To: School Nurses and Supervisory Unions
From: Susan Schoenfeld, Deputy State Epidemiologist for Infectious Disease
Date: January 27, 2012
– Please Distribute Widely –
This advisory provides an update of information sent in November and December 2011 to schools and the medical community:
Pertussis 2011: 94 cases of pertussis were confirmed in Vermont. This is still a provisional total and may increase slightly. Most cases (70%) occurred in Chittenden County in November and December. Ages of those with confirmed pertussis ranged from one month to 71 years. Children ages 5 to 18 accounted for 75 percent of these cases. Three of the adult cases occurred in individuals associated with schools. Among 80 children between the ages of 2 months and19 years with confirmed pertussis, 32.5 percent were unvaccinated or not up to date for age.
January 2012: As of January 25, 26 cases have been confirmed in Chittenden (14), Washington (6) Grand Isle (2), Addison (2), Orleans (1), and Windsor (1) counties. Many others are under investigation. School age children account for 92 percent of these cases, with cases occurring in at least 10 schools.
Action Steps for Schools:
Think of pertussis: Consider pertussis in students and staff who have the following symptoms, regardless of vaccination history, and refer for evaluation by a health care provider:
- paroxysmal cough of any duration, especially if followed by whooping, vomiting, or gagging
- cough in a person who has been notified of a close exposure to pertussis
- coughing illness that lasts more than two weeks
If pertussis cases have been identified in your school among students or staff, cough lasting at least seven days should be evaluated.
Report suspected cases to your District Health Office or to the Health Department’s Epidemiology Unit at 802-863-7240.
- Information: Families and staff should be aware when pertussis has been diagnosed in the school. The Health Department has sample letters you can use. Information about pertussis is available at the Health Department’s website: http://healthvermont.gov/prevent/pertussis/Pertussis.aspx
- Exclusion: Students or staff with suspected pertussis should stay at home and avoid close contact with others until they have completed the fifth day of an appropriate antibiotic - OR - had cough symptoms for at least three weeks.
- Antibiotic prophylaxis: The public health nurse from your District Health Office helps to identify close personal contacts and refer them to discuss antibiotic prophylaxis with their health care provider. Prophylaxis is rarely recommended for whole classrooms, but should be considered for individuals at higher risk of developing complications from pertussis, even if exposure is more limited. When recommended, prophylaxis should be given despite immunization status. Asymptomatic contacts receiving prophylaxis do not need to be excluded from school or activities.
Immunizations: Vaccination is the best protection against pertussis. However, the more pertussis is circulating, the greater the chance that a fully vaccinated person may become infected.
- Because immunity from childhood pertussis vaccination wanes over time, the adolescent/adult pertussis booster vaccine (Tdap) 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.
One dose of Tdap vaccine is recommended for people 11 years and older. There is no minimal time interval between doses of Td and Tdap.
- Specific indications for Tdap in those who are high-risk:
- Children age 7 to 10 who have not completed the five dose DTaP series
- Pregnant women during the third or late second trimester (after 20 weeks)
- Adults over 64 years who anticipate contact with infants
- Health care providers