Texas on pace to record the highest number of whooping cough cases in 50 years

Posted Thursday, Aug. 22, 2013  comments  Print Reprints
Pertussis symptoms Early symptoms can last for one to two weeks and usually include: • Runny nose • Sneezing • Low-grade fever • Mild occasional cough • Apnea — a pause in breathing As the disease progresses, the traditional symptoms of pertussis appear and include: • Children and babies can cough very hard, over and over. • When children gasp for breath after a coughing fit, they make a “whooping” sound. This sound is where the name “whooping cough” comes from. Babies may not cough or make this sound. • Coughing fits make it hard to breathe, eat, drink, or sleep. Coughing fits happen more at night. • Babies and young children may turn blue while coughing from lack of oxygen and vomit after coughing fits. • Coughing fits can last for 10 weeks and sometimes recur with the next respiratory illness. Sources: Department of State Health Services, Centers for Disease Control

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Cases of West Nile virus, measles and a stomach bug called cyclosporiasis have already made headlines in Tarrant County this year, and health officials are now grappling with a more common but still serious illness sweeping Texas and the nation: pertussis, commonly known as whooping cough.

As of Wednesday, 413 pertussis cases have been reported in Tarrant County, the most in the state, according to Russell Jones, chief epidemiologist for the Tarrant County Public Health Department.

“We’re having more pertussis cases in Tarrant County than we have since the ’60s or ’70s. It doesn’t get our attention like measles does as far as ‘Oh, my gosh, we’ve got a case.’ But it gets our attention,” said Jones.

Texas reported 1,885 pertussis cases Wednesday, up from 1,670 on Aug. 12, according to the Department of State Health Services.

If the cases continue to be diagnosed and reported at the current rate Texas will report the highest number of whooping cough cases in 50 years, the state health agency said.

The deaths of two infants have been attributed to the respiratory disease in Texas and as of Aug. 12, 13 percent of the cases have required hospitalization, said Chris Van Deusen, a spokesman for the state health department.

“Pertussis is a serious illness, particularly for very young children. For newborns it causes uncontrollable coughing and they can’t get enough oxygen,” he said.

“It’s of biggest concern for very young children. Infants can’t be vaccinated until they are two months old. That’s why we are encouraging anyone around newborns — parents, family, doctors, nurses and other medical providers — to make sure they have a recent pertussis vaccine,” Van Deusen said.

The outbreak of what is also known as the “100-day cough” appears to be centered in North Texas. New numbers from other counties were not available late Wednesday but on Aug. 12, there had been 173 cases reported in Dallas County and 124 in Denton County, according to the state health department.

Thirty-six of the Tarrant County cases have required hospitalization and of those 31 were 12 months old or younger, Jones said.

There have also been 127 Tarrant cases involving children between the ages of 8 of 11, he said.

“The vaccination appears to be waning for the children in that age group. They are just before the normal vaccination booster age of 12,” Jones said

“The vaccination is very effective for the first few years. It prevents death and does something, but it’s not perfect,” he said.

Highly contagious

Whooping cough tends to be cyclical and the last big outbreak in Texas was in 2009 when 3,358 cases were reported, Van Deusen said.

In 2010, 27,550 cases of pertussis were reported in the United States, but many more go undiagnosed and unreported, according to the Centers for Disease Control. That was the most cases reported in the country since 1959, when 40,000 cases were reported. In 2011, 18,719 cases were reported nationally.

Worldwide, there are an estimated 30-50 million cases of pertussis and about 300,000 deaths per year, according to the CDC.

The number of cases in Texas peaked in the mid-1940s at over 20,000. The rate dramatically declined after 1949 when a vaccine was introduced. The highly contagious disease was almost nonexistent in the state from the early 1970s until 2000 when the number of cases started to climb, according to state health department records.

From 2000-2012, 43 deaths in Texas were attributed to pertussis, according to the state health agency. Most of the deaths occurred in infants under 1 year old and most of those were among children too young to be vaccinated.

Dr. David Lar, a pediatrician and assistant professor of pediatrics at UNT Health Sciences Center in Fort Worth, said the spike in cases tracks with what he’s seeing.

“In our practice alone, I could easily see two or three cases a week. I’m seeing a lot of school-aged children and some infants which is the population that is most vulnerable to pertussis,” Lar said

“I started to see the first cases in late spring and it has been steady since then,” he said.

Infants, first vaccinated at 2 months old, are adequately protected after the third dose of the vaccination which they will receive at their six-month checkup, Lar said.

“In the first year we give three doses and then a fourth dose at 15 months and a fifth dose between 4 and 6 years old. That’s the vaccination number required by public schools,” Lar said.

The state health department also recommends a booster shot when children are 12, Jones said, noting that the vaccine appears to wane and that many of the cases in Tarrant County involve children from 8 to 11 years old.

“We don’t know why this is occurring. I think the vaccines we are using are not getting the job done,” Lar said.

Severe coughing

People suffering from pertussis usually spread the disease through coughing or sneezing.

The whooping cough starts with cold-like symptoms and a mild cough or fever. After one to two weeks, severe coughing can begin.

“The coughing can be so strong, it often causes them to throw up afterward. They have coughing fits where they have trouble catching their breath so they will gasp at the end of the coughing attack — that’s what the ‘whooping’ refers to,” Lar said.

The “whoop” is often nonexistent, and the infection is generally milder in teens and adults, especially among those who have been vaccinated, according to the state health department.

Because pertussis appears to be just be a common cold in its early stages, the illness is often not diagnosed until severe coughing begins. Infected people are most contagious during this time, up to about two weeks after the cough begins.

The coughing can last for up to 10 weeks or more, hence the name “100-day cough.”

The disease is usually treated with Azithromycin, commonly called a Z-Pak, which is a five-day course of antibiotics, Lar said.

The success of the treatment depends on how early the illness is diagnosed.

“If you catch it during the first third of the illness, you can shorten the duration. If you wait too long then you are not going to benefit the patient but you can make them less contagious,” Lar said.

In the United States, the vaccine for infants and children is DTaP, a combination vaccine that protects against three diseases: diptheria, tetanus and pertussis, according to the state health department.

Before 2005, the only booster available contained protection against tetanus and diphtheria and was recommended for teens and adults every 10 years.

Today, there are boosters for pre-teens, teens and adults that contain protection from all three diseases.

“Just like with the measles outbreak, prevention is the best medicine for pertussis,” Lar said.

Jones has only been on the job since June, and the rash of disease outbreaks in Tarrant County has him feeling like he “jumped right into the fire.”

“Some people have said I’m cursed,” said Jones, who spent the past 25 years with the state health department.

Steve Campbell, 817-390-7981 Twitter: @stevecamp

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