Re: KY: Whooping Cough Cases On Rise Across State
Source:
http://www.courier-journal.com/article/20081215/NEWS01/812150393
Whooping cough on rise in Kentucky
Ky. cases double from last year
By Laura Ungar ? lungar@courier-journal.com ? December 15, 2008
Whooping cough, once considered a health scourge, is making a big comeback.
Rates of the highly contagious respiratory disease have risen more than tenfold in the United States since 1980. And in Kentucky, cases this year have more than doubled from last year, leading to mass vaccine clinics in some hard-hit communities, and a statewide call for more people to get booster shots.
"It's normal for us to have a couple of cases," said Wendy Keown, director of outreach services in the health department serving Hardin County, which has had 29 confirmed cases this year. "We haven't ever had an outbreak of this magnitude."
Whooping cough, also known as pertussis, is a bacterial illness that causes severe coughing attacks often punctuated by a high-pitched "whoop" when people inhale. It's especially dangerous for children and infants, who can develop pneumonia, seizures, suffer brain damage and even die.
Throughout Kentucky, there have been 122 confirmed cases this year, half in the past two months -- and health officials expect more.
The largest outbreaks have been in Bullitt, Franklin and Hardin counties, but Louisville, Lexington, Northern Kentucky and Owensboro have also reported cases.
Indiana, meanwhile, had 100 confirmed cases through Nov. 29, almost twice as many as last year at that time.
In addition, federal officials say the vast majority of cases go unreported; they cite 15,000 confirmed cases nationally in 2006 and an estimated 600,000 unreported cases.
Experts attribute whooping cough's return to several factors, chiefly waning immunity among children 10 and older who were vaccinated against the disease as young children.
They also blame decisions by some families to forgo vaccinations, immunization policies in some states that make it easy to skip the shots and the fact that the vaccine is not 100 percent effective.
Linda Horsman of Hikes Point said her son David, 4, was fully immunized but still woke up on a recent night with what his doctor feared could be whooping cough.
"It had that kind of barky sound to it," said Horsman, 39. "They gave him (antibiotics) just in case ? and the barkiness went away. He still had the cough, but it wasn't the same scary kind of cough."
Doctors said recent outbreaks underscore the need for everyone to get their shots, including boosters now recommended for older children and adults.
Late last week, several pupils and staff members received boosters at Hearn Elementary School in Frankfort.
Among the pupils was Sierra Newton, 11, who had been exposed to the disease and took a preventive course of antibiotics for five days.
After she got her shot, she said, "I was scared at first, but then I looked the other way and it didn't hurt."
Routine vaccinations
Beginning in the 1940s and 1950s, pertussis vaccines were routinely recommended for children, in combination with diphtheria and tetanus vaccines -- leading reported whooping cough cases to drop from 120,718 in 1950 to 14,809 in 1960.
Now, children typically get a series of five shots at 2, 4 and 6 months, between 12 and 18 months and between 4 and 6 years old. Since 2005, the federal government has also recommended boosters for teens 11 to 18 and for adults up to age 64. Although symptoms are usually much milder in adults -- studies show one out of five lingering coughs are caused by pertussis in adults -- doctors fear they may pass it on to children.
But doctors said many Americans don't get whooping cough boosters, partly because they don't know about them and aren't aware their immunity gradually wears off.
Dr. Matthew Zahn, medical director of the Louisville Metro Department of Public Health and Wellness, said researchers have explored whether the bacteria has become less susceptible to the vaccine, but have found little evidence that it has.
"The vaccine works. But it doesn't work forever," said Zahn, whose department has had 22 confirmed whooping cough cases this year.
In Bullitt County, where nine students at Freedom Elementary School tested positive for the disease, school officials said all were vaccinated as young children. The same is true for the Hardin County cases, Keown said.
But in Franklin County Public Schools, which had 11 cases spread among several schools, district spokesman Wayne Dominick said a couple of the children had never gotten their immunizations.
"A lot of people have opted out of the vaccines," he said.
Exemptions possible
A 2006 study in The Journal of the American Medical Association said states that easily grant exemptions to school immunization laws have more cases of whooping cough.
The study ranked Kentucky and Indiana among the states where it's most difficult to get exemptions, although both are among the many states that allow religious and medical exemptions.
Physicians must certify medical exemptions in both states, while parents certify religious ones.
Parents and health officials said some people opt out because of a fear that autism is linked to some compounds in vaccines, particularly the vaccine preservative thimerosal -- a fear the mainstream medical community argues is unfounded.
Horsman said she respects parents' choices, but worries that unvaccinated children could catch the disease and spread it to others. "When it starts affecting my child," she said, "I am concerned."
Dr. Kraig Humbaugh, Kentucky's state epidemiologist, acknowledged that some parents opt out of having their children vaccinated, but said he doesn't think that's a big factor behind whooping cough's rise in this state.
According to the U.S. Centers for Disease Control and Prevention, an estimated 85 percent of Kentucky children 19 to 35 months old were vaccinated against pertussis as of last year, slightly higher than the national average.
Dominick said his district tries to enforce vaccination requirements as strictly as possible, but is sometimes stymied by waiting for records of children changing schools. Since the outbreak, he said, "We're definitely looking at (enforcement) a lot harder than in the past."
Sierra Newton's mother, Necole, 35, of Frankfort, said, "I'm very concerned about the disease. From my understanding, it can be a deadly illness. I believe it's important for all children to have the shots."
Reporter Laura Ungar can be reached at (502) 582-7190.
