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Whooping cough hits Tri-County area

July 17, 2012

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The Tri-County area of Ferry, Stevens and Pend Oreille Counties are experiencing significant numbers of pertussis (whooping cough) cases, according to Dr. Ed Gray, M.D., Health Officer of the Northeast Tri-County Health District.
“There has been a sharp increase in the number of cases in the Inchelium, Colville, and Kettle Falls areas in the last two weeks,” says Dr. Gray. “Many of these cases have led to exposures at places of business, sports events, daycares, churches, health care facilities, and exposure for out of state/country residents.”
Four infants have been diagnosed with the disease, and two children have required hospitalization in the Tri-County region of northeast Washington.
This coincides with a statewide pertussis outbreak, with nearly 3,000 cases in the state of Washington so far in 2012, up from 210 cases from the same time last year.
“Any individuals with close contact to someone who has tested positive for pertussis should contact their health care provider as soon as possible for evaluation, and determine whether preventive antibiotic treatment is needed,” advises Dr. Gray.

Airborne disease

‘Close contact exposure’ includes direct face-to-face contact during the infectious period; direct contact with respiratory, oral or nasal secretions from the infected person, or close proximity to the infected person during the contagious period.
Risk of exposure increases with longer duration and closer proximity of contact. Because the pertussis vaccine is not 100 percent effective, this recommendation applies even for those who are up to date on their immunizations. Pertussis cases are occurring in individuals who are partially or fully immunized.
Pertussis is a highly communicable airborne disease. The time between exposure to pertussis and the beginning of symptoms is five to 21 days, with an average incubation period of seven to 10 days. The first symptoms appear like a cold (runny nose, sneezing, sore throat, cough, and low-grade fever). During this first phase of the disease that lasts one to two weeks, the symptoms can be mild, and the cough progressively becomes more persistent. As a result, individuals often don’t go to their health care provider until the second phase of the disease, when their symptoms worsen.
In the second phase of the illness, the cough progresses to explosive bursts, followed by a “whoop” and occasionally vomiting.
In infants, these bouts of coughing can end in their turning blue or their breathing stopping altogether. Because of this, pertussis in infants can be life-threatening, especially those under six months of age. Older children and adults may present with mild cold-like symptoms and persistent coughing spells, and the “whoop” is often absent.
Whooping cough is frequently misdiagnosed as bronchitis or allergies. It can cause severe illness in older and immune compromised individuals.

Incubation period
of 7 to 10 days

Pertussis is spread by ill people coughing and sneezing close to other people, especially in enclosed spaces and for long periods of time.
According to Dr. Gray, “Pertussis patients are infectious during the first phase of disease when symptoms are sometimes very mild. Because patients often do not seek medical care until their symptoms worsen during the second phase of the disease, they have often exposed others for 10 to 14 days before testing positive for pertussis.”
The average incubation period is seven to 10 days, so the individuals who have been exposed are often already developing symptoms before they know they have pertussis. These factors, plus the fact that pertussis is highly contagious, make it a disease that is hard to control once it gets started.”
Those experiencing possible pertussis symptoms should consult a health care provider for evaluation, and stay home until pertussis is ruled out.
“Before seeing a health care provider, please let them know in advance the reason for your appointment so they can provide a mask during the visit, for the protection of other patients and staff,” advises Dr. Gray. “If your provider suspects pertussis, please keep yourself and any other ill family members home until test results come back negative, or he/she has completed five days of treatment after a positive test result.”
The most effective strategy to prevent the transmission of pertussis is to vaccinate all children on time and give a booster dose to adolescents and adults.
People who received the vaccination when they were young are typically no longer immune as adults, but don’t even realize this, and can inadvertently spread the disease. School-aged children and adults are now the major spreaders of the disease. Across the state, the highest number of pertussis cases is in the 10-13-year-old age group. Though the vaccine doesn’t always produce full immunity, it is the best means of protection available. The recommended vaccine schedule for pertussis is:
•Children should get five doses of Tdap vaccine before age seven years. •The following people should get a single dose of Tdap vaccine (booster shot):
•Children seven-10-years that are not fully vaccinated against pertussis. •Adolescents 11-18 years who have completed the DTP/DTaP series. •Pregnant and post-partum women, preferably during the third or late second trimester, after 20 weeks gestation. •All adults aged 19 years and older, especially adults who have or anticipate having close contact with infants less than 12-months-old.
In Washington, all recommended vaccines are offered at no cost to all children under 19-years-old through health care provider offices participating in the state’s Childhood Vaccine Program. Health care providers may charge an office visit fee and a fee to give the vaccine, called an administration fee. People who cannot afford these fees can ask their health care provider if they’ll waive or reduce the fees. Most health insurance carriers will cover the pertussis vaccine; adults should double check with their health plan.
For those interested in receiving adult Tdap vaccination, but finances are a concern, NE Tri-County Health District has a limited supply of free Tdap vaccine for eligible individuals. If individuals are low income, unemployed, have no insurance, or insurance does not cover Tdap vaccination, they may be eligible to receive the free Tdap vaccine.
For information about vaccinations, contact your family’s healthcare provider or the Northeast Tri-County Health District office in your area: Colville Community Health (509) 684-5048, Newport Community Health (509) 447-3131, or Republic Community Health (509) 775-3111.
For a list of immunization providers in the Tri-County area, go to http://www.netchd.org.

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