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Pertussis on big rise
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The California Department of Public Health announced earlier this week that pertussis or whooping cough cases in California had reached epidemic levels.

As of June 10, there have been 3,458 cases of pertussis reported to CDPH in 2014, more than were reported in all of 2013. Over 800 new cases have been reported in the past two weeks.

"Preventing severe disease and death in infants is our highest priority," says Dr. Ron Chapman, director of the CDPH and state health officer. "We urge all pregnant women to get vaccinated. We also urge parents to vaccinate infants as soon as possible."

Stanislaus County has recorded 29 cases of whooping cough as of June 10. Two weeks ago the county had 25 reported cases. The current number of cases is already higher than the total number of cases seen in the county for all of 2012 and 2013.

Pertussis is cyclical and peaks every three to five years as the numbers of susceptible persons in the population increases due to waning of immunity following both vaccination and disease. The last epidemic in California occurred in 2010. In that year the state saw 9,159 cases. Stanislaus County had 159 cases during that peak.

Of the current confirmed cases in the state, 119 have required hospitalization with 18 percent of those needing intensive care, the CDPH reported. Infants too young to be fully immunized remain most vulnerable to severe and fatal cases of pertussis. Two-thirds of pertussis hospitalizations have been in children four months or younger. Two infant deaths have been reported.

The majority of the cases in California have been in infants and children, including 2,090 confirmed cases in children between the ages of 7 to 16 years of age.

Elementary, middle and high school outbreaks have been reported from counties all over California.

The overall incidence of pertussis has increased since the 1990s. One reason for the increase is the use of acellular pertussis vaccines, which cause fewer reactions than the whole cell vaccines that preceded them, but do not protect as long, according to the CDPH.

The Tdap vaccination for pregnant women is the best way to protect infants who are too young to be vaccinated. The CDPH recommends all pregnant women be vaccinated with Tdap in the third trimester of each pregnancy, regardless of previous Tdap vaccination. In addition, infants should be vaccinated as soon as possible. The first dose of pertussis vaccine can be given as early as 6 weeks of age.

Older children, pre-adolescents, and adults should also be vaccinated against pertussis according to current recommendations. It is particularly important that persons who will be around newborns also be vaccinated.

"Unlike some other vaccine-preventable diseases, like measles, neither vaccination nor illness from pertussis offers lifetime immunity," said Chapman. "However, vaccination is still the best defense against this potentially fatal disease."

The symptoms of pertussis vary by age. For children, a typical case of pertussis starts with a cough and runny nose for one to two weeks. The cough then worsens and children may have rapid coughing spells that end with a "whooping" sound. Young infants may not have typical pertussis symptoms and may have no apparent cough. Parents may describe episodes in which the infant's face turns red or purple. For adults, pertussis may simply be a cough that persists for several weeks.