To: Health Care Providers, Hospitals, and Ambulatory Care Centers
From: Susan Schoenfeld, Deputy State Epidemiologist
Date: August 19, 2010
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In the past two weeks, the Vermont Department of Health has received an increased number of reports of pertussis, including one culture-confirmed case in an infant less than 6 months of age who was hospitalized in early August. Among the contacts to this culture-confirmed case were several adults and young children, including another young infant who was also hospitalized with respiratory distress. Both infants have since been discharged from the hospital and all contacts were prescribed antibiotic prophylaxis.
In the first half of 2010, several states are reporting increased cases of pertussis. California has reported 2,174 cases and 7 infant deaths due to pertussis as of July 27, 2010.
Pertussis is most severe in infants. More than half of infants less than one year of age with pertussis require hospitalization. Many infants are infected by family members or caregivers with undiagnosed disease.
Vaccination remains the best protection against pertussis. Because immunity from childhood pertussis vaccination wanes over time, a booster shot for adolescents and adults is essential to reduce the risk of contracting pertussis and can decrease severity of disease. Vaccinating adolescents and adults, especially family members or caregivers of infants and health care workers, can help prevent pertussis transmission to infants too young to be vaccinated.
The adolescent/adult pertussis booster vaccine (Tdap) can be used for individuals ages 10 through 64, and may be given before the 10-year mark since the last tetanus and diphtheria (TD) booster. For providers participating in the Vermont Vaccines for Children (VFC) program, Boostrix® is available for children 10-18 years. For providers participating in the Vaccine for Adults (VFA) program, Adacel® is available for those 19-64 years. For information about these programs, call the Immunization program at 1-800-640-4374 or 802-863-7240.
Pertussis presents with mild upper respiratory symptoms and an irritating cough that gradually increases in severity to the classic symptoms of pertussis, which include paroxysmal coughing along with possible whooping, apnea, or post-tussive vomiting. In the youngest infants, atypical presentation is common; the cough may be minimal or absent and the primary symptom may be apnea.
Clinicians are asked to:
- Consider the diagnosis of pertussis in patients presenting with the above symptoms.
- Test for pertussis. This not only provides diagnostic information for the patient, but allows for public health interventions to decrease disease transmission to close contacts and in the community. Testing for B. pertussis is available at the Vermont Department of Health Laboratory. Culture testing (no charge) or culture/PCR testing ($36) can be requested. Culture results are available within 7 days, and PCR testing is performed on Mondays and Thursdays. In an outbreak situation, or by special request, PCR testing can be performed on a day other than Monday or Thursday by calling Epidemiology at 802-863-7240. Specimens should be collected using a Dacron nasopharyngeal swab, and transported in Regan Lowe charcoal medium. Please request a Health Department Kit #5 for proper collection and transport materials.
- Make sure patients are up-to-date on pertussis-containing vaccines. For a link to the Health Department Immunization Registry visit: http://healthvermont.gov/hc/IMR/index.aspx
- Report suspected cases of pertussis to the Vermont Department of Health (802-863-7240 or 1-800-640-4374 in-state) to allow for timely public health interventions.