E-News: Whooping Cough in Oregon (NVIC)

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An investigation into why Oregon is having outbreaks of pertussis in a highly vaccinated population is warranted. Several questions should be answered: (1) have the “reported” cases been culture confirmed to be bordetella pertussis? There are other diseases which mimic pertussis, such as parapertussis; (2) if the reported cases of whooping cough are due to B. pertussis - how many of the individuals have been fully or partially vaccinated? (3) if many of the cases have occurred in vaccinated individuals, has there been a determination if the B. pertussis organism involved mutated into a vaccine-resistent form such as has occurred in populations in Europe? Additionally, where are the published, peer reviewed studies demonstrating that it is safe and effective to vaccinate babies at 6,10, 14 weeks and one year of age with DTaP rather than the current schedule of 8,16, 24 weeks and 18 months? Hopefully, Oregon doctors are also aware that the contraindications for DTaP are the same as for the older, cruder DPT vaccine.

With the occurrence of whooping cough in Lane County already more than twice the number reported all of last year, local health officials are recommending children be vaccinated at younger ages than normal to prevent potentially fatal infections in infants.

Under the new recommended schedule, children should get their first vaccinations at the ages of 6 weeks, 10 weeks and 14 weeks, with additional doses at 1 year and 4 years.

The stepped-up vaccination effort was recommended by the U.S. Centers for Disease Control and Prevention. All private physicians in the area have been notified of the change, county spokeswoman Melinda Kletzok said. Vaccinations typically are given at the ages of 2, 4 and 6 months, with additional doses at 15 months and before beginning school.

There is no shortage of the vaccine and the new schedule also complies with school entry requirements, health officials said.

Whooping cough, also called pertussis, begins with mild coldlike symptoms. Within two weeks, the cough becomes more severe, along with a thick, clear mucous and episodes of severe coughing spasms that may be followed by a high-pitched whoop. It can be fatal to infants, while it is less serious in adults and children older than 6.

“Whooping cough is very common, highly contagious and causes a nagging cough that can last for weeks,” said Dr. Sarah Hendrickson, Lane County’s public health officer. “The vaccine doesn’t completely prevent all cases of disease, but it does prevent severe illness, hospitalization and death. Whooping cough can kill babies. We need to begin a more aggressive vaccination program to decrease the possibilities of this happening.”

By mid-June, Lane County had 102 reported cases, compared with 44 for all of last year. Oregon averages about 70 cases annually. A Klamath County infant died of the disease last year. An outbreak in Lane, Klamath and Jackson counties this year is generating a rate of whooping cough that is 11 times more than the national average, health officials said.

Hendrickson said the current vaccine is “very safe,” and rumors of problems with old vaccines should not discourage parents from immunizing their children. The vaccine also immunizes against diphtheria and tetanus.

Public health clinic vaccinations are provided for a $10 fee at the Wednesday drop-in clinic in Eugene and by appointment at the county’s clinics in Oakridge, Florence and Cottage Grove. Fees are waived for low-income families. Private physicians also provide immunizations, Kletzok said.

Meanwhile, the state is still in the running for a $325,000 annual federal grant that would help Lane County public health officials track cases of whooping cough and assist diagnosis of the disease.

The grant was in jeopardy earlier this month when the co-chairmen of the Joint Was & Means Committee indicated that they were not inclined to accept the grant because state health officials applied for the money without waiting for legislative approval.

DonaldaDodson, administrator of the state Office of Family Health, said her agency had assumed the Legislature would authorize pursuit of the grant, as it typically does, when it applied last spring to the Centers for Disease Control and Prevention.

But the co-chairmen the Ways & Means Committee have been refusing to allow grants to move forward - lobbyists have estimated that at least $22 million in federal aid has been passed over. The two lawmakers, Sen. Kurt Schrader, D-Canby, and Rep. Randy Miller, R-Lake Oswego, have expressed several concerns, including that such grants would result in future costs to the state if agencies decided to continue programs once the federal money runs out.

In the wake of high-profile criticism at letting the grant money go, the budget panel gave the state Office of Family Health authority to seek the grant. The deadline was June 5, but Dodson said her office remained eligible for the money, which will be awarded in September.

Dodson said the state planned to use the money to study whooping cough in Lane County. Although the persistent cough is most harmful - and can be fatal - among infants and toddlers, Dodson said officials think the best strategy may be to focus on adults and adolescents, too. These older populations are thought to be passing the disease along to small children - a process that vaccinations could stop.

The state is concentrating on Lane County because last year it reported 97 of Oregon’s 193 statewide cases. Oregon as a whole had twice the rate of whooping cough as the rest of the nation, Dodson said.

The Lane County Public Health Department provides low-cost immunizations to protect young children from whooping cough. The Eugene clinic operates each Wednesday. Immunizations are offered by appointment at all other county clinics. A $10 fee is waived for low-income families. Immunizations also are available through private physicians.

Eugene: Wednesdays, 8 a.m. to 11:30 a.m., Lane County Annex, corner of Sixth Avenue and Oak Street

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