Whooping Cough racks Pondera County

According to the Pondera County Health Department, a total of 10 cases of pertussis have been confirmed in Pondera County since October of this year.

While most of the cases have been confirmed in school age children, health nurse Cynthia Grubb reports that “though pertussis commonly affects infants and young children our county has seen cases in preschoolers and adults as well.”

This potentially dangerous disease, more commonly known as Whooping Cough, is known for uncontrollable, violent coughing which often makes it hard to breathe. After fits of many coughs, someone with pertussis often needs to take deep breathes which result in a “whooping” sound, hence the nickname “Whooping Cough”.

According to the CDC website, since the early 1980s, there has been an overall trend of an increase in reported pertussis cases. Pertussis is naturally cyclic in nature, with peaks in disease every 3-5 years. But for the past 20-30 years, the peaks are getting higher and overall case counts going up.

There are several reasons that help explain why we’re seeing more cases as of late. These include increased awareness, improved diagnostic tests, better reporting, more circulation of the bacteria, and waning immunity possible because the acellular vaccine we now use may not protect for as long as the whole cell vaccine we used to use. These reasons make pertussis hard to contain.

Pertussis cases are by law reported to the health department largely due to the danger of this disease to infants.

When a case is lab confirmed, it is reported to the local health department who then begins a close contact investigation. Grubb describes the process. “We start with securing antibiotics for the household and determining if anyone else in the household has symptoms that warrant testing.

From there we attempt to make a close contact list which is defined by prolonged exposure to the confirmed case within the period when the individual would have been contagious.

If the close contact has symptoms, they are then tested and treated with antibiotics and they are restricted in activity till either the testing comes back negative or they have been on antibiotics for five days. If they have no symptoms, close contacts are still recommended to complete a course of approved antibiotics but are allowed to attend school, work, etcetera.

“In the state of Montana with 633 cases reported this year, pertussis activity in 2013 has been the highest level reported since 1957. Health Officer Todd Gianarelli states, “There are many reasons why pertussis can linger in communities increasing case counts. First, many illnesses begin with a runny nose and cold like symptoms including cough. Because of this, cases are often not diagnosed until an individual has been coughing for a prolonged period of time or has had a cough that ‘whoops’ or causes post-tussive vomiting (intense coughing that causes vomiting). Additionally, many do not seek care from a provider or get tested. Sometimes testing is delayed and ill persons may spread the disease long before they become aware of their diagnosis.”

He went on to say, “Because transmission among persons occurs readily through respiratory droplets and the time between exposure and symptom onset may be as long as 21 days, pertussis tends to run a course in a community despite public health efforts.”

Vaccination remains the best defense. CDC recommends vaccine for infants and children, who will be covered if they are current on their regular immunizations. Also a dose of Tdap vaccine is recommended for all adults especially those are in close contact with infants who are too young to be fully vaccinated. The newest recommendation is for pregnant women within their last trimester to be vaccinated with the purpose of passing on immunity to their infants before their babies can be fully vaccinated regardless of when their last vaccination occurred.

The health department reminds people of a few key points that may help your community.

First, if you have not received Tdap vaccine, now is the time. Second, if you are contacted by the department as being a close contact to a case of pertussis, cooperate fully by taking your antibiotics and reporting any onset of coughing illness and following any restrictions the department recommends. Third, be especially vigilant about cough illness and infants under six months of age or those with underlying respiratory illness such as asthma.

To complicate matters, the department confirmed this week the presence of influenza in the county. With multiple illnesses presenting with cough symptoms, how do you know if the cough you have is pertussis? According to Grubb, “we are watching for prolonged coughs lasting longer than a week accompanied by one or more of the following symptoms,inspiratory whoops, vomiting after the cough or paroxysmal (severe spasmodic) coughing and focusing our efforts on infants and close contacts who might expose infants.”

For more information, call the health department at 271-3247 or go to www.cdc.gov/pertussis.