Health officials puzzled by whooping cough outbreak

[Snowy Owl]

Health officials puzzled by whooping cough outbreak
http://news.bostonherald.com/localRe...ticleid=173928

By Associated Press
Tuesday, December 26, 2006 - Updated: 08:24 AM EST

BOSTON - What city health officials at first thought was an outbreak of whooping cough among employees at Children?s Hospital Boston may have been something else entirely.

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But exactly what is still in question.

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It started when a 19-month-old patient came down with the classic symptoms of whooping cough, a respiratory disease also known as pertussis. Symptoms include a runny nose, sneezing, slight fever, and mild cough, which can develop into a violent and persistent cough.

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A laboratory test confirmed he had the disease.

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Three dozen hospital employees and one other patient tested positive for whooping cough from late September through early November.
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But further testing, different from the initial tests, could find little evidence of the highly contagious bacteria. Now no one can say for sure what made the workers sick, but pertussis hasn?t been ruled out.

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Federal and state health officials joined the city in trying to figure out exactly what ailed the workers, all of whom recovered.

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The Children?s Hospital cases were at first confirmed through a test called polymerase chain reaction, or PCR.

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Based on the tests, Children?s moved to contain the outbreak.

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?Children?s, much like we do at the local health department, really relies on laboratory tests to guide us on what the diagnosis is, especially illnesses that can look like a lot of different things,? said Dr. Anita Barry of the Boston Public Health Commission. ?Having accurate test results early on, particularly when they?re consistent with the clinical symptoms, really launches us into control steps.?

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State lab workers then performed other tests, including the laborious task of culturing samples and taking blood samples from hospital workers.

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The additional tests were almost uniformly negative for pertussis.

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Samples were sent to the federal Centers for Disease Control.

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?The results were inconclusive,? said Dr. Amanda Cohn, a medical epidemiologist for the federal agency.

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There are competing theories, ranging from a cold virus to a bacterial relative of pertussis to the virus that causes the condition commonly known as walking pneumonia.

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It?s unlikely that the causes of all the respiratory illnesses will ever be fully known.

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?What I can say is that whatever it was, it went away,? Barry said. ?And that?s the good news.?

[Niko]

Respiratory disease outbreaks not whooping cough

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</td> </tr> <tr> <td colspan="3"></td> </tr> <tr> <td align="left"> Respiratory disease outbreaks not whooping cough
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</td> </tr> <tr> <td colspan="3"></td> </tr> <tr> <td align="left" valign="top"> NEW YORK (Reuters Health) - In a new report, researchers from the U.S. Centers for Disease Control and Prevention and elsewhere describe three recent outbreaks of respiratory illness that were incorrectly attributed to pertussis, also known as whooping cough.

The current study findings underscore the importance of confirming that whooping cough is the cause of a disease outbreak, particularly when the clinical and laboratory findings do not match those of a typically outbreak, the authors emphasize in the Morbidity and Mortality Weekly Report released Thursday.

The investigators describe two hospital outbreaks that occurred in New Hampshire and Massachusetts and one community outbreak in Tennessee, which occurred between 2004 and 2006.

In all three outbreaks, which together involved more than 2,000 patients, the results of polymerase chain reaction (PCR) test suggested pertussis as the cause. However, follow-up investigations revealed that laboratory results were often negative or equivocal and that the epidemiologic and clinical features of the outbreaks did not match the typical pertussis profile.

The results illustrate the pitfalls of relying solely on PCR testing for confirming a pertussis diagnosis, according to the report. While PCR testing can provide vital information when there is strong supporting evidence and when timely treatment is critical, over-reliance on this measure can lead to unnecessary, costly control measures.

The CDC recommends timely collection and testing of throat culture specimens in at least some of the people involved in an outbreak to confirm that whooping cough is, in fact, responsible for the outbreak.

SOURCE: Morbidity and Mortality Weekly Report, August 23, 2007.

http://www.sciam.com/article.cfm?alias=respiratory-disease-outbr&chanID=sa003&modsrc=reuters

full report here: Outbreaks of Respiratory Illness Mistakenly Attributed to Pertussis --- New Hampshire, Massachusetts, and Tennessee, 2004--2006


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