping for air after a coughing spell)
Microbe type: bacterium
· Pertussis leaves its victims literally gasping for air. At first, this tricky pretender might seem like a common coldrunny nose, fever, and cough. Thats stage 1, when pertussis is just warming up. After a week or two, pertussis infection delivers its cruel surprisesthick, gluey mucous and extreme coughing spells. In these fits people can literally cough so hard and long that they throw up or turn blue because they cant breathe. Victims of pertussis make a gasping “whoop” sound when they suck in air after a coughing fit. Pertussis infection is no jokeabout 40% of infants who get it wind up in the hospital! Weeks after Stage 2, as the body finally fends off pertussis, the victims cough tapers down.
· Powers & Abilities
· Pertussis is highly contagious (easy to catch). Want proof? A person with pertussis will infect almost everyone in their household if those people arent vaccinated.
· Preferred Method of Attack
· Pertussis is primarily an “air attacker,” flying through the air looking for its next victim, when an infected person coughs or sneezes. The bacterium may also infect people who touch places where wetness from those coughs and sneezes lands, and then touch their noses our mouths.
· Known Weaknesses
· Pertussis fears four letters — D, T, a and P — and 2 vaccines, “DTaP” and “Tdap”. Kids get “DTaP” while teenagers and grownups get a “boost” with “Tdap.” The vaccine ammo contains diphtheria (the D), tetanus (the T), and acellular pertussis (aP). The term “acellular” (pronounced A-SELL-you-lur) means that the vaccine uses pieces of pertussis bacteria (not the whole bacterium cell). By using just pieces, the vaccine can “teach” the body to protect itself, with the fewest side effects.
· Since the days before the vaccine, pertussis cases are down more than 80%.
· Pertussis may be tough, but some simple basics can help to keep it in checklike washing hands with soap, covering up coughs and sneezes, and not sharing cups and silverware.
· Preferred Victims
· Pertussis is a bully, slamming young children and babies the hardest. Very young kids are just not as able to cough up the gluey mucous as older people are. Also, other bacterial infectors just love to join pertussis party, moving into a sick persons mucousy, pertussis-infected lungs and throat to cause their own infections. These are called “secondary infections.” Pertussis mostly pulls off its complications among young children, toosuch as pneumonia, seizures, and encephalopathy (disease of the brain).
· Precautions for the Public
· Stay vigilant. We may think weve gotten the upper hand against pertussis. But, the disease is always scheming to get back on top. Since the 1980s, doctors have been reporting increasing numbers of pertussis cases. At the moment, there are still far fewer cases than there were before the vaccine. Still, the number of people infected seems to peak every three or four years, showing that pertussis is still out there figuring out its next move.
· Area of Operations
· Pertussis operates worldwide. It is especially busy and deadly in developing areas of the world, where fewer people are vaccinated and medical care is less accessible. Pertussis infects millions of people each year, and claims hundreds of thousands of lives.
· Criminal Record
· Doctors have been dealing with pertussis for at least 500 years. Finally, in 1906, scientists were able to identify and see Bordetella pertussis bacteria through a microscopea first step in learning how to stop its evil tricks. From 1940-45, before the vaccine was widely used, 175,000 people in the U.S. were infected each year. In the 1940s, vaccinating against pertussis became routine and the tables turned for the better. Now, 1,000 to 25,000 people are infected each year, and very few die.
Causes & Transmission
Pertussis, a respiratory illness commonly known as whooping cough, is a very contagious disease caused by a type of bacteria called Bordetella pertussis. These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper respiratory system. The bacteria release toxins, which damage the cilia and cause inflammation (swelling).
Pertussis is a very contagious disease only found in humans and is spread from person to person. People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many infants who get pertussis are infected by older siblings, parents or caregivers who might not even know they have the disease. Symptoms of pertussis usually develop within 7 10 days after being exposed, but sometimes not for as long as 6 weeks.
Pertussis vaccines are very effective in protecting you from disease but no vaccine is 100% effective. If pertussis is circulating in the community, there is a chance that a fully vaccinated person, of any age, can catch this very contagious disease. If you have been vaccinated, the infection is usually less severe. If you or your child develops a cold that includes a severe cough or a cough that lasts for a long time, it may be pertussis. The best way to know is to contact your doctor.
Signs & Symptoms
Pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks.
In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the childs breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized.
Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud “whooping” sound. This extreme coughing can cause you to throw up and be very tired. The “whoop” is often not there and the infection is generally milder (less severe) in teens and adults, especially those who have been vaccinated.
Early symptoms can last for 1 to 2 weeks and usually include:
· Runny nose
· Low-grade fever (generally minimal throughout the course of the disease)
· Mild, occasional cough
· Apnea a pause in breathing (in infants)
Because pertussis in its early stages appears to be nothing more than the common cold, it is often not suspected or diagnosed until the more severe symptoms appear. Infected people are most contagious during this time, up to about 2 weeks after the cough begins. Antibiotics may shorten the amount of time someone is contagious.
