By Mark J. Ingerman, M.D., FACP, Chief, Infectious Diseases and Chief, Infection Prevention and Control
This is an addendum to the Chester County Department of Health alert published in the MLH Clinician last week. The Chester County Department of Health received an increase in reports of confirmed pertussis and pertussis exposure in several school districts, and in several healthcare facilities.
Pertussis or Whooping Cough is an acute infectious disease caused by Bordetella pertussis. In the 20th Century, pertussis was one of the most common childhood diseases and a major cause of childhood mortality in the United States. Before the availability of the pertussis vaccine in the 1940s, more than 200,000 cases of pertussis were reported annually. Since widespread use of the vaccine began, incidence has decreased by more than 75%.
Since the 1980s there has been an increase in the number of reported cases of pertussis. Several factors have contributed to the increase in reported cases. Of these, the most discouraging is the lack of vaccination in various populations.
Pertussis can cause serious and potentially life-threatening complications in infants and children who are not fully vaccinated. In infants younger than 12 months of age who get pertussis, about half are hospitalized; 61% develop apnea, 23% develop pneumonia, 1% develop seizures and another 1% may die.
Why get vaccinated? Pertussis is a very serious disease. Tdap vaccine given to pregnant women can protect newborn babies from pertussis. Tdap is especially important for healthcare professionals and anyone having close contact with a baby younger than 12 months. Pregnant women should get a dose of Tdap during every pregnancy.
The Main Line Health Occupational Health Department offers Tdap to all new hires and all existing employees. A one-time adult dose of Tdap is offered. Although presently not a mandatory vaccination at MLH, Tdap is an essential means of preventing the transmission of pertussis in our pediatric population.
Treatment of a diagnosed case of pertussis or a strongly suspected case of this infection should be completed as soon as identified. In addition, prophylaxis for individuals with known exposure to pertussis, especially if they live with infants, pregnant women or immuno-compromised individuals, should be administered. Patients being treated with pertussis (even empirically) may not return to school until completing five days of the antibiotic therapy.