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3:34 am
Mon June 11, 2012

Doctors Deploy Shots And Drugs Against Whooping Cough Outbreak

Originally published on Tue June 12, 2012 6:45 pm

A couple of weeks ago I got an e-mail from my son's middle school alerting families that several students had been diagnosed with whooping cough, also called pertussis. I didn't pay too much attention; my son has been vaccinated and he got a booster shot a couple of years ago so I hoped he would be protected.

Then I started to cough.

A visit to my doctor and a pertussis test confirmed that I am one of the 338 people infected with it in Oregon this year. That's three times higher than last year.

Oregon's increase is nowhere near the number of cases the state of Washington is reporting. The Washington State Department of Health has declared a whooping cough epidemic and as of June 2 they've reported 2,092 cases.

Still, public health officials in Oregon are trying to keep the outbreak from spreading. It's a highly contagious disease known for its long fits of uncontrollable coughing. In adults it's highly unpleasant, but in infants and young children it can cause serious respiratory problems and can be fatal, especially in babies less than a year old.

As soon as I was diagnosed, my doctor put me on a five-day course of the antibiotic azithromycin and told me to stay home until I'd finished them. The antibiotics don't necessarily shorten the course of the illness but they do kill the bacteria so I won't spread it to anyone else.

My husband and daughter, who were showing no symptoms, were also put on the antibiotic as a precaution and, because my son Max had started to cough, I took him in to get tested. Despite his vaccination and his booster shot Max's pertussis test was also positive.

Dr. Paul Cieslak, the medical director of the Oregon immunization program, says the booster is not 100 percent effective, but data shows people who have it are far less likely to get sick. In fact most of Oregon's current cases are in people who have never been vaccinated.

Once there's an outbreak pertussis spreads quickly, Cieslak says. "One case in a susceptible group of people will cause many, many more cases. So it's pretty contagious probably because there's so much coughing going on and the bacterium is jumping out of your nose and throat with each cough," he says.

Which is why it's important to get vaccinated, Cieslak says, to protect yourself from the disease and to stop spreading it to others. Health officials are recommending that everyone over the age of 11 get a booster shot.

A big problem is many cases don't get diagnosed. For every case of whooping cough that is reported, Cieslak says there could be five, ten, even 20 cases that don't. "What that means is there are a lot of people walking around with it coughing, which is one of the reasons we are so set on covering your cough, coughing into your sleeve, and washing your hands," he says. "So you don't spread it even if you don't know you have it."

In most adults the tell-tale "whoop" sound doesn't happen, that's only in young children who's airways are very small. In adults the cough is dry, hacking and long lasting — it's sometimes called the 100-day cough. So anyone with a persistent cough should get checked.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, HOST:

This is MORNING EDITION from NPR News. Good morning. I'm Renee Montagne.

DAVID GREENE, HOST:

And I'm David Greene.

Today in Your Health, allergies and adolescence. We'll get to that in a moment. First, let's hear about whooping cough, which is also known as pertussis. There's a current outbreak of this potentially deadly disease in the state of Washington. Two thousand cases have been reported this year. That's twelve times more than last year. And now their neighbor to the south, Oregon, is also reporting an upward surge in cases. NPR's Jane Greenhalgh has a close up look at the resurgence of whooping cough.

JANE GREENHALGH, BYLINE: My goal is to get through this report without coughing, because sadly I'm one of the 338 people who've contracted whooping cough in Oregon this year. Whooping cough is very contagious and there's been an outbreak at my son Max's school. Now that I've tested positive, the doctor wants Max to get checked.

DR. SMITA TOMKORIA: Hey, there.

GREENHALGH: Hello. This is Max.

TOMKORIA: Oh, hi, Max. OK. Come on in.

GREENHALGH: They told us to come to the isolation door just in case...

We're hustled through the back door, straight into an examining room. They don't want us spreading germs at the front desk. Pertussis can cause serious respiratory problems in infants younger than six months, so they're taking no chances.

TOMKORIA: Stick your tongue out and say ahh.

MAX: Ahh.

TOMKORIA: Good.

GREENHALGH: The treatment for pertussis is a five-day course of antibiotics. These don't necessarily shorten the course of the illness, but they do kill the bacteria so you can't spread it. Max has been coughing, so Dr. Smita Tomkoria wants to get him on treatment right away.

TOMKORIA: We will test him. We're also going to treat him just because of the exposure. Now, if we get the test result back and it's negative, he still needs to finish the five days, but he can go back to school before he finishes it.

GREENHALGH: Max has been vaccinated against pertussis and he got a booster shot a couple of years ago. I was also vaccinated as a child, but that was many years ago and my vaccine has obviously worn off. Health officials are now recommending that everyone over the age of 11 get a booster shot.

Dr. Paul Cieslak is the medical director of the Oregon immunization program.

DR. PAUL CIESLAK: The booster isn't 100 percent effective. That said, we know from our data that you're much less likely to get sick if you've had the booster dose of vaccine.

GREENHALGH: In fact, most cases in Oregon this year are in people who've never been vaccinated. And once there's an outbreak, it spreads quickly.

CIESLAK: One case in a susceptible group of people will typically cause, you know, many, many more cases. Maybe 10 more cases, for example. So it's pretty contagious, probably because there's so much coughing going on and the bacterium is, you know, jumping out of your nose and throat with each cough.

GREENHALGH: Which is why it's important to get vaccinated, Cieslak says, to protect yourself from the disease and to stop spreading it to others. One of the problems is people don't often get diagnosed. For every case that's reported, Cieslak says there could be five, ten, even 20 cases that don't.

CIESLAK: What that means is that there's a lot of people walking around there with it coughing, you know, which is one of the reasons that we're so set on covering your cough. You know, cough into your sleeve. Wash your hands frequently. Just so you can not spread it to other people, even if you don't know you have it.

GREENHALGH: In adults the give away whoop sound doesn't happen. That's only in young children whose airways are small. In adults the cough is dry, hacking and long lasting. It's sometimes called the 100-day cough. So anyone with a persistent cough should get it checked.

TOMKORIA: All right. So this feels weird.

GREENHALGH: The test is a simple nasal swab.

TOMKORIA: I'm going to put this in your nose and I've got to leave it there for a few seconds. And it doesn't feel very good, but try to bear with me. It'll be gone as soon as I stop. OK?

(SOUNDBITE OF COUGHING)

TOMKORIA: God, you did good.

GREENHALGH: Sadly for Max, despite the booster shot, his pertussis test is positive. He'll have to stay home until he's taken his five daily doses of azithromycin.

MAX: I don't want to miss school. School is important.

GREENHALGH: That's music to my ears, Max.

MAX: Yeah.

GREENHALGH: I'm Jane Greenhalgh in Portland, Oregon. Transcript provided by NPR, Copyright NPR.