NE: Spike in whooping cough cases prompts health warning

[Omaha Steve]

http://www.livewellnebraska.com/health/spike-in-whooping-cough-cases-prompts-health-warning/article_acdc5a79-c8ee-58c8-b863-74f76c90c0e0.html

By Bob Glissmann / World-Herald staff writer

Nebraska in the first month of the year saw more than half the number of whooping cough cases it saw in all of 2014. The high number of cases is prompting a notice from health officials.

“The concern is really with infants,” said Tim Timmons of the Lincoln-Lancaster County Health Department. “If they get exposed and come down with it, they can have a more severe illness.”

Anyone in contact with babies, toddlers or school-age children should be vaccinated against whooping cough, health officials say.

Lancaster County had a total of 162 probable and confirmed cases last month. Many of those were school-age children who were current on their vaccinations, Timmons said. They had milder cases than if they hadn’t been vaccinated.

FULL story at link.

[NuclearDem]

1. Will this nonsense ever end?

[Demit]

2. Many of the 162 in Lancaster Co were current on their vaccinations?

I don't understand. That's concerning.

[Hestia]

3. Same with the measles outbreak - what is it, 27 kids, who were current. I'll have to go back

and find that article.

[jeff47]

8. The measles part of the MMR vaccine is 98% effective.

In about 2% of cases, long-term immunity does not occur.

Normally, that 2% is protected by herd immunity. We lost herd immunity.

If all of Disneyland's 16M visitors had the recommended MMR shots, that's still 320,000 people per year that visit and failed to develop long-term immunity.

[jeff47]

9. No vaccine is 100% effective.

Long-term immunity does not form in a small number of cases. The failure rate depends on the vaccine. The measles part of the MMR is 98% effective. Actually catching measles is also not 100% effective, btw. Nothing in biology is 100% effective.

With pertussis, even getting the disease does not confer long-term immunity. You need a booster every 5 to 10 years to maintain immunity.

As long as the failure rate for a vaccine is low enough, vaccine failure is protected by herd immunity. But herd immunity requires a high vaccination rate. Pertussis is a disease where we don't have that. Because after people graduate from school, they usually stop bothering to get their boosters.

[Demit]

11. Yes, but the story says "many." And they were schoolkids whose vaxes were current.

Long-term immunity isn't pertinent, b/c they're kids. If their vaccinations were current, there should have been only a small percentage who came down with whooping cough, not "many." Is there a known failure rate for the pertussis vaccine?

Maybe the story was overstating the number of kids who were properly vaccinated but got sick anyway. Or maybe the pertussis part of the vaccine given to kids in Lancaster Co wasn't as effective as it's supposed to be. I am curious.

[countryjake]

4. Pertussis reached epidemic levels back in early 2012 in wa state.

Cutbacks Hurt a State’s Response to Whooping Cough May 12, 2012

http://www.nytimes.com/2012/05/13/health/policy/whooping-cough-epidemic-hits-washington-state.html?_r=0


MOUNT VERNON, Wash. — Whooping cough, or pertussis, a highly infectious respiratory disease once considered doomed by science, has struck Washington State this spring with a severity that health officials say could surpass the toll of any year since the 1940s, before a vaccine went into wide use.

Although no deaths have been reported so far this year, the state has declared an epidemic and public health officials say the numbers are staggering: 1,284 cases through early May, the most in at least three decades and 10 times last year’s total at this time, 128.

The response to the epidemic has been hampered by the recession, which has left state and local health departments on the front lines of defense weakened by years of sustained budget cuts.

Here in Skagit County, about an hour’s drive north of Seattle — the hardest-hit corner of the state, based on pertussis cases per capita — the local Public Health Department has half the staff it did in 2008. Preventive care programs, intended to keep people healthy, are mostly gone.

The county’s top medical officer, Dr. Howard Leibrand, who is also a full-time emergency room physician, said that in the crushing triage of a combined health crisis and budget crisis, he had gone so far as to urge local physicians to stop testing patients to confirm a whooping cough diagnosis.

[PADemD]

6. 2012

That's when I got a booster shot. I had whooping cough 55 years ago, and I don't want to get it again. Is it possible that it has mutated?

Whooping cough is a bacterial infection.

[jeff47]

10. Pertussis immunity fades over time.

A booster is required every 5 to 10 years (depends on the vaccine, and there's a debate going on about 5 versus 10)

Immunity fades even in cases where the person caught the disease. So getting it when you were younger does not mean you have lifelong immunity.

