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Your children’s health: addressing pertussis (whooping cough)

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Pertussis, known more commonly as whooping cough, is a serious and potentially fatal infection that has begun to increase among those not vaccinated against it.

Pertussis is a highly contagious disease that is spread through the air by cough. It begins with cold symptoms and a cough that can worsen within one to two weeks. According to the New York State Department of Health, pertussis can lead to long hospitalizations and is particularly dangerous for infants.

Since the 1980s, the number of reported pertussis cases has gradually increased in the United States. In 2005, more than 25,000 cases of pertussis were reported in the United States, the highest number since 1959. In 2012, New York was ranked third highest in the United States for pertussis. New York is not alone. States across the country are seeing increases in pertussis. Several factors are thought to be affecting the uptick in cases: waning immunity, increasing numbers of unvaccinated children and adults, and improved awareness of the resurgence of pertussis, leading to improved reporting and diagnosis.

Pertussis can affect people at any age. Children who are too young to be fully vaccinated and those who have not yet completed the series of vaccines are at highest risk for severe illness.

Infants—especially those younger than six months—are most likely to have severe symptoms if they develop pertussis. When possible, young infants should be kept away from people with a cough.

Children who have been around someone with pertussis could become sick, even if their shots are up to date.

Symptoms of pertussis

Pertussis symptoms usually include a long series of coughs (“coughing fits”) followed by a whooping noise. However, older children, adults and very young infants might not develop the whooping sound. The cough is often worse at night and cough medicines usually do not help alleviate it.

Other symptoms of pertussis include a slight fever, vomiting, turning blue or difficulty breathing.

Major complications of pertussis are more common among infants and young children and could include pneumonia, middle ear infection, loss of appetite and sleep disturbance.

Parents who suspect their child has been in contact with someone with pertussis should contact their family physician. Antibiotics may prevent the child from becoming ill. If the child is already sick, giving antibiotics early can help shorten the duration of the illness and lessen the chances of the disease being spread to others.

Pertussis is most dangerous in infants who are too young to be vaccinated.

If untreated, a person can transmit pertussis from onset of symptoms to three weeks after the onset of coughing episodes. The period of communicability is reduced to five days after treatment with antibiotics.

Notifying others of illness
According to the Centers for Disease Control and Prevention (CDC), if a child is diagnosed with pertussis by his or her doctor, parents should notify the child’s school.

School nurses then call their local health departments to verify that the student has, indeed, been diagnosed with pertussis. They are careful not to report suspected cases, only reacting to cases that have been formally diagnosed with a lab test.

Once doctors diagnose pertussis, they also are required to report it to their respective county health departments. County health departments, however, also receive notification through the New York State

Electronic Laboratory System, to which the State Department of Health also is connected.

Once a case has been confirmed, the child’s school alerts parents of children who have been in contact with the affected student. Privacy laws, however, prohibit the school from releasing any information that would reveal the identity of the sick student. So, letters home likely will only state from which building or grade level the child is.
County health departments often work with the doctor to follow up with the family to make sure the proper care is being carried out and doing what they call “contact tracing,” which is notifying those who might have been exposed to the disease.

School officials likely will request that parents keep their children home from school and activities, such as sports or play groups, until children have been on antibiotics for five days to treat pertussis.
County health officials say notification that children may have come in contact with a child infected with pertussis means that parents should watch for symptoms. Visit the doctor if a child begins exhibiting cold-like symptoms and a mild cough or fever.

Preventing pertussis with vaccinations
According to the CDC, neither vaccination nor natural infection with pertussis guarantees lifelong protective immunity against the disease. Because immunity decreases after five to 10 years from the last pertussis vaccine dose, older children, adolescents and adults are at risk of becoming infected.

However, vaccination is the best protection against the disease and the number of cases is still far fewer than before vaccines. The CDC recommends getting all children and adults fully vaccinated against pertussis.

Children who are seven years of age and older can receive a vaccine called Tdap, which may give them additional protection.

Further reading:

CDC’s pertussis homepage:
http://www.cdc.gov/Pertussis/about/index.html

Fact sheet on pertussis from the NYS Health Department: http://www.health.ny.gov/diseases/communicable/pertussis/fact_sheet.htm

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