Thursday, August 30, 2012


      


A Public Health Issue too Dangerous to Ignore.

     More than seven hundred cases of pertussis (whooping cough) were reported in Colorado this month, the most since 2005. A surge in nationwide cases suggests that this is the worst outbreak in fifty years.

    Pertussis is an upper airway bacterial infection caused by bordatella pertussis or parapertussis. Sneezing and coughing propel tiny droplets into the air that spread the bacteria from person to person. Initial symptoms begin a ten to twelve days after infection, and the illness persists for six weeks. The tell-tale sign is a “whoop” noise in children when they try to inhale. Adults, however, rarely whoop.

   Pertussis can infect people of any age, though it’s most common in infants and young children.Since most children are immunized before school, the greatest number of cases occur in adolescents and adults. 

   Diagnosis involves swabbing mucus from the back of the throat, then sending it to a lab for testing. Antibiotic treatment is started before the culture results return. Unfortunately, many affected people are not diagnosed right away, and this decreases antibiotic effectiveness. However, antibiotics reduce bacterial spread. Over the counter medicines and are not helpful.
Why is this important for adults?
   Compared to children, affected adults have longer recovery and greater risk for hospitalization. Five percent may have pneumonia, hospitalization, loss of consciousness, and rib fracture. Women can develop bladder incontinence. High lung pressure from coughing attacks can lead to cough syncope (loss of consciousness), groin hernia, collapsed lung (pneumothorax ), fluid aspiration, , herniated lumbar disc, bleeding in the external eye (subconjunctival hemorrhage), and one-sided hearing loss. Severe, untreated cases can progress to pertussis encephalopathy (seizures triggered by coughing episodes), worsening of migraine headache, memory/concentration loss, sweating, and severe weight loss.
 Vaccine prevention:
    A one-time dose of Tdap (tetanus, diphtheria, and acellular vaccine) is recommended for adults under age sixty five if they have not received this vaccine earlier. In addition, adults sixty five and older who have not had Tdap and who have close contact with infants less than twelve months should get Tdap. Adolescents eleven to eighteen years of age, preferably at eleven to twelve years, should receive a single dose of Tdap. When an adult gets Tdap, he or she should get the Td (tetanus and diphtheria) booster every ten years from then on.
   Getting sick once with pertussis does not provide long term immunity. Though the vaccine does not provide immunity in everyone, it limits the severity and duration of sickness. Oral antibiotic treatment cures most cases.


For questions or comments, contact Dr. Clem at clementhanson.blogspot.com

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