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Health Advisory: Pertussis on the Rise in Monterey County

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June 1, 2017

 

From:  Edward L. Moreno, MD, MPH                                 Kristy Michie, MS

           Health Officer    831-755-4585                                Epidemiologist   831-755-4503

 

 Pertussis on the Rise in Monterey County

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The Monterey County Health Department requests your assistance

in preventing the spread of illness to vulnerable populations.

The Monterey County Health Department has received 10 reports of new pertussis cases since January 1, 2017.  Most of the cases were reported within the last 8 weeks.  Age of affected individuals ranged from 5 to 70 years of age, with the majority being between the ages of 8 and 16 years.  At this time, local Health Officials recommend that medical providers:

  • Suspect pertussis in any individual with a progressive cough of greater than one week duration, especially if post-tussive vomiting and/or paroxysmal coughing occurs.
    • Infants may have atypical presentation with mild symptoms initially.
    • Common misdiagnoses include bronchitis, asthma, and GERD.
    • Consider pertussis even in recently vaccinated people when evaluating patients with symptoms compatible with pertussis.  Immunity after immunization wanes within a few years.
    • 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 episodes or feeling as if they are choking.
  • Test for pertussis.  PCR (nasopharyngeal specimens) is the most sensitive method.
    • In young infants (≤ 3 month old), leukocytosis with lymphocytosis (white blood cell count of ≥20,000 cells/mm3 with ≥ 50% lymphocytes) and a cough illness is a strong indication of B. pertussis infection.
  • Start treatment immediately if pertussis is suspected; do not wait for laboratory confirmation.  Prophylactic antibiotic treatment for contacts is recommended in households with infants less than 1 year of age.
  • Vaccinate households with infants.  Parents, household members age 10 years of age and older, and other caregivers should receive a single dose of Tdap. 
  • Vaccinate and educate pregnant women.  Immunize all 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.  This is the most important measure to help protect young infants against pertussis.
    • Tdap during pregnancy has not been found to be associated with an increased risk of adverse events in vaccinated women or their infants. 
    • Immunization of pregnant women with Tdap is covered by insurers, including Medi‑Cal.
    • Postpartum vaccination does not provide transplacental antibodies to newborns but may prevent maternal acquisition and transmission of pertussis. If the postpartum mother has never received Tdap, promptly administer Tdap before discharge home.
  • Report suspected cases promptly to the Health Department (call 831-755-4521 or fax Confidential Morbidity Report forms to 831-754-6682).  Timely reporting supports prevention and control measures.

 

For more information about pertussis diagnosis, treatment, and reporting, please contact the Monterey County Health Department’s Communicable Disease Unit at 831-755-4521 or visit our pertussis website at:  http://www.co.monterey.ca.us/government/departments-a-h/health/diseases/pertussis-whooping-cough.  For information about immunizations, please contact the Health Department’s Immunization Coordinator at 831-755-4683.  Additional pertussis information is available at: http://www.cdc.gov/pertussis/ or http://eziz.org/resources/pertussis-promo-materials/.  

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Health Alert:  Warrants immediate action or attention.   Health Advisory:  Provides information for a specific incident or situation; may not require immediate action. Health Update:  Provides updated information regarding an incident or situation; unlikely to require immediate action.