Tuesday - November 30, 2010

The Next Epidemic

Whooping Cough Reaches Epidemic Level in California
Federal health officials say whooping cough has reached epidemic proportions in California and could escalate in other states if more adults don’t get vaccinated.

Dr. Patrick Joseph, a California infectious disease physician, told reporters at a press conference Wednesday in Washington that more than 6,400 cases of pertussis—aka whooping cough—have been diagnosed in his state this year. He said the epidemic is at its highest level in more than 50 years and implored more adults to get vaccinated. At least 10 infants, all under 3 months old, have died from the disease this year. “While the epidemic is in adults, the tragedy is in kids,” said Joseph, who is vice president of the National Foundation for Infectious Diseases (NFID). “The situation is grave when babies too young to be immunized are dying.”

Although California has faced the worst of the outbreak, several others states are seeing unusual spikes in the disease, including Ohio, South Carolina, Michigan, Texas, Idaho and New York.

NFID Medical Director Dr. Susan Rehm said most American adults still remain unvaccinated against many preventable diseases. “For more than six decades, vaccines have protected us from infectious illnesses that have a wide range of consequences, from lost work days to pain, hospitalization, long-term disability and death,” she said. “By foregoing vaccines, adults not only leave themselves vulnerable to sickness, but they expose those around them to unnecessary risks, too.”

Federal officials also released the results of a survey showing slow growth in adult awareness of vaccines that prevent diseases. In fact, less than half of adults know that vaccines exist for several major illnesses, including shingles, pertussis, hepatitis B, and meningitis. “Awareness is not nearly as high as we would like it to be,” said Dr. Melinda Wharton, deputy director of the CDC’s National Center for Immunization and Respiratory Diseases.

LOS ANGELES—More than 5,270 cases of whooping cough have been reported in California’s growing epidemic, which has killed nine infants this year. This week’s report from the California Department of Public Health found that the highly contagious illness hasn’t infected this many in the state since 1955, when 4,949 cases were reported for the entire year.

[ Chicago area ] Over the Thanksgiving break, Winnetka School District 36 maintenance staff is doing “enhanced cleaning” in the schools due to whooping cough and stomach virus outbreaks.

On Nov. 3, the Tribune reported six local cases of pertussis, otherwise known as whooping cough. That number has since increased to 17, according to a message on District 36’s Web site, signed by the two interim co-superintendents.

The first six cases were reported at Carleton Washburn School. There are now 14 confirmed cases at that school, along with two at The Skokie School and one at Crow Island School, according to interim co-superintendents Ken Cull and Mark Friedman.

Whooping cough has swept through schools in the North Shore in the last six weeks, with a total of 41 cases reported across 11 schools in Winnetka, Wilmette, Glencoe, Kenilworth and Northfield, according to statistics from the Cook County Department of Public Health.

“Pertussis is a highly contagious illness that is easily transmitted through coughing and sneezing and may persist among a population for weeks to months,” according toa letter to District 36 from the County Health Department. “Symptoms of pertussis usually occur five to 10 days after exposure, but can take up to 21 days to appear. Initially symptoms are similar to a common cold: a runny nose, low-grade fever and a mild occasional cough. However, the cough can become severe and spasmodic — with a distinctive ‘whooping’ sound — and can progress to vomiting between bouts of coughing.”

Whooping cough was also reported earlier this month at Highcrest Middle School, 569 Hunter Road, Wilmette, where 14 fifth-graders were diagnosed with the disease. The County Health Department visited the school and administered a vaccine to 84 students.

New York State has now reported a total of 462 cases of whooping cough in 2010, 66 from New York City and 396 from counties the CDC labels “upstate” [ which means not NYC, not Long Island, and not Westchester County ]. In 2009, at the same time, the state had reported 244 cases. The increase is entirely outside the City.

Twelve states have reported over 300 cases [ each ] in 2010. Upstate New York’s rate of growth in case numbers from 2009 places it second behind California. California continues in the grip of a declared pertussis epidemic. As of October 12, the California Department of Public Health is reporting 5,658 cases of whooping cough in 2010.

