Region Continues To Battle Whooping Cough Outbreak
KANSAS CITY, Mo., December 20, 2012 - The number of pertussis cases for 2012 in the United States is on track to exceed all prior years since 1959. So far, nearly 40,000 cases have been reported and there have been 16 deaths in the United States.
With that in mind, practitioners should be prepared to diagnose the disease and provide recommendations for the index case and other contacts. An organized approach to school outbreaks is necessary.
Consider the diagnosis of pertussis in patients with cough two or more weeks plus at least one of the following: paroxysms, post-tussive emesis, or whoop.
In cases of suspected pertussis:
- Confirm the diagnosis by appropriate lab testing or establish an epidemiologic link (contact with lab confirmed case)
- Provide treatment
- Recommend exclusion from child care or school until 21 days after the onset of symptoms if no therapy is given (i.e. parent refuses treatment) or five days after appropriate antibiotic therapy is begun
- Update immunizations
- Report to health department
- Chemoprophylaxis should be provided to all household members of an index case
Chemoprophylaxis is also recommended for close contacts of an index case. A close contact should have one of the following exposure histories
- Face-to-face in a shared a confined space (≥ 6 feet) for a prolonged period of time (≥ 1 hour)
- Directly contacted secretions from a symptomatic case
Health care providers should collaborate with public health officials in situations where school or child care center outbreaks are identified. The response to an outbreak in child care centers and schools involves a number of steps that should be facilitated by the local health department. In most cases, an outbreak will be related to a specific school classroom, or other extra-curricular contact such as a sports team. An outbreak is defined as two or more cases clustered in time.
If an outbreak is confirmed, then the following should occur: education of families (education/messaging to families), identification of and treatment of symptomatic and close contacts of a confirmed case PLUS exclusion from school of symptomatic and exposed (see above 1c).
Children are considered susceptible if asymptomatic and not a close contact of a confirmed case. Such patients should be provided pertussis-containing vaccine if they are eligible and return to school.
Messaging for families in response to an outbreak should involve a letter to families that is generated in collaboration with the local health department that takes into account a variety of factors and includes information related to where the exposure occurred, specific recommendations targeting those who are unvaccinated (including infants younger than 1 year of age), a description of the signs and symptoms of pertussis (including the incubation period so parents know when to expect symptoms), what to do if symptoms develop and who to contact.
The outbreak response depends on where (school vs. child care center) and the type of interaction (classroom vs. extracurricular) that has occurred.
Practitioners should verify outbreak information by calling the health department if a letter is not provided by the family regarding school or child care exposure.
In cases where a child presents related to a school exposure, practitioners should determine if the case has been confirmed, and whether or not the patient meets definition of close contact.
For children presenting related to a school outbreak, determine whether the child is a) symptomatic OR b) exposed (close contact) OR c) susceptible (asymptomatic and not a close contact). Treat, report and exclude from school those in scenario a and b. Provide immunization and send back to school those in scenario c.
Assess the immunization status of every patient with all health care visits and provide appropriate pertussis-containing vaccine to all especially those who have or were exposed to pertussis.
Mary Anne Jackson, MD
Division Director, Infectious Diseases, Children's Mercy Hospitals and Clinics
Associate Chair of Community and Regional Pediatric Collaboration
Professor of Pediatrics at UMKC School of Medicine
About Children's Mercy Hospitals and Clinics
Children's Mercy Hospitals and Clinics, located in Kansas City, Mo., is one of the nation's top pediatric medical centers. The 351-bed hospital provides care for children from birth through the age of 21, and has been ranked by U.S. News & World Report as one of "America's Best Children's Hospitals." For the third time in a row, Children's Mercy has achieved Magnet nursing designation, awarded to fewer than seven percent of all hospitals nationally, for excellence in quality care. Its faculty of 600 pediatricians and researchers across more than 40 subspecialties are actively involved in clinical care, pediatric research, and educating the next generation of pediatric subspecialists. For more information about Children's Mercy and its research, visit childrensmercy.org or download our mobile phone app CMH4YOU for all phone types. For breaking news and videos, follow us on Twitter, YouTube and Facebook.