Health Watch

Pertussis, or "Whooping Cough", has reached epidemic levels in the state of Washington. According to the Washington State Department of Health, as of May 19th, there have been 1,738 cases reported statewide, compared to 148 reported cases in 2011 during the same time period. Infants and children have been hit hardest, both in number and in severity of the illness.

The majority of these cases have been in counties with larger cities. Walla Walla County has reported 12 cases to date in 2012. Most of these cases have been in Walla Walla City, but recently there was a case reported in Prescott. In Columbia County there were no cases until May, when 2 cases were reported.

The Washington State Department of Health has issued recommendations to help battle this epidemic. Columbia County Health District (CCHD), consisting of the Dayton General Hospital, the Columbia Family Clinic and the Waitsburg Clinic, would like to inform the local community of these recommendations, hence this press release.

Pertussis is a highly contagious bacterial infection that causes a long-lasting and often severe cough. Pertussis is spread by coughing or sneezing. Symptoms usually start 7-10 days after exposure, although symptoms may take up to 21 days to develop. The cough can last for weeks.

The illness usually starts with mild upper respiratory symptoms, similar to a cold. A cough develops, but as the other symptoms resolve the cough persists and may become more severe. The cough tends to come in spells or "paroxysms", which are often associated with gagging or vomiting. The cough is sometimes associated with a "whoop" sound when the patient tries to catch the breath between coughs.

Anyone exposed to the bacteria can get pertussis, although immunization is very effective at preventing the spread of pertussis. Younger children and infants have smaller airways and often have less immunity, so are at higher risk of complications. These complications include difficulty breathing, pneumonia, convulsions and even death.

The bacterium that causes pertussis, Bordetalla pertussis, is sensitive to antibiotics. Unfortunately the damage done to the airways by the bacteria persists even after the bacteria is killed, which is why the cough lasts so long. Therefore prevention is the best defense against pertussis.

Immunization is very effective at preventing the spread of pertussis. However, immunity wears off over time, so booster immunizations are important. Our entire community can be protected against the spread of pertussis if enough of us are immunized. This "herd immunity" only works to prevent the spread of pertussis if 9 out of 10 of us are immune. Older kids and adults can do their part to protect the infants and other at risk patients by being vaccinated.

Children are routinely immunized against pertussis by the DTaP vaccine, which immunizes against Diphtheria, Tetanus and Pertussis. DTaP is usually given at 2, 4 and 6 months of age, with booster immunizations between 15 to 18 months and between 4 to 6 years of age. If your child has not received five DTaP immunizations by age 7, or, if you are not sure about their immunizations, contact your child's health care provider.

In the past only children were vaccinated against pertussis. Adults and older adoles- cents received Td booster shots, which immunized against tetanus and diphtheria, but not against pertussis. In 2005 a new vaccine, Tdap (not DTaP), became available in the U.S. for use in older adolescents and adults. Tdap also immunizes against all three infections, tetanus, diphtheria and pertussis. In 2006 the U.S. ACIP (Advisory Committee on Immunization Practices) recommended that adults and adolescents receive Tdap instead of Td for their next routine immunization, which is usually given every 5 to 10 years. However, Tdap may be given to adults regardless of the time interval since the previous Td dose, especially if the adult has close contact with infants. The ACIP has also made a new recommendation that pregnant women get Tdap during their pregnancy (after 20 weeks gestation) unless they have previously received a Tdap vaccination. Women who get Tdap before or during pregnancy pass on extra protection against pertussis to their babies.

To summarize, the current recommendations for pertussis immunization are:

1. Children should receive five doses of DTaP before age seven.

2. Children age seven to ten who did not receive all 5 doses of should receive DTaP before age seven.

3. Adolescents aged 11 to 18 years (preferably at age 11 or 12) should receive one DTaP.

4. All adults who have not had the Tdap vaccine before, especially pregnant women in the late second or early third trimester, Health Care workers, and anyone who cares for babies less than 12 months old, i.e. child care providers.

The Columbia Family Clinic and the Waitsburg Family Clinic have plenty of Tdap available, and are making efforts to immunize all appropriate patients.