Re: TX: Whooping cough cases
Re: TX: Whooping cough cases
Source:
http://www.statesman.com/news/content/news/stories/local/2009/11/10/1110whoopingcough.html
Williamson struggling with state's worst whooping cough rate
Other Central Texas counties, including Travis, also reporting high rates of pertussis.
By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Tuesday, November 10, 2009
This has been a bad year for whooping cough in Central Texas ? worse even than 2005 ? and Williamson County is grappling with the state's most daunting outbreak.
The Williamson County and Cities Health District has investigated reports of hundreds of sick residents since the spring, many of them children, and Williamson County is on pace to have well over 700 cases by the end of next month, according to the health district.
The county's current rate is 165 cases per 100,000 people, which includes confirmed and probable cases, and David Bastis, the health district's epidemiologist, said the district expects the rate to reach 185 by the end of the year.
In 2005, the state's worst year for pertussis since the 1960s, the rate was 9.7 cases of whooping cough per 100,000 residents; the state rate has often been below 1 per 100,000 residents over the past 40 years.
This year, the state's preliminary rate is 8.5 cases per 100,000, and state health officials say that by the end of the year, they expect it to surpass 2005's rate.
Dr. Chip Riggins, executive director of the health district, had to go back to 1951, an era soon after pertussis vaccines became widely used in the United States in the mid-1940s, to find a Texas rate comparable to what Williamson County is experiencing now.
"It's very dramatic," Riggins said. With whooping cough, or pertussis, "we see peaks every three to five years, (but) ... this is worse, and it's startling."
Other Central Texas counties also are grappling with unusually high pertussis rates.
Travis County's rate is 43.3 cases per 100,000 people, Blanco County's is 69 per 100,000, Burnet County's is 128 per 100,000, and Llano County's is 52.3 per 100,000, according to the state health department.
But the Texas Medical Association is so concerned about the Williamson County outbreak that it will spearhead a pilot program next month to inoculate the relatives of newborns, who are at the greatest risk of dying from pertussis.
The rate in Travis County translates into 1,143 confirmed and probable cases, said Dr. Philip Huang, medical director of the Austin/Travis County Health and Human Services Department.
Of those, 893 cases are in children under age 18, and "we have definitely seen some clusters in schools and have sent notices to parents and to the administration," Huang said.
In Leander, Vista Ridge High School sent a letter home to parents Wednesday ? its second in as many weeks ? notifying them of another case of pertussis in a student.
Whooping cough is named for the high-pitched "whoop" of breath a child takes between coughs, which can become fits that result in vomiting.
A slight fever often accompanies the illness, and patients are advised to seek medical treatment, get an antibiotic and stay home for five days after the antibiotic is started, Huang and Riggins said.
Most important, anyone who is ill should stay away from newborns, they said.
Babies younger than 6 months are at greatest risk of complications, hospitalizations and death from pertussis; in older children, the disease is generally not severe. Babies are vaccinated against pertussis at 2 months, 4 months and 6 months, with boosters at 18 months and 4 years.
No one knows why Williamson County ? or Central Texas, for that matter ? is seeing such large numbers of pertussis cases, but much of the speculation focuses on better disease reporting. Since pertussis ebbs and flows, "they may be on the upswing of a cycle or maybe they are particularly good at identifying and reporting it," said Dr. Mary Healy, director of vaccinology and maternal immunization at the Center for Vaccine Awareness and Research at Texas Children's Hospital in Houston. She is assisting with the pertussis project in Williamson County.
More doctors are testing for pertussis when they suspect it, and the test is quicker and easier to do,said Rita Espinoza, manager of the infectious disease data and prevention group at the Department of State Health Services.
Williamson County health officials "do a very good job of educating providers (doctors, nurses and other medical professionals)" about pertussis, Espinoza said, so awareness is high. "Our best reporters are school nurses," she said.
No one in Williamson County is known to have died of pertussis this year, Riggins said.
After pertussis vaccines became widely available, it took a couple of decades for them to make a big dent in pertussis rates, but once they did, rates and deaths declined dramatically, not only in Texas but in the United States. But for some reason ? experts can only speculate on why ? rates started ticking back up, especially in the past decade.
Next month or in early January, Healy, who is a vaccine expert, will start the project in Williamson County that involves vaccinating parents, siblings and grandparents of newborns against pertussis to prevent babies from dying after they are brought home from the hospital. About 75 percent of infected infants get it from someone who lives in their household, she said.
Even adults and adolescents who were vaccinated against pertussis can catch it later because immunity wanes after about five or 10 years, Healy said.
That's why in 2006, the U.S. Centers for Disease Control and Prevention recommended that adolescents and adults be vaccinated with a pertussis booster if they had not received one in the past 10 years. That booster became a school requirement in Texas, starting with seventh-graders.
Healy said she is directing a similar "cocooning project" like the one in Williamson County at Ben Taub General Hospital in Houston. Since early last year, it has vaccinated 8,000 new mothers ? 96 percent of those who are eligible ? and some family members, she said.
maroser@statesman.com; 445-3619
