Thursday, December 5, 2013
By Gillian Graham firstname.lastname@example.org
Cases of whooping cough in Maine have more than quadrupled in the past year, mirroring a trend that has the United States headed for its worst year of whooping cough in more than 50 years.
Medical assistant Anne Serra gives 12-year-old Nehemiah Brown of Dresden a vaccine booster shot for pertussis – also known as whooping cough – Wednesday at Mid Coast Pediatrics in Brunswick. The government recommends that children receive a tetanus, diphtheria, pertussis booster shot around age 11 or 12.
John Ewing / Staff Photographer
SIGNS AND SYMPTOMS OF WHOOPING COUGH
The first signs of pertussis, or whooping cough, are similar to those of a common cold, with sneezing, runny nose, low-grade fever and a cough. The cough gets worse after one or two weeks.
The cough occurs in sudden, uncontrollable bursts in which one cough follows the next without a break for breath.
Many children make a high-pitched whooping sound after coughing. Whooping cough is less common in infants and adults.
Patients may vomit, look blue in the face or have trouble breathing after a coughing spell.
The cough is often worse at night.
The patient may seem well between coughing spells, but the illness is exhausting over time.
Coughing spells may continue for several weeks or months.
Source: Maine Center for Disease Control and Prevention
WHOOPING COUGH BY THE NUMBERS
• 347 cases reported so far this year, including 99 in Cumberland County, 25 in York County and 85 in Somerset County
• 205 cases in 2011, including 79 from Jan. 1 to Aug. 9
• 53 cases reported in 2010
• 82 cases per year, average 2002-2011
• More than 21,000 cases to date in 2012
• 15,216 cases in 2011
• 27,550 cases in 2010
• This year, Washington declared a statewide epidemic with 3,484 cases from Jan. 1 to Aug. 11. The state had 965 cases in 2011 and 608 cases in 2010.
• In 2010, California declared an epidemic with 9,143 reported cases, including 10 infant deaths.
• 30 million to 50 million cases annually, with about 300,000 deaths
In Maine and across the country, large numbers of cases are being seen in adolescents who may be overdue for a vaccine booster. The increase has prompted federal health officials to investigate its cause and the effectiveness of vaccines.
Federal health officials see better detection and more reporting of pertussis as factors in the increase.
The Maine Center for Disease Control and Prevention reported 347 confirmed or probable cases of whooping cough statewide through Aug. 9 this year, compared with 79 cases during the same period last year. This year's cases include 99 in Cumberland County, 85 in Somerset County and 47 in Penobscot County.
Nationally, more than 21,000 cases of pertussis -- and nine related deaths -- have been reported this year, according to the national Centers for Disease Control and Prevention. There were 15,216 reported cases in all of 2011 and 27,550 cases in 2010.
To date, 37 states have reported increases in whooping cough over the same period in 2011. A whooping cough epidemic was declared in Washington state, where nearly 3,500 people have been diagnosed this year, more than three times the number for 2011.
Most cases in Maine have been in children ages 7 to 19, though cases in adults are also on the rise, said Dr. Sheila Pinette, director of the Maine CDC. The CDC has been notified of 16 cases in adults in their 30s and 17 cases in adults in their 40s.
Whooping cough is a highly communicable respiratory disease that causes long coughing fits and is characterized by a "whooping" sound as a person gasps for air. Coughing fits caused by pertussis infection usually last one to six weeks, but can go on longer. It can be a life-threatening disease for babies.
The high rate of whooping cough among teenagers in Maine reflects a national trend and may indicate early waning of vaccines, say federal health officials. It also indicates that teenagers and adults are not being immunized, Pinette said.
Children are typically vaccinated for whooping cough as part of a series of immunizations, but the vaccine loses effectiveness over time. Unvaccinated children are eight times as likely to become infected with pertussis. Vaccinated children who get pertussis have milder symptoms and recover faster, according to the CDC.
Health officials expect to see peaks in whooping cough every three to five years, as well as frequent outbreaks. This year's dramatic increase -- especially among adolescents -- prompted federal health officials to look into the cause.
Tami Skoff, an epidemiologist with the national CDC in Atlanta, said health officials attribute the rise in part to more reporting of cases by doctors and improvements in lab tests for whooping cough. They also are looking at the length of vaccines' effectiveness.
The vaccine that children got for many years was replaced in the 1990s because of concerns about side effects. The new version is considered safer but may not be as effective in the long term, Skoff said.
The government recommends that children get vaccinated in five shots between the age of 2 months and 6 years. A tetanus, diphtheria, pertussis booster shot is recommended around age 11 or 12.
Doctors also recommend that adults who have not had the booster receive a one-time dose, especially if they have close contact with an infant.
"We're most concerned when young infants get the disease," Skoff said. "This is the age group where we have pertussis deaths."
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