As the disease progresses, the traditional symptoms of pertussis appear and include:
· Paroxysms (fits) of many, rapid coughs followed by a high-pitched “whoop”
· Vomiting (throwing up)
· Exhaustion (very tired) after coughing fits
The coughing fits can go on for up to 10 weeks or more. In China, pertussis is known as the “100 day cough.”
Although you are often exhausted after a coughing fit, you usually appear fairly well in-between. Coughing fits generally become more common and severe as the illness continues, and can occur more often at night. The illness can be milder (less severe) and the typical “whoop” absent in children, teens, and adults who have been vaccinated.
Recovery from pertussis can happen slowly. The cough becomes less severe and less common. However, coughing fits can return with other respiratory infections for many months after pertussis started.
Diagnosis & Treatment
Pertussis (whooping cough) can be diagnosed by taking into consideration if you have been exposed to pertussis and by doing a:
· History of typical signs & symptoms
· Physical examination
· Laboratory test which involves taking a sample of secretions (with a swab or syringe filled with saline) from the back of the throat through the nose see Figure 1
· Blood test
Pertussis is generally treated with antibiotics and early treatment is very important. Treatment may make your infection less severe if it is started early, before coughing fits begin. Treatment can also help prevent spreading the disease to close contacts (people who have spent a lot of time around the infected person) and is necessary for stopping the spread of pertussis. Treatment after three weeks of illness is unlikely to help because the bacteria are gone from your body, even though you usually will still have symptoms. This is because the bacteria have already done damage to your body.
There are several antibiotics available to treat pertussis. If you or your child is diagnosed with pertussis, your doctor will explain how to treat the infection.
· Isolate the person (separate bedroom) until he or she has received five days of antibiotics. During this time, everyone who comes into contact with the sick person should wear a surgical mask to cover their face.
· Practice good hand washing. Whooping cough bacteria can be transmitted through contact with contaminated inanimate objects such as dishes.
· Drink plenty of fluids, including water, juices, soups, and eat fruits to prevent dehydration.
· Eat small, frequent meals to decrease the amount of vomiting.
· Do not give cough medications unless otherwise instructed by your doctor.
· Use a cool-mist vaporizer to help loosen secretions and soothe the cough.
· Keep the home environment free from irritants that can trigger coughing, such as smoke, aerosols, and fumes.
· Monitor a sick child for signs of dehydration, such as dry lips and tongue, dry skin, decrease in the amount of urine or wet diapers, and crying without producing tears. Report any signs of dehydration to your doctor immediately
The best way to prevent pertussis (whooping cough) among infants, children, teens, and adults is to get vaccinated. Also, keep infants and other people at high risk for pertussis complications away from infected people.
In the United States, the recommended pertussis vaccine for infants and children is called DTaP. This is a combination vaccine that protects against three diseases: diphtheria, tetanus and pertussis. For maximum protection against pertussis, children need five DTaP shots. The first three shots are given at 2, 4, and 6 months of age. The fourth shot is given between 15 and 18 months of age, and a fifth shot is given before a child enters school, at 46 years of age. Parents can also help protect infants by keeping them away as much as possible from anyone who has cold symptoms or is coughing.
Vaccine protection for pertussis, tetanus and diphtheria fades with time. Before 2005, the only booster available contained protection against tetanus and diphtheria (called Td), and was recommended for teens and adults every 10 years. Today there are boosters for pre-teens, teens and adults that contain protection against tetanus, diphtheria and pertussis (Tdap). Pre-teens going to the doctor for their regular check-up at age 11 or 12 years should get a dose of Tdap. Teens who did not get this vaccine at the 11- or 12-year-old check-up should get vaccinated at their next visit. Adults who did not get Tdap as a pre-teen or teen should get one dose of Tdap instead of the Td booster. Most pregnant women who were not previously vaccinated with Tdap should get one dose of Tdap postpartum before leaving the hospital or birthing center. Getting vaccinated with Tdap is especially important for families with and caregivers of new infants.
The easiest thing for adults to do is to get Tdap instead of their next regular tetanus boosterthat Td shot that they were supposed to get every 10 years. The dose of Tdap can be given earlier than the 10-year mark, so it is a good idea for adults to talk to a healthcare provider about what is best for their specific situation.
Vaccine protection for pertussis, tetanus, and diphtheria fades with time, so adults need a booster shot. Experts recommend adults receive a tetanus and diphtheria booster (called Td) every 10 years and substitute a Tdap vaccine for one of the boosters. The dose of Tdap can be given earlier than the 10-year mark. Getting vaccinated with Tdap is especially important for adults who are around infants.
Remember that even fully-vaccinated adults can get pertussis. If you are caring for infants, check with your healthcare provider about whats best for your situation.
