Health Advisory: Pertussis

sbcountyH

By Staff Reports

(Victor Valley)– The California Department of Public Health (CDPH) recently declared an epidemic of pertussis. Pertussis is cyclical and incidence naturally peaks every 3-5 years.  CDPH is closely monitoring reported cases. As of June 10, 2014, there have been 3,458 cases of pertussis reported. This amount is more than total number of cases reported in 2013. In the last two weeks alone, 800 new cases of pertussis have been reported.

The County of San Bernardino, Department of Public Health has also seen a rise in the number of reported pertussis cases. In 2013, there were a total of 37 reported cases. As of June 13, 2014, 43 cases of pertussis have been reported to the County of San Bernardino Department of Public Health compared to 7 cases at this time last year.  More than 85% of cases reported are those 19 years of age and younger.  Currently, the most impacted demographic group infected with pertussis within San Bernardino County are Hispanic (47%).

Infants are most at risk to develop severe complications from pertussis. Of Infants who are hospitalized with pertussis, about 1 in 5 will get pneumonia and 1 in 100 will die. Two-thirds of pertussis hospitalizations in California have occurred in children less than four months of age. According to Dr. Maxwell Ohikhuare, Health Officer for the County of San Bernardino Department of Public Health, “With this recent epidemic, young infants remain the most vulnerable to severe disease and death from pertussis, therefore we urge medical providers to prioritize prevention strategies for this population.”

Recommendations for Medical Providers:

  • The most important measure to help protect young infants against pertussis is to immunize all pregnant women, irrespective of their immunization history, with Tdap during every pregnancy between 27-36 weeks gestation to optimize antibody transfer and protection of infants at birth.
  • Advise women during pregnancy and delivery that other adults in contact with the newborn, such as fathers, grandparents, older siblings, and babysitters, should also be up-to-date with their Tdap vaccine at least two weeks before coming into contact with infants less than 12 months of age.
  • Immunize young infants timely with DTaP. The first dose can be administered as early as six weeks of age.
  • Consider pertussis regardless of age in patients with persistent cough. Symptoms are generally milder in teens and adults, especially in those who have received Tdap.
  • Consider testing and treatment for pertussis despite immunization history in patients with respiratory illness. The recommended testing for pertussis is PCR from nasal pharyngeal swab or wash. Serologic testing for pertussis is not recommended.
  • Report cases of pertussis within 1 working day of identification (suspect and confirmed) to the Communicable Disease Section at 1-800-722-4794.
  • Consider pertussis regardless of age in patients with persistent cough.  Symptoms are generally milder in teens and adults, especially in those who have received Tdap.  Adults may report sweating episode or feeling as if they are choking.
  • Consider pertussis even in recently vaccinated people when evaluating patients with symptoms compatible with pertussis.  Immunity after immunization wanes within a few years.
  • Provide treatment or antibiotic prophylaxis for exposed household contacts, caregivers or others potentially exposed to symptomatic pertussis cases, especially when there is an infant or pregnant woman in the home.

For additional resources on testing, treatment and prophylaxis recommendations; and healthcare exposures, please contact the Communicable Disease Section at 1-800-722-4794. Additional resources can be found at http://www.cdph.ca.gov/HealthInfo/discond/Pages/Pertussis.aspx, http://www.cdph.ca.gov/HealthInfo/discond/Pages/Pertussis.aspx and the Communicable Disease Section Facebook page at http://www.facebook/CommunicableDiseaseSection.

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