Preventing pertussis

Billy and Ruth Waddell of Howland know the importance of getting vaccinated against pertussis, especially since their great-granddaughter was born prematurely.

“The nurses at the hospital said anyone who would be around her should get it,” Billy Waddell said.

He and Ruth were at the Niles Health Department for their boosters and the rest of the family was expected to get vaccinations later that day, he said.

Although children receive vaccinations for pertussis from the time they are infants, the disease is still very much around, said Kathy Salapata, director of nursing with the Niles Health Department.

“After about five years, the immunity fades,” Salapata said.

For this reason, children are given the vaccine not just as babies and toddlers, but also before entering the seventh grade. The booster for children ages 11 and 12 is now required in Ohio due to an amendment to the school immunization bill signed into law in 2010.

According to Salapata, women who are expecting should get the booster between the 25th and 36th months of pregnancy and anyone over the age of 65 who has contact with children under 12 months old also should get the pertussis booster, or Tdap vaccine.

“We’re seeing a lot of grandparents coming in who are going to be caregivers for the grandchildren,” Salapata said. “The disease can be fatal for infants younger than four months,” she said.

Pertussis, also known as whooping cough because of the “whooping” sound a person makes while trying to inhale during a coughing fit, can attack anyone at any age, according to the Centers for Disease Control and Prevention.

Children are normally vaccinated five times before they start first grade, at 2, 4 and 6 months, between 15 and 18 months and again between ages 4 and 6. This vaccination, called the DTaP (Diphtheria, Tetanus and Pertussis), fades over time which is why the booster is required before a child enters the seventh grade to continue their immunity through high school.

The disease is caused by a virus called Bordetella pertussis, and is most severe for babies who catch the illness from a family member or other caregiver. According to the Ohio Board of Health, more than half of infants younger than one year old who get the disease are hospitalized.

In infants, the cough may be mild or non-existent, but can cause a pause in the child’s breathing pattern known as apnea. However, infants and children with pertussis also can cough violently and rapidly until the air is gone from their lungs and they are forced to inhale.

Pertussis begins gradually and initially resembled the common cold with sneezing, a low grade fever and mild cough. According to the Ohio Department of Health, this stage usually lasts one to two weeks. The disease is not normally suspected until the cough gradually becomes more severe and periods of violent coughing followed by the whooping gasps for air that can sometimes lead to vomiting.

By this time there is no fever and the patient appears normal between coughing spells. This stage can last from four to six weeks but might last as long as 10 weeks. The coughing spells occur most often at night. Once the patient begins to recover, it could take another two weeks before the cough goes away completely.

In infants, however, the cough may be minimal or absent with apnea being the only symptom.

Diagnosis of the disease is done by way of a nasal swab. The sooner a patient seeks a diagnosis, the better chance of identifying the disease. According to the ODH, a high percentage of children will have positive cultures the first week of the illness, but only 50 percent will be positive by the end of the third week. Less than 20 percent test positive after the fifth week.

Pertussis is a reportable disease and area health departments are required to investigate all cases, Salapata said. Once a patient has been diagnosed with Pertussis, the health department will contact the family physician as well as family members and all known persons who may come in contact with the person or child.

Although 2012 was one of the highest years for reported cases of Pertussis, 2013 has seen a drop in the percentage of outbreaks, according to the CDC. Still, there are 13 states that have a higher percentage of outbreaks than last year, with Ohio being one of them.

There are no current outbreaks reported in Trumbull County, Salapata said. The last time an occurrence of the disease was reported was just a few cases in January, but Pertussis is probably under reported, she said.

According to the CDC, reported cases of whooping cough vary from year to year and tend to peak every three to five years. Prior to 2012, the last peak for the disease was 2012 when more than 27,000 cases were reported.