Maine Department of Health and Human Services

Maine Center for Disease Control and Prevention (Maine CDC)

(Formerly Bureau of Health)

11 State House Station
Augusta, Maine 04333-0011

Phone 1-800-821-5821 / Fax 207-287-7443

**ADVISORY – Important Information**

 

2006PHADV016

 

TO:                 Border Medical Officers, EMS, Hospitals, Infection Control Practitioners, ME Correctional Facilities, ME Lab Facilities, ME Primary Care, MEMA, Public Health Nurses, Public Health, Regional Resource Centers, School Nurses, State and Federal Agencies     

 

FROM:           Dora Anne Mills, M.D., M.P.H., Public Health Director           

 

SUBJECT:  Pertussis Outbreaks in Western and Southern Maine

 

DATE:            13 October 2006                    

 

TIME:            9:00 AM

 

PAGES:          3

 

PRIORITY:    Review

 

 

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Pertussis Outbreaks in Western and Southern Maine

 

Background: 

Maine CDC has been notified of a possible cluster of suspected Pertussis cases in a high school in Portland, Maine.  In the past two months, Maine CDC was also notified of small clusters in some daycares in western and southern Maine.

 

Pertussis is a highly communicable, vaccine-preventable disease that lasts for many weeks. It is transmitted through direct contact with discharges from respiratory mucous membranes of infected persons. Symptoms include apnea, paroxysmal spasms of severe coughing, whooping, and post-tussive vomiting.  Complications include hypoxia, apnea, pneumonia, seizures and encephalopathy.

 

Recommendations: 

1. Consider Pertussis when evaluating any patient with an acute illness characterized by cough >2 weeks in duration, or cough with paroxysms, whoop, or post-tussive vomiting. Infants may present with apnea and/or cyanosis.

 

2. Report known or suspected cases promptly to the Maine CDC at 1-800-821-5821.

 

3. Persons who exhibit symptoms consistent with Pertussis should be tested for Pertussis with nasopharyngeal swab. The state Health and Environmental Testing Laboratory (HETL) tests specimens by culture and polymerase chain reaction (PCR). Serologic testing through private laboratories has not been well standardized and should not be used.

 

4. Individuals with suspected Pertussis should be treated after a nasopharyngeal specimen is collected for testing. The federal CDC has recently updated guidelines for antibiotic treatment for Pertussis cases and contacts (MMWR; December 9, 2005. RR-14). The guidelines are available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm . 

 

5. Individuals with symptoms of Pertussis should be considered to be infectious and should not attend school, work, or daycare until they have completed 5 days of an appropriate antibiotic treatment. This is especially important for persons working in medical settings or with infants and young children.

 

6.  Providers should be aware that the Azithromycin regimen recommended by CDC for the treatment and prophylaxis of Pertussis is five (5) days in duration. A shorter course of Azithromycin is not suitable for the treatment of and prophylaxis against Bordetella Pertussis infections.   

 

7.  Children under age 7 should be up-to-date for Pertussis immunization. Also, consider vaccinating patients 11-18 years of age with the Tdap vaccine if they have had their latest Td booster more than 5 years ago.  In an outbreak setting, Tdap may be given 2 years after the last Td booster.

 

In 2005 two tetanus toxoid, reduced diphtheria toxoid and acellular Pertussis vaccine (Tdap) products were approved: Adacel ® (Sanoffi-Pasteur) for use in persons 11-64 years old and Boostrix ® (GlaxoSmithKline) for use in adolescents 10-18 years of age.

 

In June 2005 ACIP recommended the use of a single Tdap dose instead of the usual Td toxoid booster vaccine for protection of adolescents 11-18.  This recommendation if implemented widely should result in the reduction of the number of adolescent cases and also reduce the number of outbreaks that are seen each year.

 

 

 

 

8. For more information on Pertussis control measures, please go to www.cdc.gov/nip/publications/Pertussis/guide.htm and http://www.cdc.gov/nip/publications/Pertussis/2005_summary_updates.pdf

 

 

For More Information:  Maine Immunization Program 1-800-867-4775