The U.S. is seeing an outbreak of whooping cough that could become the largest in 50 years, and while no major outbreak has hit Palm Beach County, the number of cases here is up significantly over last year.
As of July 19, 18,000 cases had been reported in the U.S. this year, more than twice as many as last year, and 10 children have died. According to the Centers for Diseases Control, if reports of total cases continue at that rate, the outbreak will be the worst since 1959 when there were 40,000 cases.
In Palm Beach County, reported cases are up from 11 at this time last year to 18 so far this year, including at least two new cases in the past two weeks. No child has died this calendar year in the county, but an infant too young to be immunized died of the disease in a Palm Beach County hospital in September. In the interest of protecting the family's privacy, health officials revealed no other details.
"Infants are the most susceptible and if they contract it tend to have very poor outcomes that result in hospitalization and even death as the infection is overwhelming," said Tim O'Connor, spokesperson for the Palm Beach County Health Department.
To protect infants from whooping cough, health officials recommend that they receive the DTaP vaccine at two, four and six months, another dose between 15 and 18 months and a fifth dose between 4 and 6 years of age. Kids 11 to 12 should receive a booster. DTaP stands for diphtheria, tetanus and pertussis. Pertussis is the scientific name for whooping cough.
O'Connor said of the cases this year, five were infants under age 1; three were pre- schoolers; seven were school age, K-12; and three were adults. Some of the younger children had not completed the recommended five-shot regimen and the older children affected had not yet received the booster, underlining the need for immunization.
Since infants younger than two months can't be immunized, health officials say the way to protect them is for pregnant women and anyone else who will come in contact with infants to be immunized. After the death of the child in September, county health department director Dr. Alina Alonso urged county residents to heed that crucial advice.
In general, health officials say, adults should get a booster every 10 years.
But so far Palm Beach County and Florida as a whole have been spared the worst of the outbreak. Wisconsin and Washington state have both reported more than 3,000 cases. For Washington that is 13 times the number of cases last year; for Wisconsin it is 10 times more than last year. Other states with high numbers include Arizona, Minnesota and New York.
Florida has had 323 cases reported this year, as of Thursday. Those include confirmed cases and other instances where whooping cough was strongly suspected. One child died – a 1-year old in Miami-Dade. The total number of cases compares with 328 cases in all of 2010 and 313 in 2011.
In April, state health officials issued an advisory on the disease, urging parents, grandparents and other relatives to get immunized before they spend time around an infant.
"Family members are most often the transmission source of pertussis to infants," the advisory said. "A typical case of pertussis starts with a cough, runny nose, sneezing and a low-grade fever. After one to two weeks, the coughing becomes more severe. Rapid coughing fits can occur that often end with a whooping sound. Pertussis is spread when infected individuals cough or sneeze while in close contact with others…. Pertussis is treated with antibiotics."
On July 16, state health officials issued another advisory encouraging all parents and guardians to check the immunization status of their children before the new school year begins.
"As children and families across Florida prepare to start another school year, it is vital that all students have their required immunizations," the advisory said. "Immunization documentation on a DOH Form 680, Certification of Immunization, is required for all students in grades pre-kindergarten through 12."
State officials urged parents to schedule appointments with private or public providers right away.
But even if a child has been immunized, he or she could develop the disease and parents should keep a close eye on children who develop serious coughing.
"Vaccines have done a good job at reducing the incidence of pertussis," said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control. "But our pertussis vaccines are not perfect. They don't provide protection for as long as we wish they would."
Between 1960 and the 1990s, the U.S. saw a decline in the number of whooping cough cases, until they reached fewer than 5,000 per year. But then the vaccine used was replaced due to concerns over side effects, including rashes and fevers. Some experts, including Schuchat, believe that the new vaccine may not last as long
But those experts still say that the vaccination process is the best way to protect children.
"Without vaccines, we know we would have hundreds of thousands of pertussis cases each year," she said. "So given how dangerous pertussis is for babies, preventing infant deaths for the disease is our primary national goal."
Palm Beach post researcher Niels Heimeriks contributed to this story.
Immunization against whooping cough for all ages.
• Infants and children should receive five doses of the DTaP vaccine at two, four and six months, at 15 through 18 months, and at age four through six, for maximum protection.
• Adolescents should receive a booster at their regular checkup at age 11 or 12. If teenagers 13 through 18 years missed getting the vaccine, parents should ask the doctor about getting it for them now.
• Adults should get a booster every 10 years.
• Pregnant women who have not been previously vaccinated should get one dose during the third trimester or late second trimester – or immediately postpartum, before leaving the hospital or birthing center. By getting vaccinated during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines.
Note: The vaccine administered after age six is a slightly different formula and is called Tdap