H EALTH ALERT DATE JULY 6 2015 FROM SPOKANE

WORKERS’ COMPENSATION DIVISION WORKER’S AND HEALTH CARE
BREVE TAMIZ DE SALUD BRIEF HEALTH SCREEN
10 III HEMISPHERIC WORKSHOP ON OCCUPATIONAL HEALTH

APPLICATION FOR AMENDMENT OF PERSONAL OR HEALTH INFORMATION
COLLEGE OF HEALTH RELATED PROFESSIONS CONTINUING EDUCATION MEDICAL
CONSTRUCTION ENVIRONMENTAL SAFETY & HEALTH PLAN (CESHP)

Pertussis Activity Increasing

H H EALTH ALERT DATE JULY 6 2015 FROM SPOKANE ealth Alert

Date: July 6, 2015

From: Spokane Regional Health District Epidemiology

To: Spokane County Healthcare Providers

Subject: Pertussis Epidemic in Washington; Activity Increasing in Spokane

Please ensure that this information is shared with the appropriate personnel in your facility. Thank you.

Pertussis (whooping cough) is epidemic in Washington. Through June 27, 2015, there have been 834 cases reported statewide, compared to just 143 cases during the same time period in 2014. To date, most cases have been reported from western Washington, but pertussis activity has recently increased in Spokane County. Locally, 25 cases have been reported through June 30, 2015 compared with 5 during the same period last year.

The disease affects people of all ages, but is most serious in infants. In Washington, the rate of pertussis in infants is nearly five times the disease rate for all ages. Most infants get this disease from parents, siblings, or other family members. So far this year, 47 cases have been reported in infants <1 year of age and 9 were hospitalized.

Advice from a healthcare provider plays a vital role in patients’ choice to get vaccinated. Additional activities for healthcare providers to prevent and control pertussis are to:

Vaccinate pregnant women during each pregnancy with Tdap vaccine. Vaccination during pregnancy between 27 and 36 weeks gestation is preferred; the timing of the dose is very important for optimal antibody transfer to the infant. Post-partum vaccination is acceptable for cocooning purposes if Tdap has not been given during pregnancy.

Check the immunization status of all of your patients and vaccinate them if they are not up to date. It is especially important for anyone who has or anticipates close contact with infants to be current on their pertussis vaccine. This includes household members, childcare providers, healthcare providers and grandparents.

Consider the diagnosis of pertussis in the following situations, even if the patient has been immunized:
- Persistent or worsening cough with no fever or a low-grade fever in an infant ≤3 months, or in an older infant without other explanation;
- Persistent or paroxysmal cough with no fever or a low-grade fever in an infant <1 year and any of the following: apnea, cyanosis, post-tussive vomiting, seizure, pneumonia, non-purulent coryza, or inspiratory whoop;
- Cough illness ≥7 days that is paroxysmal, accompanied by gagging, post-tussive emesis, or inspiratory whoop in patients of any age;
- Cough illness of any duration and no alternative diagnosis in: 1) anyone with close contact with infants or pregnant women, 2) pregnant women in the third trimester, and 3) patients who have had contact with someone known to have pertussis or with prolonged cough illness; and
- Any cough illness ≥2 weeks in duration with no alternative diagnosis in patients of any age.

Conduct testing, which is appropriate until at least three weeks after onset of paroxysmal coughing. After three weeks of cough, infectiousness and test accuracy decrease significantly. Testing is most critical for symptomatic high risk persons and their contacts:
- Infants <1 year old (greatest risk for severe disease and death),
- Pregnant women in their last trimester,
- Healthcare workers with direct patient contact, or
- Anyone who may expose infants <1 year old or pregnant women.

To confirm pertussis, send a nasopharyngeal specimen for pertussis polymerase chain reaction (PCR) or culture – PCR is more sensitive and rapid than culture, but is more expensive and less specific.

If one member of a household has tested positive, it is not necessary to test other family members who are presenting with symptoms. If multiple members of a household present at the same time with symptoms, it is sufficient to just test one person (preferably the person with the most recent onset of symptoms).

