Vaccines help protect against pertussis

Spikes in the number of cases of pertussis are 'concerning” for health care professionals in southeast Iowa.

'When you go from zero cases to double digits of a vaccination-preventable disease, it is concerning,” said Danielle Pettit-Majewski, director of the Washington County Public Health Department.

Pettit-Majewski said that in Washington County, the number of pertussis cases went from zero cases of pertussis, which also is known as whooping cough, in fiscal years 2014, 2015, 2016 and 2017 to 15 cases in 2017 and 10 cases in 2018.

'There was a spike throughout southeast Iowa last year,” she continued.

'It seems to be a cyclical thing, and some years we do see a spike,” said Jefferson County Public Health Department administrator Chris Estle. 'There's not a year I've worked that I haven't seen at least a couple of cases.”

According to the Iowa Department of Health website pertussis is a disease caused by a bacteria which causes severe spells of coughing. These spells can interfere with eating, drinking, and breathing. Pertussis can lead to pneumonia, convulsions, inflammation of the brain and sometimes death. It is most common in infants less than 1 year old, but anyone can get it. It is known as whopping cough because of the high-pitched whooping sound made when breathing in during coughing spells.

'Once you hear it, you will know it,” said Estle.

'It's very frightening to witness,” added Lynn Fisher, Washington County Public Health nurse. 'It leaves quite an impression on you.”

Pertussis is reportable to the Iowa Department of Public Health by Iowa Administrative Code 641 Chapter 1. In 2017, there were 161 confirmed and probable cases reported to IDPH.

On average, it will take nine to 10 days after being infected with pertussis to start to show signs and symptoms. At first, symptoms will look a lot like the common cold: runny nose, nasal congestion, sneezing, red and watery eyes, a mild fever and a dry cough. Within two weeks, symptoms worsen and a severe cough develops that might: become a series of violent coughs making it hard to breathe, be more severe at night, expel thick phlegm, cause vomiting and end with a high-pitched 'whoop” sound when breathing in after a series of coughs. However, infants under 6 months old might not develop a whoop but might temporarily stop breathing or have a bluish tint to their skin. Older children and adults also might not develop a whoop, but will have a long lasting cough, or have symptoms like bronchitis or asthma. Vaccinated people might also have milder symptoms.

Pertussis is caused by breathing in bacteria carried on droplets from other's coughs and sneezes. Estle said that is one of the reasons it is important for people to cover their mouths when they cough or sneeze and to wash their hands often. She also said it is important that if a person is sick, they stay home; and if they have a persistent cough that is getting worse, they should see their health care professional.

Once inhaled into the lungs, the bacteria grows and produces a toxin that keeps the lungs from moving fluids and germs out. Thick mucus accumulates inside the airways and results in an uncontrollable cough.

The 'whoop” sound is caused by the sucking in of air through the restricted airways after a coughing fit.

According to the state's health department website, an appropriate antibiotic can be taken if given early in illness, and fluids, oxygen, and mild sedation might help a child during prolonged periods of severe coughing. The website also states to always consult a health care provider with questions or before starting any treatment.

Pertussis is a immunization-preventable disease, said Fisher.

There are four combination vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. DTaP and DT are given to children younger than 7 years of age, and Tdap and Td are given to older children and adults.

Several other combination vaccines contain DTaP along with other childhood vaccines. Children should get five doses of DTaP, one dose at ages: 2, 4, 6, and 15-18 months and 4-6 years.

DT does not contain pertussis, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine.

Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances.

Tdap is similar to Td, but also contains protection against pertussis. Adolescents 11-18 years of age - preferably at age 11-12 - and adults 19 through 64 years of age should receive a single dose of Tdap. For adults 65 and older who have close contact with an infant and have not previously received Tdap, one dose should be received. Tdap should also be given to 7-10 year olds who are not fully immunized against pertussis. Tdap can be given no matter when Td was last received.

Estle pointed out that a pertussis-only vaccine is not available. 'It isn't manufactured that way,” she said.

The state's website says the protection against pertussis, wears off five to 10 years after the last dose leaving most teenagers and adults not fully protected.

Both Pettit-Majewski, Fisher and Estle pointed out it is recommended that new parents and new grandparents receive pertussis vaccines to insulate and protect a new baby since the vaccine cannot be given to young babies younger than 2 months.

'Children and infants are the most likely ones to end up in the hospital because it interferes with their drinking, eating and breathing,” Fisher said. 'It is quite a serious illness for children and infants.”

Fisher said the vaccine is required by state law for children entering kindergarten, and a booster is required for children entering seventh grade. 'Immunity decreases so it is important to get a booster,” she said.

Henry, Jefferson and Washington's county public health departments offer immunization clinics.

In Fairfield, the immunization clinics are held from 1-4 p.m. the first and Third Tuesdays of each month, with no appointment needed, at the Jefferson County Public Health Department. For information, call 641-472-5929.

In Washington, clinics are held from 10 a.m. to 4 p.m. the first and third Tuesdays and Thursdays of the month and from 3-6 p.m. the second Thursday of the month at the Washington County Public Health Department. A clinic also is held from 3-5 p.m. the fourth Thursday of the month at the department's office in Kalona. For information, call 319-653-7758

In Mt. Pleasant, immunization clinic hours are 9-11 a.m. Tuesday, 1-4 p.m. Wednesday and Thursday and 1-6 p.m. the first and third Thursday of the month at the Henry County Public Health Department. For details, call 319-385-0779.