If your doctor confirms that you have pertussis, your body will have a natural defense (immunity) to future infections. Since this immunity fades and does not offer lifelong protection, routine vaccines are recommended.
Your local health department may recommend preventive antibiotics (medications that help prevent diseases caused by bacteria) to close contacts, including all household members of a pertussis patient, regardless of age and vaccination status. This might prevent or reduce the chance of getting pertussis. A close contact is anyone who had face-to-face contact or shared a small space for a long period of time with an infected person or had direct contact with respiratory secretions (like from coughing or sneezing) from a person with pertussis.
· In 2009, nearly 17,000 cases of pertussis (whooping cough) were reported in the U.S., but many more go undiagnosed and unreported.
· Coughing fits due to pertussis infection can last for up to 10 weeks or more; sometimes known as the 100 day cough.
· Pertussis can cause serious illness in infants, children and adults and can even be life-threatening, especially in infants.
· The most effective way to prevent pertussis is through vaccination with DTaP for infants and children and with Tdap for pre-teens, teens and adults protection from the childhood vaccine fades over time.
· Vaccinated children and adults can become infected with and transmit pertussis; however, disease is less likely to be severe.
· Worldwide, there are 30-50 million cases of pertussis and about 300,000 deaths per year.
· Since the 1980s, there has been an increase in the number of reported cases of pertussis in the U.S., especially among 10-19 year olds and infants younger than 6 months of age.
· Pertussis is also known as “whooping cough” because of the “whooping” sound that is made when gasping for air after a fit of coughing.
· More than half of infants less than 1 year of age who get pertussis must be hospitalized.
· Vaccination of pre-teens, teens and adults with Tdap is especially important for families with new infants.
· Pertussis is generally treated with antibiotics, which are used to control the symptoms and to prevent infected people from spreading the disease.
Questions and Answers
Q: How common is whooping cough?
A: Even with the success of whooping cough vaccines, the disease is still common in the United States. Many cases are not diagnosed and so are not reported. Yet over the past 5 years, between 8,000 and 25,000 cases have been reported each year. Institutional outbreaks of whooping cough, such as those in a daycare center, school or hospital, are common, taking place each year in many states.
Q: Why is there more whooping cough in some years than others?
A: Reported cases of whooping cough vary from year to year and tend to peak every 3-5 years. Our last peak year nationally was in 2005 when more than 25,000 cases were reported. This pattern is not completely understood, but thats why its important that everyone get vaccinated. If it werent for vaccines, wed see many more cases of whooping cough. It is too early to know if 2010 will be a peak year nationally.
Q: What should I do if I live in an outbreak area?
A: You can make sure you and your loved ones are up to date with recommended whooping cough vaccines. There are two types of whooping cough vaccines DTaP for infants and children and Tdap for adolescents and adults. Getting vaccinated with Tdap is especially important for family members with and caregivers of new infants. Also, if caring for an infant, keep him or her away from anyone with cough or cold symptoms.
· Infants and children are recommended to receive 5 doses of the DTaP vaccine at 2, 4, and 6 months, at 15 through 18 months, and at 4 through 6 years. All 5 doses are needed for maximum protection
· Adolescents are recommended to receive the Tdap vaccine at their regular check-up at age 11 or 12. If teenagers (13 through 18 years) missed getting the Tdap vaccine, parents should ask the doctor about getting it for them now
· Adults who are 19 through 64 years old are recommended to get a 1-time dose of Tdap in place of the Td booster theyre recommended to receive every 10 years. No need to wait until you are due for your Td boosterthe dose of Tdap can be given earlier than the 10-year mark since the last Td booster. It’s a good idea for adults to talk to a healthcare provider about what’s best for their specific situation.
· Pregnant women should ideally receive Tdap before pregnancy. Otherwise, it is recommended that Tdap be given after delivery, before leaving the hospital or birthing center. If a pregnant woman is at increased risk for getting whooping cough, such as during a community outbreak, her doctor may consider giving Tdap during pregnancy. Although pregnancy is not a contraindication for receiving Tdap, a pregnant woman and her doctor should discuss the risks and benefits before choosing to receive Tdap during pregnancy.
· People 65 years and older do not currently have a whooping cough booster vaccine licensed for their age group. However, people in this age group can talk to their healthcare provider to see if getting Tdap is a good decision for them. This discussion can include weighing the risks and benefits of receiving Tdap. Receiving Tdap may be especially important during a community outbreak and/or if caring for an infant.
Q: Should I delay travel to an area that is having a whooping cough outbreak
A: No, but those traveling to an area with a whooping cough outbreak should make sure they are up to date on their vaccines. People who are not vaccinated or who are under-vaccinated, including infants too young to be vaccinated, are putting themselves at risk for catching whooping cough.
Today’s post comes to us courtesy of Ken Oswald
Safety and Security Manager for Plateau