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Pertussis Activity Increased in Sonoma County

Posted: July 10, 2009
To: Healthcare Providers
From: Mark Netherda, Deputy Health Officer, 565-4567

The County of Sonoma Department of Health Services Public Health Division has received several reports of confirmed pertussis cases in recent weeks. Although the overall number of pertussis cases this year is low, 14 of the 15 cases reported in 2009 have been diagnosed since mid-May, indicating that pertussis activity is currently high in Sonoma County. Disease Control investigations suggest that this number is even higher, based on reports of symptomatic household members and close contacts of confirmed cases. Many of these cases have been in infants and young children (age < 5). Infants are of special concern for pertussis as they are too young to be fully vaccinated, symptoms are often non-specific and the illness is life threatening. The last pertussis related death in Sonoma County was in a young infant in December of 2007.

Pertussis is a vaccine preventable disease. Healthcare providers are reminded to review immunization records with patients and families to ensure that all household members are up to date. A vaccine booster is now available for teens and adults and should be offered when appropriate to help prevent older community members from passing the disease to young, unvaccinated infants. Providers should be aware of the signs and symptoms of pertussis and are asked to follow the guidelines given below.

Pertussis is an infection of the respiratory tract caused by Bordetella pertussis bacteria that is spread when an infected individual coughs or sneezes. Early symptoms of pertussis are runny nose, sneezing, low grade fever, and mild cough (catarrhal stage). This stage is followed in a week or two, by a persistent cough which may occur in explosive bursts (paroxysmal coughing) sometimes ending in a high-pitched whoop and sometimes vomiting (paroxysmal stage). In infants younger than 6 months, older children, and adults, the characteristic whoop may be absent. The coughing attacks usually increase during the first two weeks of illness, and then remain the same for two or three more weeks before gradually decreasing. Communicability is highest during the catarrhal stage, but can persist into the first 2 weeks of the paroxysmal stage before gradually decreasing over the subsequent 3 weeks. Communicability is eliminated with 5 days of appropriate antibiotics. Pertussis is sometimes complicated by pneumonia, encephalopathy or other serious sequelae, particularly in infants. Adolescents and adults often serve as reservoirs for infection of infants.

For patients who meet the clinical case definition, or are suspected pertussis cases, the following is recommended:

  1. Complete the Confidential Morbidity Report (CMR) and fax to Sonoma County Public Health, Disease Control, fax 565-4565.
  2. If within 2 weeks of symptom onset, obtain a nasopharyngeal specimen for PCR and culture from the posterior nasopharynx and send to the Public Health Lab (565-4711). PCR results are available within 3-4 days. Testing of asymptomatic contacts is not recommended. PLEASE DO NOT REFRIGERATE SPECIMENS.
  3. Treat the patient (if within 3 weeks of cough onset) and members of his/her household according to the table below.
  4. Advise symptomatic patients to stay at home for at least the first 5 days of antibiotics.
  5. All household contacts of cases should receive chemoprophylaxis according to the table below, whether or not they have symptoms and regardless of their immunization history.
  6. VACCINATE: All healthy contacts > 2 months and < 7 years old should be vaccinated against pertussis according to the ACIP vaccine schedule (pdf). Children who have not received at least 4 doses of DTP/DTaP by age 18 months or for whom the last dose was over 3 years ago, should receive a DTP/DTaP dose.
  7. Tdap (tetanus, diphtheria, acellular pertussis vaccine) is now available and recommended for individuals 10-64 years of age to replace a single dose of Td vaccine when appropriate. Adolescent and adult patients should be vaccinated. For more information about Tdap vaccine, go to ACIP Recommendations.

For more information regarding pertussis, please go to the Sonoma County Public Health webpage on pertussis. If you have questions or comments, please contact the Disease Control Unit at 565-4566 (provider line), e-mail phnurse@sonoma-county.org, or fax 565-4565. For after hours emergencies, call the Health Officer on call via REDCOM at 568-5992.

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