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Last week the California Department of Public Health declared a pertussis (whooping cough) epidemic. As of June 15 the state recorded 910 cases of pertussis, a four-fold increase from the same period last year. During this year, 2010, five infants, all under three months of age, have died from the disease. Pertussis is cyclical. Cases tend to peak every two to five years. In 2005, California recorded 3,182 cases and seven deaths.

To date there are 46 confirmed cases in the Stanislaus county. There was one infant death during early May.

Clinical symptoms: There are 3 stages:

1. 1.Catarrhal stage: cold-like symptoms (coryza, sneezing, occasional cough). Fever is usually absent. This stage lasts 1-2 weeks with cough gradually worsening.

Infants less than 6 months of age:

-         may have a shorter catarrhal stage.

-         may not go into the next “whooping” phase.

-         may gag, gasp or stop breathing (apnea).

-         likely will have an increased absolute lymphocyte count in their CBC.

1. 2.Paroxysmal stage: spasms of severe cough are followed by a sudden deep inspiration, often resulting in the characteristic “whooping” cough. Post-tussive vomiting is common in all ages. Adolescents are likely to have a milder disease.
2. 3.Convalescent stage: decreasing frequency and severity of coughing, whooping and vomiting. Classic pertussis lasts 6-10 weeks in duration.

Transmission is by close contact via aerosolized droplets from the respiratory tracts of infected persons. Incubation is typically 7-10 days (range 5-21 days). Persons with pertussis are infectious (contagious) from the onset of any catarrhal (cold-like) symptoms until after 5 days of treatment or until 21 days after onset of paroxysmal cough if no (or partial) treatment is given.

The diagnosis is confirmed by polymerase chain reaction (PCR) test for Bordetella pertussis (the bacteria that gives this disease).

Control measures:

1. 1.Children 0-6 years should receive age appropriate DTaP vaccine (in this vaccine P stands for pertussis; there is no isolated specific vaccine for pertussis).
2. 2.All persons 10-64 years should receive a dose of Tdap vaccine if they did not receive a dose after the age of 10 years. The Td vaccine was changed to Tdap only 5 years ago so there are still a lot of persons who did not receive a pertussis booster so they are not immune to this disease – this is one of the reasons of the present epidemic.
3. 3.Small babies should be treated aggressively if there is any doubt that the disease may be present or if there are positive contact cases. The treatment is with Zithromax for 5 days and all doctors should have been informed by now about the appropriate dosage according to the patient’s age.
4. In small babies the DTaP vaccine can be given in an accelerated schedule, starting at 6 weeks of age.
5. 4.New moms need TdaP protection, as well as all members of the family that are around the newborn. For future mothers, ideally they should get it before they get pregnant so ask your doctor to give it to you. It can also be given during pregnancy or right after giving birth. These vaccines, for the new parents, are available now for free in the state of California. It is safe to get a Tdap shot while breastfeeding.
6. 5.Healthcare workers who did not receive the Tdap booster should get it as soon as possible.

7. Florin Vlasie, M.D., F.A.A.P.

   Board Certified Pediatrician

   1425 West H Street, Suite 330 • Oakdale, CA 95361 (209) 848-8133

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