Linn County Public Health

501 13th Street NW
Cedar Rapids, IA 52405-3700

February 6, 2002

PERTUSSIS ALERT

Attention: Health Care Providers

Pertussis cases are occurring in Linn County. We have had 10 lab confirmed cases reported in the last 6 weeks. The ages of these cases range from 2 months to 18 years. Seven of these cases have been reported in the last 3 weeks. We are concerned about this recent increase in disease. Linn County had a total of 5 lab confirmed cases reported in 2001. Our neighbor, Johnson County, reported 101 cases of Pertussis from August through December 2001.

Currently Kennedy High School has 3 cases, Jefferson High has 2 cases, Washington High 1 case, and Roosevelt Middle 1 case. Three of the cases are linked as contacts, the remaining four cases are not currently epidemiologically linked to any of the other cases. The Health Department anticipates additional cases will occur.

Therefore, Linn County Public Health recommends the following Centers for Disease Control (CDC) guidelines:

• Consider Pertussis when evaluating any infant, child, youth, or adult with an acute cough illness characterized by prolonged cough or cough with paroxysms, whoop, or post-tussive gagging/vomiting. Infants may present with apnea and /or cyanosis.
   
• Report cases promptly to Linn County Public Health. Call 892-6000 and ask for a nurse.
   
• Current CDC recommendations indicate 14 days of erythromycin or trimethoprim-sulfamethoxozole as the drugs of choice for treatment of diagnosed cases and prophylaxis of household/close contacts, regardless of age or immunization status. Clarithromycin or azithromycin should only be used if these antibiotics (erythromycin or TMP/SMX) cannot be tolerated.
   
• Close contacts should receive prophylaxis. The Health Department is working closely with school personnel to identify close contacts of each case. Because the protective efficacy of Pertussis immunization wanes after the last vaccine dose, the great majority of teenagers and adults are susceptible to Pertussis, even if they were immunized in early childhood. Persons with Pertussis symptoms - cough with paroxysms, post-tussive gagging/vomiting, whoop, or acute cough lasting 7 or more days, may return to school or work after completing the first 5 days of medication, however the full 14 day treatment regimen must be completed.
   
• A booster dose of DTaP vaccine is also recommended for any contact less than seven years of age who has not completed the four-dose primary immunization series or who has not received a dose of DTaP within three years before exposure.
   

Thank you for your assistance with this matter.

Sincerely,

Vickie J. Smith

Nursing Supervisor