Whooping cough outbreak reported on peninsula

Posted: Sunday, November 02, 2003

The Alaska Division of Public Health is combating an outbreak of whooping cough in two isolated villages east of Homer.

As of late last week, the only confirmed cases are confined to Kachemak Selo and Voznesenka, Russian communities on the shores of upper Kachemak Bay, according to the division.

Five cases had been confirmed by laboratory tests of cultures taken from residents of the villages, Dr. Beth Funk, a public health medical epidemiologist, said Friday.

As of Thursday, of 75 children interviewed, 11 in Kachemak Selo and 5 in Voznesenka had severe symptoms "that were highly suggestive of pertussis (another name for whooping cough)," according to health officials. Another 25 in Kachemak Selo and 13 in Vozne-senka had mild symptoms, which included a cough, rhinorrhea (excessive discharge of mucus) or both. Another 21 youngsters interviewed in the two communities had no symptoms.

Five of the cultures taken from the children have returned positive results for whooping cough, Funk said. Lab work continues on the remaining cultures, including cultures taken from parents and teachers who were in contact with the children.

Whooping cough is a highly infectious disease of the respiratory mucous membrane caused by a bacteria called Bordetella pertussis that attach to tiny hairs called cilia lining the respiratory tract. Resulting inflammation prevents the cilia from functioning.

The disease's incubation period may run from one to three weeks while the bacteria multiply, during which time there are no symptoms, Funk said.

That is typically followed a one- to two-week period of a low-grade cold with standard complaints sneezing, runny nose and possibly a light fever.

A developing cough, mild at first, slowly gets worse until serious coughing spasms occur, which are often followed by the "whoop" sound as the sufferer attempts to gather air. There often is heavy mucus and occasional choking and vomiting.

Adults, teenagers and immunized children often experience milder symptoms. Unimmunized children, however, may experience severe symptoms. Infants are at particular risk, Funk said.

Coughing can linger for two weeks to a month but eventually goes away, though coughing may reoccur during subsequent colds or exertion.

State health officials began tracking the outbreak on Oct. 9 when the Epidemiology Section received a report of "a culture confirmed case of pertussis" in a Kachemak Selo child visiting relatives in another part of the country.

On Oct. 21, the section sent an investigating team to Homer and were joined by Homer Public Health nurses and the school nurse at Kachemak Selo. Parents were asked to bring their children to meet with the team, which recorded the presence or absence of pertussis symptoms.

Cultures were taken from children with coughs or runny noses, as well as from their parents. Children with severe symptoms "paroxysmal cough of more than two weeks with or without post-tussive vomiting were treated with azithromycin (an antibiotic) for five days," health officials said. Households with symptomatic children also were given a five-day supply of the antibiotic.

Epidemiology extended the investigation into Voznesenka because of the frequent contact between the two villages.

Altogether, 115 children and adults were interviewed.

The Epidemiology Section recommended that all unimmunized children under 7 years old in the affected communities begin a DTaP vaccination series as soon as possible. DTaP stands for Diphtheria, Tetanus and "acellular" Pertussis, a modern version of the vaccine package that does not produce the kinds of side effects common in older versions, Funk said.

Instead of waiting for positive results from the lab, those with symptoms were assumed to have the disease and were put on a treatment regimen with antibiotics, Funk said.

Health-care providers and school officials on the lower Kenai Peninsula are all aware of the outbreak, Funk said.

Traci Davis, the Kenai Peninsula Borough School District's health services coordinator, advised parents of children under 7 who are not current with their pertussis vaccine to see the public health nurse or their doctor to be evaluated.

The vaccine is not given to people older than 7. Older people do not develop the dangerous symptoms common in small children and infants for whom the disease can be deadly.

"The difference between pertussis and a normal cold is a cough that interferes with breathing, talking and eating," Davis said. "That type of cough needs to be evaluated by a health-care provider."

Davis said the district is awaiting further instructions from state health officials.

"We will follow the recommendations of Epidemiology," she said.

According to an Epidemiology Section bulletin, few children in the villages had been immunized because of religious beliefs.

Funk said the chance of a pertussis outbreak tends to increase when the rate of immunization in a community falls. Thus, it is not unusual that such an outbreak would occur in villages where religious convictions may lead parents not to immunize their children. Such occurrences have happened in Amish villages and other communities where opposition to vaccination has been widespread.

In the Russian Old Believer villages east of Homer, religious belief is very strong, Funk said. Health-care officials generally have not been successful in convincing residents of the efficacy of vaccinating children against common childhood diseases.

"Whether this episode changes their minds, time will tell," she said.

Funk said she talked with local health officials who said they had vaccinated some village children since the outbreak. That might indicate that some villagers are rethinking the issue, she said.

Parents might argue against vaccinating children from a variety of perspectives, "but religious exemption is the only legal exemption in Alaska," Funk said.

She said she hoped more village children would be immunized. Even though people might never have seen the disease, it will come back if people aren't immunized, she said.

"Childhood immunization is the best way to protect your child," Funk said. "Immunization is one of the most important gifts you can give your child."

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