HEALTH ADVISORY FOR SCHOOL HEALTH CARE PROVIDERS: COLORADO CONTINUES TO EXPERIENCE EPIDEMIC RATES OF PERTUSSIS

From the Colorado Department of Public Health and Environment
November 25, 2013 

KEY POINTS: 
• Review immunization records to assure that students and teachers are appropriately vaccinated and meet state immunization requirements. 

• Evaluate students for pertussis if they are experiencing a severe cough – often accompanied by gagging, coughing fits, and/or vomiting or whoop, persistent cough lasting longer than 14 days, or apnea (a pause in breathing) or gasping in infants. 

• Exclude any child or adult diagnosed with pertussis from school, child care, and extracurricular activities until they have completed 5 full days of antibiotics (return on 6th day after antibiotics were started) or until 21 days after the cough began if antibiotics are not taken. 

• Consider exclusion of children with symptoms consistent with pertussis until the child is evaluated by a health care provider for appropriate testing and/or treatment. A note from a provider may be required to return to school. 

• Encourage social distancing, cough etiquette, frequent hand washing and staying home from school or work when ill. 

• Persons completely vaccinated against pertussis may still develop disease, with milder illness generally seen among vaccinated persons. However, unvaccinated children have an 8-fold increased risk of developing pertussis as compared to completely vaccinated children. 

BACKGROUND INFORMATION: 

From January 1 through October 31 2013, a total of 1110 cases of pertussis have been reported in Colorado, compared to a 2007-2011 average of 219 cases during the same calendar period. Cases of pertussis have been above epidemic levels since 2012 but an especially high number of cases have been reported during the last two weeks of October. Though cases are widespread throughout Colorado, Arapahoe, Boulder, Denver, and Jefferson counties have the highest number of cases. 

Primary Objective of Pertussis Testing, Treatment, Exclusion and Antibiotic Prophylaxis 

The primary objective of testing, treatment and exclusion of pertussis cases and prophylaxis for those exposed to pertussis is to prevent illness in persons at increased risk of severe illness or in persons who may expose those at high-risk of developing severe disease. 

Those at increased risk include (but are not limited to): infants < 12 months of age*, immunocompromised persons, patients with neuromuscular disease, and patients with moderate to severe lung disease including those with moderate to severe medically treated asthma. 

 *13 of 18 pertussis related deaths in the United States reported to CDC in 2012, were among infants < 3 months of age. 
 

FOR MORE INFORMATION 

 • Pertussis Reporting: suspected and confirmed pertussis cases and pertussis outbreaks should be reported to public health. To report, please contact your local public health agency, or contact CDPHE at 303-692-2700 and provide the following: child’s name/date of birth, school and grade level, parent name and contact number and if available, the diagnosing health care provider’s name and contact number so the diagnosis of pertussis can be confirmed. 

• For more information regarding pertussis including Sample Notification Letters: 
http://www.colorado.gov/cs/Satellite/CDPHE-DCEED/CBON/1251611026285 
and see Pertussis Information and Guidelines for Schools and Childcare Settings under Resources for Schools and Childcare. 

• Infectious Diseases in Childcare and School Settings Guidance: 
http://www.colorado.gov/cs/Satellite/CDPHE-DCEED/CBON/1251607755294 

 • Colorado School and Child Care Immunization Requirements are available at: 
http://www.colorado.gov/cs/Satellite/CDPHE-DCEED/CBON/1251609960682 

• Pertussis outbreak and immunization informational posters are available free for schools and child care settings. To order, please contact Erica Bloom from the CDPHE Immunization Section at: Erica.bloom@state.co.us