[countryjake]

13. Skagit County's were mostly tween-age kids who'd had early vaccines that got it...

and our junior high schools were a hot mess that year. Everybody around here rushed to get the Tdap vaccine if they had or knew anybody with younger kids in school (especially those of our generation with grandkids, who mistakenly thought that they couldn't come down with it again).

As Jeff says, your immunity to Whooping Cough fades over time, and even someone who's been vaccinated may come down with the disease, tho suffering a much milder case of it.

[PADemD]

14. People who have never had whooping cough do not realize the seriousness of the disease.

Whooping cough usually lasts a month. So, if there are 2-3 kids in the family, that could mean up to 3 months of caring for sick children. No school or daycare and no work for the caregiver. Up every night with a coughing, wheezing child. It's usually worse at night. Cough so much that no food or liquid stays down.

I used to sleep with a bucket beside the bed because I didn't have enough time to get to the bathroom once the coughing started. I couldn't even keep down codeine cough syrup. Yuk, that stuff tastes awful. I lost 20 pounds in a month, ending up at 80 pounds and looking like I had been in a concentration camp.

I seriously think whooping cough would kill an infant.

[countryjake]

15. The infection can kill anyone, any age, with high risk lungs...asthma, emphysema

chronic bronchitis, or even just a long-time smoker. I was lucky in 2012 and felt reasonably safe after the epidemic was announced, as I'd gotten a nasty scratch working with rusty fencing earlier, and had gone in for a Tetanus shot; the Tdap vaccine they gave me includes protection from Pertussis. Other seniors I knew did not fair so well and one ended up in hospital under an oxygen tent. He did recover from the Whooping Cough but was left in an extremely weakened state and died from pneumonia the following winter...young, only 72.

Pertussis is really a horrible disease. No little baby should ever get it.

[Omaha Steve]

7. Good info

Thanks.

[countryjake]

12. Last week's news: Skagit Co Health Department to stop offering immunizations

County to Shift its Focus with Health Care January 31, 2015

http://www.goskagit.com/all_access/county-will-shift-its-focus-with-health-care/article_00068336-a8d9-11e4-bc55-c70f764dbc2a.html

Mount Vernon - The Skagit County Health Department will stop offering immunizations and other clinical services now that expanded treatment options are available through the Affordable Care Act, the county announced Friday.

Certain changes will take effect April 1, including the end of immunizations for children under 19, as well as family planning and sexually transmitted disease services...

The changes are part of a broader effort to shift the department's focus from direct patient service to health education and disease-outbreak prevention, said Jennifer Johnson, director of Skagit County Public Health and Community Services.

Johnson said the shift is also meant to bring the health department's goals better in line with federal health care reform objectives, including a patient-care model known as the "medical home," which encourages patients to develop one-on-one relationships with a doctor who can manage their comprehensive medical care.

In 2014, the county's health department provided 4,472 vaccines, both to children and adults...

Ending the clinical services will not save the county money since revenue generated by the health department through service fees and Medicaid payments will likely be reduced, Johnson said. But county health officials believe the department's new focus will allow them to make better use of their resources and improve health outcomes for county residents.

County Public Health to re-direct some clinical services

http://www.skagitcounty.net/Departments/Home/press/013015.htm

Skagit County Health Officer Dr. Howard Leibrand emphasized the national goal of a “medical home” such as a family practice physician for everyone, from infant to elderly. Health care, he said, is ideally provided on an ongoing basis, as opposed to emergency treatment only.

“We want to take the latest opportunity provided by ACA to remove barriers and reduce the fragmentation of personal health care,” said the Health Officer. “We have been providing some services to a ‘gap’ population that can now be served through the ACA. As we encourage the transition to one-on-one health care for all, we are in an improved position to focus County resources on population based prevention, notification and investigation.”

Johnson added: “We want Skagit County residents to know we will continue to work with the Center for Disease Control (CDC), the state Department of Health and community partners to prioritize the prevention of communicable diseases ranging from influenza to Ebola.”

I'm at a loss to understand how eliminating our Health Department's immunization services will effectively improve disease prevention and prevent outbreaks like the Pertussis epidemic in 2012...many many people here were lined up there to receive vaccines and boosters for Whooping Cough back then. Dr. Leibrand fails to note that the "gap population" he's mentioned has now totally fallen thru the cracks of the ACA. A door has been slammed shut on them.

[onecaliberal]

5. It got so bad in central California

That the 2 areas largest districts required Tdap booster before entering 7th grade.