BeHealthySpringfield

Whoopng cough cases climb in county, state


BY DEAN OLSEN
THE STATE JOURNAL-REGISTER
Published Jan. 15, 2011 @ 8:29 a.m.

Stacey Rademaker of Petersburg wasn't aware of whooping cough until her then-9-month-old son was diagnosed with it in May.

Katherine Smith thought only children came down with pertussis, the medical name for whooping cough, until the Dawson woman learned she had it in November.

"I was coughing real deep - until I couldn't breathe," said Smith, 51, a part-time personal care assistant.

Coyt Rademaker, who would cough continuously for two or three minutes at a time, "would turn a little blue and then vomit," said his mother, Stacey, 24, a part-time hairstylist.

Public health officials in Sangamon County, like those in the rest of Illinois and nationwide, are seeing an upward swing in whooping cough, a disease more likely to cause complications and deaths among the very young.

No state is seeing the epidemic levels that California has experienced in recent months. That state has been the site of more than 8,300 confirmed, probable and suspect cases in 2010, including 10 deaths.

But Sangamon County's 17 confirmed and probable cases in 2010 - 10 involving children and three involving infants - compared with a total of five in 2009 and seven in 2008. Statewide, there were 1,015 pertussis cases in 2010, up from 648 in 2009.

"What we're seeing is a trend," said Jim Stone, director of the Sangamon County Department of Public Health.

Get vaccinated

The Illinois increase may be part of a cyclical trend, according to Karen McMahon, chief of the immunization section at the state Department of Public Health.

The last peak occurred in 2004, with 1,604 cases, according to agency statistics. Most recently, deaths from whooping cough in Illinois were reported in 2010 (one case), 2008 (one case) and 2006 (two cases), according to state Public Health spokeswoman Melaney Arnold.

The trend is no cause for alarm, McMahon said, noting that whooping cough usually spreads among families and caregivers of children.

But she said the statistics underscore the need for parents to get their young children immunized and for adults - many for the first time - to at least consider getting a shot called "Tdap," which contains protection for pertussis, as well as tetanus and diphtheria.

"It's important that everyone who should be vaccinated get vaccinated," McMahon said.

Before 2005, no shot was available for adults who wanted a boost for their immunity to pertussis.

"There are many adults who have not had that booster dose," said Dr. Subhash Chaudhary, a pediatrician who is chief of pediatric infectious diseases at Springfield's Southern Illinois University School of Medicine.

Tdap shots are available from private physicians and also from the Sangamon County Department of Public Health.

Possible causes

It's unclear what is causing the rising reports of pertussis in Illinois and nationwide. But public health officials agree that the effectiveness of the childhood vaccine protecting against pertussis - called "DTaP" - can wane over time.

Improved reporting and testing techniques may be more adept at detecting the result of the waning protection, McMahon said.

Experts are finding that adults - whether they are young parents, day-care providers or grandparents - may catch whooping cough, experience mild symptoms, then unknowingly pass the disease on to other adults or to young children who haven't yet finished the childhood series of vaccinations or not received the booster shot recommended during adolescence.

In California, the epidemic also may be fueled by parents choosing not to get their children immunized based on unjustified fears that vaccines may cause autism and other complications, according to Dr. John Talarico, chief of the immunizations branch at the California Department of Public Health.

But the impact of skeptical parents' decisions on California's epidemic is probably mild, Talarico said.

Illinois officials say fears about vaccines are playing little or no role in the state's rising numbers.

Arnold noted that thimerosol, the mercury-containing preservative that is the focus of criticism from many vaccine opponents, is banned from childhood vaccines in Illinois.

Tip of iceberg?

Dr. Samir Patel, a Springfield Clinic pulmonologist who treated Smith with antibiotics after her pertussis was diagnosed, said he has treated 15 to 20 adults with the disease in the past two years.

Many other adults probably go undiagnosed, he said.

"I probably am seeing the tip of the iceberg," Patel said.

Illinois health officials recommend that adults younger than 65 who will have close contact with an infant receive a Tdap shot. Other adults younger than 65 should talk with their physicians about whether a booster shot is needed, McMahon said.