Three states, California, Texas and Ohio, have reported over 1,000 cases. The twelve states reporting over 300 cases in 2010 represent 75% of all whooping cough cases reported in the United States. All but Texas have higher case counts in 2010 than in 2009. Texas has reported 62 fewer cases in 2010, at 2,020.

The issue of vaccination remains at the core of the case counts. Twenty states allow parents to refuse immunizations for their children based upon a “strong personal belief”. Four of the top five states with high case counts allow this exemption. 74% of the total whooping cough cases reported in 2010 are from the 20 states allowing the exemption.

12,680 cases of whooping cough have been reported from six states, California, Texas, Ohio, Michigan, Minnesota and Pennsylvania. These states have the highest case counts and all six states allow the personal belief exemption. New York State does not allow a personal belief exemption.

[ Texas ] Pertussis is a bacterial infection of the respiratory system that produces a persistent, chronic cough, according to the National Institutes of Health. Also known as whooping cough, it’s most prominent in children and especially dangerous for infants.

The pertussis vaccine was first developed in the 1930’s. Before the invention of the vaccine, whooping cough was one of the most common childhood diseases and a major cause of death.

The worst case of pertussis since the 1960’s occurred in 2005 when the Travis County Department of Health reported just over 500 cases. Since the outbreak began in November 2009 over 1,000 children were tested for the contagious disease and no less than half of that number tested positive for whooping cough. More concerning, according to UCLA research, “The odds of having a history of asthma was twice as great among vaccinated subjects than among unvaccinated subjects.”

I would rather that my child had a greater chance of getting some asthma than be dead. And it’s just a greater chance, not a guarantee. And asthma comes in all strengths, from really mild and merely slightly annoying from time to time, all the way up to life threatening. And any one of those conditions beats being dead.

Whooping cough—also known as pertussis—was once a major cause of childhood illness and death in the United States, but all that changed with an effective vaccine introduced in 1940. That vaccine reduced whopping cough to a minor blip on the medical radar, with less than several thousand cases reported annually. However, there is an increasing number of parents wary of vaccines which has led to a resurgence in whooping cough in California and in several states across the nation.

Whooping cough is a serious bacterial infection caused by the bug Bordetella pertussis. It is spread through the air, meaning that coughing, sneezing, or simple conversation can spread the infection. It starts with symptoms such as a runny nose, sneezing, and a general body ache. While seeming like a normal, dry cough accompanying a cold, within the first week it turns into a wheezing cough where the patient suffers attacks of coughing. After gasping for air, these symptoms can become worse over time if not treated properly. The cough can end in a high-pitched whooping noise, hence where the infection got its interesting name. Whooping cough is dangerous in nature because if ignored it can lead to pneumonia, ear infections, and even seizures.

Bordetella Pertussis, a rod-shaped coccobacillus human pathogen, is nonenteric and encapsulated that can be transmitted through direct contact with droplets or inhalation of aerosols. It is a gram-negative bacteria, like brucellosis and Legionnaire’s Disease.  It is very similar to bordetella bronchiseptica which causes bronchitis (kennel cough) in livestock and pets. Hard surfaces can be disinfected with dual quat disinfectants like that D-128 stuff I always talk about. Phenolic disinfectants should also work (eg Lysol disinfectant, not the detergent), as may chloride based ones (eg bleach); look for “encapsualted bacteria” on the kill list of the product if Bordatella is not specifically listed.  Another way to disinfect cloth would be with sodium dichloroisocyanurate, commonly called NaDCC and used in water purification tablets; NaDCC will kill both encapsulated and unencapsulated bacteria. It also kills canine parvo, distempter, and the Bordetellas that your veterinarian is concerned with on contact, so I’d bet on it for disinfecting laundry too if nothing else was available.

Be concerned. Be prepared. And get your immunizations up to date.

Posted by Drew458     on 11/30/2010 at 02:48 PM   
Filed Under: • Health-Medicine •  
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