Monday, September 6, 2010

Pertussis Advisory for Parents and Clinicians

Pertussis is still an important concern in Maine and throughout the U.S. To date in 2010, Maine has seen 32 confirmed cases of pertussis with 11 of those reported in the past month. The majority of people identified are younger than 13 years of age. Half are not up to date on their vaccines or their vaccine status is not known. This advisory provides information on pertussis for the public and clinicians as well as a reminder about required vaccines for school attendance.


Pertussis Info for the Public:

The cyclical nature of pertussis, also known as whooping cough, historically causes it to peak every few years, especially when there are high rates of non or under immunization. This year appears to be one of those peak years, given the increase in new cases in many parts of the U.S. As of two weeks ago, almost 10,000 new cases of pertussis were reported nationally. This figure is close to surpassing the total number of cases reported in all of 2009. One in eight of the reported cases this year are from California, which has seen the highest number of cases in 52 years. Tragically, 8 young infants have died in California from pertussis. All were too young to be vaccinated except for one who had just received one dose. The vaccine protects not only those who are receiving it but also young infants who are too young to be fully vaccinated and are more vulnerable to the devastating effects of the disease.

Children need 5 doses of DTaP by kindergarten (ages 4 -6) and a TDaP booster by age 11. All teens and adults are recommended to receive TDaP boosters.

FMI for Consumers:

* Video stories of those affected by pertussis and being undervaccinated against various diseases: http://shotbyshot.org/story-gallery#Pertussis
* U.S. CDC’s info page on pertussis: http://www.cdc.gov/pertussis/about/index.html

Pertussis Info for Clinicians:

1. Consider pertussis when evaluating any patient with an acute illness characterized by cough >2 weeks in duration, or cough with paroxysms, whoop, or post-tussive vomiting. Infants may present with apnea and/or cyanosis.

2. Report known or suspected cases promptly to the Maine CDC at 1-800-821-5821.

3. Persons who exhibit symptoms consistent with pertussis should be tested with a nasopharyngeal swab. The Maine CDC’s Health and Environmental Testing Laboratory (HETL) tests specimens by culture and polymerase chain reaction (PCR) in addition to other reference labs in the state. Serologic testing through private laboratories has not been well standardized and should not be used.

4. Individuals with suspected pertussis should be treated after a nasopharyngeal specimen is collected for testing. Guidelines for antibiotic treatment for pertussis cases and contacts have been published by the federal CDC in the MMWR (December 9, 2005. RR-14) and are available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm.

5. Individuals with symptoms of pertussis should be considered to be infectious and should not attend school, work, or daycare until they have completed 5 days of an appropriate antibiotic. This is especially important for persons working in medical settings or with infants and young children.

Reminder about School Immunizations:

As the school year begins, it is important to remind patients and their families to check that they are up to date on their immunizations. This is also an excellent opportunity for patients to catch up on any immunizations they may have missed. Maine’s school immunization law requires the following vaccines for children entering school:

* Diphtheria/Pertussis/Tetanus (DTaP)
* Measles/Mumps/Rubella (MMR)
* Poliomyelitis
* Varicella

The Maine Immunization Program supplies these required vaccines free to healthcare providers:

* DTaP: for any child under 7
* MMR/Polio/Varicella: for any child under 18

Additionally, federal CDC maintains a recommended immunization schedule, which includes schedules for children and adolescents up to age 18 as well as a recommended catch up schedule. This is listed here: http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm

Going back to school is a busy time of year for both families and health practitioners. By reminding and encouraging patients to stay up to date on their vaccines, we can create a healthy and safe learning environment for all Maine children.

For more information on pertussis control measures, please go to www.cdc.gov/nip/publications/pertussis/guide.htm or call 1-800-821-5821.

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