Treat and prophylax: The recommended antimicrobial doses are the same (see below). Antimicrobial treatment does not generally lessen the severity of disease unless it is begun in the catarrhal phase, prior to paroxysmal coughing, but treatment reduces transmission and is essential for disease control. Persons with pertussis are infectious from the beginning of the catarrhal stage through the third week after the onset of paroxysms or until 5 days after the start of effective antimicrobial treatment, and should be excluded from work or school until 5 full days of treatment has been completed.

CDC recommends administration of chemoprophylaxis to all close contacts and all household members of a pertussis case, regardless of age and vaccination status; this might prevent or minimize transmission. A close contact is anyone who had face-to-face contact, shared a confined space for a prolonged period of time, or had direct contact with respiratory secretions from a symptomatic person. Contact with respiratory secretions can occur in many ways, including through an explosive cough or sneeze in the face, sharing food or eating utensils, and conducting a medical exam which includes nose and throat examination.

RECOMMENDED REGIMENS FOR TREATMENT OR PROPHYLAXIS OF PERTUSSIS
Preference	Drug	Age Group	Dosage	Duration
1^st choice(s)	Azithromycin (Zithromax)	< 1 month⁺	10 mg/kg in single dose (Preferred drug; limited safety data available)	5 days
		1 – 5 months	10 mg/kg in single dose	5 days
		≥ 6 months	10 mg/kg in single dose (max=500mg) on day 1 and then 5 mg/kg in single dose (max=250mg) on days 2-5	5 days
	Clarithromycin (Biaxin)	< 1 month⁺	Not recommended (Safety data unavailable)	NA
	Clarithromycin (Biaxin)	≥ 1 month	15 mg/kg/day in 2 divided doses (max=500 mg/dose)	7 days
2^nd choice	Erythromycin	< 1 month⁺	Not usually recommended, use associated with increased risk of IHPS. Only use as alternate drug for infants < 1 month using same dosage and duration listed for ≥ 1 month of age.*	NA
2^nd choice	Erythromycin	≥ 1 month	40-50 mg/kg/day in 4 divided doses (maximum 2 gm/day)	14 days
3^rd choice	Trimethoprim-sulfamethoxazole (Bactrim or Septra)	< 2 months	Should not be used due to risk of kernicterus.	NA
3^rd choice	Trimethoprim-sulfamethoxazole (Bactrim or Septra)	≥ 2 months	8 mg/kg/day of trimethoprim (max=320mg) sulfamethoxazole 40mg/kg/day (max=1600mg) in 2 divided doses	14 days
⁺All infants < 1 month of age who receive any macrolide should be monitored for development of IHPS. (Infantile hypertrophic pyloric stenosis) ^¶Trimethoprim-sulfamethoxazole should not be given to pregnant women, nursing mothers or infants < 2 months of age due to the risk of kernicterus.
For purposes of release from isolation, 5 days of treatment is required.
Note: Please refer to the Physicians’ Desk Reference (PDR) or a pharmacist for information regarding contraindications to these antibiotics.
Reference: Centers for Disease Control and Prevention. Recommended Antimicrobial Agents for the Treatment and Prophylaxis of Pertussis, 2005 CDC Guidelines. MMWR 2005; 54 (No. RR-14): 1-16.

Report all laboratory confirmed cases of pertussis to the Spokane Regional Health District at 324-1449.

For more pertussis information, please visit http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/Immunization/Forhealthcareprovidersaboutpertussis

Spokane Regional Health District (SRHD) Pertussis Activity Increasing 07/06/2015

Epidemiology 509-324-1442 www.srhd.org/providers Page 3 of 3

CONTACTS RHODE ISLAND HEALTH LABORATORIES 2225593 2226985
COUNCILLOR OCCUPATIONAL HEALTH AND SAFETY POLICY 2020 ADOPTED
CZYM JEST STRAŻ ZDROWIA (HEALTHWATCH)? STRAŻ ZDROWIA (HEALTHWATCH)

Tags: alert date:, spokane, alert, ealth