Infants should receive DTaP shots at 2 months, 4 months and 6 months of age, another dose at 15-18 months, another at 4-6 years and then during adolescence.

In response to the California epidemic of pertussis, federal health officials in October expanded their vaccine recommendations. For the first time, they now recommend the Tdap vaccine for adults 65 and older who have close contact with infants.

Others who are 65 and older should talk with their doctor about whether they should get a Tdap shot, McMahon said.

Smith said she doesn't work or live around children, so she is puzzled about how she caught whooping cough, but Patel said a source of transmission often isn't clear. He has told Smith it could take a year for her cough to go away, though she is no longer contagious.

Stacey Rademaker said her son was seen by seven doctors over 1½ months before he was diagnosed at St. John's Hospital. He had received two of the series of three DTaP shots by the time he was diagnosed.

Coyt spent five days in the hospital, receiving antibiotics, and his cough finally was subdued after five months. She said she supports childhood vaccines.

Health officials say vaccines protecting against whooping cough may not be 100 percent effective. But they credit the vaccine with reducing pertussis to manageable levels since the earliest vaccines were introduced in the 1940s. The vaccine also can lessen the severity of whooping cough, McMahon said.

***

What is pertussis?

Pertussis, also known as whooping cough, is caused by a highly contagious bacterium that lives in the mouth, nose and throat.

How is it spread?

From discharges from the nose and throat that are expelled during coughing and sneezing. The disease is diagnosed through a blood test. Treatment with appropriate antibiotics shortens the contagious period to about five days.

What are the symptoms?

The first symptoms are similar to those of a common cold - runny nose, sneezing, low-grade fever and a mild, occasional cough. The cough gradually becomes severe and, after one to two weeks, the patient has spasmodic bursts of numerous, rapid coughs. The characteristic "whoop," which is more common in children, comes from breathing in after a coughing episode. During an attack, the patient may turn blue, vomit and become exhausted.

Can there be complications?

Although most people recover, complications can be severe, especially in children under 1 year old. Less-serious complications can include ear infections, loss of appetite and dehydration.

Source: Illinois Department of Public Health

School absence rates lower this year

Student absences due to illness appear to be lower this year compared to last school year, when many schools coped with an especially busy flu season due to the H1N1 outbreak.

"Last (school) year was kind of an unusual phenomenon," said Barb Germann, health services coordinator for the Springfield School District. "I'd say this year is more normal.".

Springfield's attendance rate for August through December 2010 was 93.10 percent, compared to 91.78 percent for the same period last year.

"Last year, we were looking for influenza-like illness and we were hit hard, so we don't want to see that again," Germann said. "This year, it's hit again, but it's pockets with some schools, yes, some schools, no. And it's flu-like symptoms or strep. We are seeing more strep."

Such cases are reported most frequently in the elementary schools, where children are more vocal about their symptoms, she said.

In the Ball-Chatham School District, November's attendance rate was 95.95 percent, compared to 94.67 percent the previous November. December's rate dropped slightly to 95.21 percent, compared to 96.03 percent in December 2009.

"We really haven't had anything that's out of the ordinary for this time of year," Glenwood Intermediate School Principal Kerry Cox said. "Our unusual things have been related to immune problems or other issues."

Rochester School Superintendent Tom Bertrand said principals report normal absence rates.

"The four buildings are averaging about 2 to 3 percent absent daily this week, which is actually lower than normal for this time of the year," Bertrand said. "With the opening of the new school, we had an extended winter break - we did not start back up until (Jan. 10). That is likely why the absenteeism is lower than usual. Illnesses tend to spread faster when school is in session."

-- Amanda Reavy

Top Photo: David Spencer/The State Journal-Register -- Coyt Rademaker, 17 months, spends time with his mom Stacey Rademaker in his Petersburg home on Friday January 14, 2011. Rademaker had whooping cough last May.

Second Photo: David Spencer/The State Journal-Register -- Dr. Subhash Chaudhary examines 14-month-old Carter Corwin, who does not have whooping cough, as he's being held by his mom, Annalese, in his clinic Friday at St. John's Pavilion Building. Chaudhary says many adults have not had the shot that boosts immunity to whooping cough.

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