Whooping cough on rise throughout state
In Fresno County alone, more than 500 cases reported"
Whooping cough, a childhood scourge that was largely tamed by vaccination since the 1960s, has been making a comeback throughout California, claiming seven young lives so far this year while the number of reported cases throughout the state has doubled.
At least two of the deaths were from the Bay Area -- a San Francisco newborn and a baby from Santa Clara County, where there are already nearly three times as many cases of whooping cough as last year.
Also known as pertussis, whooping cough earned its nickname from the desperate noise that comes from the throats of infants and toddlers gasping for breath as they cough. Although children under one year of age are most vulnerable to pertussis, it strikes teenagers and adults as well, causing coughing fits so violent that patients sometimes break a rib.
Nearly a quarter of the 2,169 California cases reported so far this year come from Fresno County, where more than 500 people from all age groups have come down with it.
"I wish it would go away tomorrow, but the cases are still coming,'' said Peggy Richardson, immunization coordinator for the Fresno County Department of Community Health.
Last year, Fresno recorded only 15 cases.
California's experience this year reflects a nationwide trend. "There has been a dramatic increase in reported pertussis cases in the last four years,'' said Katrina Kretsinger, an epidemiologist for the Centers for Disease Control and Prevention.
There were 25,827 cases of pertussis reported in the United States last year -- numbers that have been climbing slowly since 1976, when universal childhood vaccination programs brought the case count to an all-time low of 1,010.
The steady rise -- punctuated by spikes in pertussis activity every three to four years -- has been puzzling to CDC disease trackers since it was first noticed in the 1980s. Two factors unrelated to the disease itself may be contributing to the increase in reports: A growing awareness of the disease that has caused more doctors to test for it; and an improved test, on the market since 1995, that is providing a more accurate diagnosis.
Many epidemiologists believe there has always been a lot of pertussis out there that is never diagnosed, or dismissed as bronchitis, flu or a persistent chest cold.
"A good proportion of the increase may be due to better reporting,'' said Richardson. "But some of it may be real.''
In fact, the death rate from pertussis has been creeping up -- but at a slower rate than the number of cases of illness. During the 1980s, only 57 people died from whooping cough in the United States. Last year alone, 27 died. And this year, seven have died just in California.
Celia Woodfill, an epidemiologist for the California Department of Health Services, is inclined to think that the rising numbers of pertussis cases seen in the state is part of the cyclic trend. "There was a huge increase in cases nationally in 2003 and 2004, but we really didn't see that in California. Now, it seems to have caught up with us,'' she said.
In the Bay Area, Santa Clara County is experiencing the largest increase in whooping cough cases, with 141 so far this year, compared to 56 in 2004; San Francisco has reported 30 cases -- the same as last year, although this year there has been a fatality. There were as few as eight cases in 2002, but an early cycle of infections peaked at 35 in 1998.
San Mateo County saw its rate double to 48 in 2004, and so far this year the rate has been about the same; Alameda County has reported 92 cases this year, compared to 84 last year and 37 in 2003; Contra Costa County has reported 46 cases, compared to 12 last year; Sonoma County has reported 49 cases so far this year, compared to only 10 in 2004.
Case counts bounce around, said Leigh Hall, Sonoma County deputy health officer. "When you get one case, you might get 10 or 15 other cases associated with that one.''
Studies have yet to show any obvious reason for the increases. No significant outbreaks have been traced to the children of parents who oppose childhood vaccination. "We've looked, and we can't see any obvious connection,'' Woodfill said.
Much of the hope for reversing the long-term trend toward more pertussis lies in a newly approved vaccine -- for adults. Studies have shown that the childhood vaccination protection wears off by the early teens. Booster shots -- with pertussis vaccine loaded into the routine tetanus shots given every 10 years -- may provide lifelong immunity to the adults who ultimately infect children.
"Adults don't die of pertussis. Babies do. But when adults get it, they are sick for weeks,'' said Dr. Roger Baxter, an infectious disease specialist for Kaiser Permanente in Northern California.
The giant health care system -- following new recommendations from the CDC -- plans to offer the new pertussis booster to anyone due for their tetanus shot. Normally, people should get the tetanus shot every 10 years, but Kaiser will offer it after only two years to families with babies, to health care workers and to teachers who are exposed to small children.
"The new vaccine is in warehouses, but we are starting to distribute it now,'' Baxter said.
Pertussis is a highly contagious respiratory infection that causes uncontrollable, violent coughing. It is known as whooping cough because of the sound patients make when they try to take a breath.
Cause: Bacteria (Bordetella pertussis or B. parapertussis) are spread by inhalation, passed from the cough or sneeze of a carrier. First symptoms show up a week after contagion and can be confused with the common cold.
Dangers: Can cause permanent disability or death in infants. Older children with pertussis should stay away from younger children.
Symptoms: A high-pitched Ã¢â‚¬Å“whoopingÃ¢â‚¬Â sound when the patient takes a breath; runny nose; slight fever (102Ã‚Â°F or below); diarrhea; choking spell in infants. Repeated coughs can cause vomiting.
What works: Antibiotics are effective. What doesnÃ¢â‚¬â„¢t work: cough mixtures, expectorants and suppressants