The following blog post is a guest blog post by Virginia Allison, DNP, CRNP
At a local Pittsburgh High School, we currently have an outbreak of pertussis cases confirmed by laboratory testing. Pertussis, also known as whooping cough, is a bacterial infection of the lower respiratory tract. Pertussis is transmitted through large respiratory droplets from coughing or sneezing, and it is highly contagious.
While most people who are vaccinated are protected, there can be “breakthrough” cases. People are most contagious before they know they have pertussis. The incubation period for pertussis is five to 10 days up to three weeks. Pertussis begins with cold symptoms and a cough which worsens over one to two weeks. Before a vaccine was introduced in the 1940s, there were more than 270,000 cases with 10,000 deaths. Cases dropped dramatically after the introduction of the vaccine. Since the 1980s, the cases of pertussis have been on the rise again with 48,277 cases reported in 2012, mostly in young infants and adolescents.
Pertussis occurs in all age groups but the disease is most severe in young infants, as they are too young to be fully vaccinated. Seventy-five percent of young infants with pertussis have complications and 1 percent will die. All of our students who contracted pertussis had been immunized with the Tdap (Tetanus, Diphtheria, Acellular Pertussis) vaccine. Although the vaccine wanes over time, it is very effective in decreasing morbidity and mortality. With this particular outbreak, none of the students who contracted pertussis were hospitalized or experienced respiratory or long-lasting complications,
Our experience supports current research that young people who have been vaccinated for pertussis have less severe symptoms and recover faster. We have worked directly with the Allegheny County Health Department to address this situation proactively in the following ways:
- Letters, emails and phone calls were made to all of the students’ families to advise them of the outbreak, what symptoms to look for, and the need to promptly contact the child’s doctor if the child had signs or symptoms of pertussis.
- Our teachers have been monitoring symptoms in their classrooms, the social worker has been monitoring absence excuses, and the nurse practitioners have been closely evaluating all students referred to them with the goal of early identification of illness and referral.
- We also have monitored the various students associations and sports/clubs within the school.
- The nurse practitioner and the health department have been in contact with local pediatrician’s offices to inform them of the outbreak.
- The American HealthCare Group offered free vaccinations to our school-based staff.
- Our school-based community was asked to consider preventive measures including updating family immunization records with healthcare providers and having children evaluated for a cough lasting longer than seven days.
- Children who have been diagnosed with pertussis are asked to stay home from school, work, or other activities until they have completed five full days of appropriate antibiotic treatment. If a student has a cough, they are asked to avoid contact with infants younger than one year old. Students are urged to wash their hands frequently with soap and warm water or use hand sanitizer if soap and water are unavailable. Students should cough or sneeze into their elbow to prevent the spread of germs.
We have been able to effectively handle this outbreak with the incredible support of our Allegheny County Health Department, our wonderful school community and school staff.