Posts for: January, 2013
Whooping Cough Resurges: Most Cases Since 1959
Austin Texas area has high rate of disease
According to the CDC, over 32,000 cases of pertussis (whooping cough) have been reported in the US in 2012. In fact, central Texas, particularly Williamson County, have been cited as having extremely high prevalence. There is a huge amount of under-reporting because the disease is frequently treated without testing for it. Also, the symptoms are usually mild and can be treated in the course of treatment for other common causes of bronchitis and respiratory infection. What usually alerts the patient and doctor is the persistence and forcefulness of the cough.
There have been 16 deaths, mostly in children, who are most vulnerable. Some deaths have occurred prior to the recommended age of immunization starting at 2 months. To protect babies during the first 3 months of life, the CDC is recommending that all pregnant women be immunized with Tdap (the combination tetanus, diphtheria and pertussis) vaccine during the 2nd or 3rd trimester of every pregnancy, regardless of prior vaccine history. The mother’s immunity to whooping cough will be transferred to the baby and persist for up to 3 months. This “passive” immunity is protective to babies and comprises much of the immune history of the mother.
Furthermore, in the late 1990‘s, the old DTP vaccine was reformulated into a safer version, DTaP, with fewer side effects. DTaP has been given since that time resulting in less fevers, seizures, irritability and local swelling. However, it is now clear that DTap is less effective than the prior vaccine, such that children become vulnerable to the disease about 3 years after the preschool booster is given.....prior to the first recommended Tdap booster at age 11.
There has been a lot of vaccine refusal by parents out of concern for the rising rate of autism and general mistrust of vaccines in general. This has contributed also to the rising rate of disease.
Flu tests are not as accurate as some other rapid tests. For example, rapid strep tests (take only 5 minutes to run) and are positive in over 95% cases of strep throat. However with flu testing, it is positive in anywhere from 20% to 80% of cases of the flu! It is fairly quick (back in only 15 minutes) but the test is usually negative after 4 days of flu illness.
The decision to treat is also a little complicated. The treatment is 5 days of twice-daily Tamiflu. It is best started before 48 hours into the illness....However, how is the start of the illness determined?
Although uncommon, there are possible side effects of Tamiflu, like nausea, vomiting, dizziness and headache. However, if any child is moderately-severely ill, especially if they are less than 2 yrs. old or have a chronic disease, they should be tested and treated. Complications of pneumonia and, rarely, encephalitis, can be prevented with "late" treatment of the flu. Tamiflu was approved down to 2 weeks of age a few weeks ago.
After vaccination, flu disease is very mild, or absent, since the 3 prevalent strains infecting the community were in the vaccine. Symptoms could be similar to a mild upper respiratory illness (URI) rather than bronchitis, pneumonia, high fever and fatigue.
We'll discuss specific flu, flu-like and common cold viruses in the next post.