+ Pertussis Madison Hilts, Tahnee Lilly, Michael Zoerb California Baptist University April 7,2016

+ What is Pertussis ■ Also known as Whooping Cough ■ Uncontrollable and violent cough which makes it hard to breathe ■ Highly contagious respiratory illness caused by a bacteria called Bordetella Pertussis ■ The bacteria is able to enter immune system and attach to cilia of lungs, releasing toxins that damage cilia, airway swells and breathing becomes labored ■ Deadly illness for infants ■ Target Population: Parents of infants/toddlers and expecting parents

+ Transmission ■ Spread from person to person ■ Through coughing, or sneezing and breathing in air from an individual who is infected ■ Many babies get infected from relatives or caregivers who are not aware they have pertussis ■ Infected individuals are most contagious up to 2 weeks after the cough starts ■ Vaccinations available but once it is circulating, even those vaccinated are at risk of getting sick. ■ Secondary attack rates of 80% among household contccts

+ Signs and Symptoms ■ 2 stages of symptoms ■ Early Symptoms ■ Last up for 1 -2 weeks ■ Includes ■ Runny nose ■ Low grade fever ■ Mild cough ■ Apnea (in babies) ■ Later symptoms ■ After 1-2 weeks of disease progress ■ Paroxysms(fits) of rapid rapid coughs coupled with a high pitch whoop ■ Vomiting during or after cough episodes ■ Extreme exhaustion after cough fits ■ Coughing gets worse as illness progressed

+ Importance Of Pertussis ■ Significant cause of infant deaths worldwide and remains a public health concern even in countries where vaccination coverage is high. ■ Signs and symptoms of pertussis are similar to that of a common cold which makes it difficult to diagnose ■ Preventing transmission to young children particularly is a major public health issue because they have the hardest time fighting off the condition ■ Since the early 1980s there has been an overall trend of an increase in reported pertussis cases

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+ Epidemiology and Statistics ■ One of the most common childhood diseases in the 20 th century ■ Prior to 1940s more then 200,000 cases were reported annually ■ Estimated 195,000 deaths worldwide in 2008 ■ In 2010, 27,550 cases of pertussis including 27 pertussis related deaths ■ Case counts in 2012 increased compared to 2010 ■ 48, 277 cases reported ■ Increase in the case count for children aged 7-10 as well as 13 and 14

+ Epidemiology and Statistics(cont’) ■ From 2008 to 2011 ■ 72 deaths reported to CDC ■ Children 3 months or younger accounted for 60 (83%) of these deaths ■ Annual mean cases of children was 3,132 ■ In America ■ 32,971 cases diagnosed and reported in 2014 ■ Highest number of cases reported in California ■ 8,273 cases ■ Texas reported to have the second most cases ■ 2,576 cases

+ Biological Factors ■ High prevalence among infants and pre school children ■ Females have a higher incidence and fatality rate than males ■ High incidence rate among children under age 5 ■ High mortality rate among infants under 6 months ■ Infants vulnerable to infection from birth ■ Due to maternal antibodies not giving full protection

+ Socioeconomic Factors ■ Areas of low income ■ Lower rate of vaccination ■ Lack of insurance coverage ■ Unable to finance vaccine ■ Do not see point in spending money on a vaccine that does not seem relevant ■ Overcrowded areas with higher germ transmission ■ Lack of education and knowledge on the prevalence of illness ■ Benefit of education ■ Vaccination gives child protection from the illness

+ Environmental Factors ■ Occurs throughout the year, but higher number of cases during cold and flu season ■ Increase in the number of cases seen during winter and spring Why? ■ Overcrowding ■ Poor socioeconomic conditions and ways of life ■ Example: Public places like Disneyland ■ States with high immigration rates and visitors vacationing from other countries, such as in California, tend to have higher rates of transmission due to the lack of vaccinations for pertussis in other countries.

+ Resolving The Health Issue ■ Educating individuals with babies, or planning on having a child on what pertussis is through ads, pamphlets and patient provider communication ■ Increase rates of vaccination among pregnant women ■ Active screenings for both symptomatic individuals and suspected cases during outbreaks ■ reduces exposure to more individuals. ■ As a part of Healthy People 2020 project, a disease reduction goal of 2,500 cases per year in children <1 year old and 2,000 caser per year among adolescents years old was proposed

+ Action/ Recommendation ■ Prevention Tip ■ Vaccination ■ Tdap (adolescents & adults) or DTaP (pediatric) ■ Infants : Administered as early as 6 weeks of age ■ Pregnant women : administer at 27 through 36 weeks gestation ■ Recommended that vaccine be given at 2,4,6, 15 to 18 months. Also at 4 years and 11 years ■ Also get booster immunizations

+ ■ Reduce exposure tip ■ Maintaining good hygiene ■ Covering mouth and nose when coughing or sneezing ■ Coughing into elbow or upper sleeve ■ Washing hands for at least 20 seconds

+ References ■ Basavanthappa, B. T. (2008). Community health nursing (2nd ed.). New Delhi: Jaypee Brothers. ■ Faulkner, A., Martin, S., Cassiday, P., Tondella, M. L., & Liang, J. (2015, May 19). Pertussis. Retrieved April 02, 2016, from ■ Pertussis Causes and Transmission. (2015, September 8). Retrieved January 25, 2016, from ■ Pertussis (Whooping Cough), (2015, November 20). Retrieved January 25, 2016, from Info/discond/Pages/Pertussis.aspx Info/discond/Pages/Pertussis.aspx ■ Pertussis( Whooping Cough) Prevention. (2015, September 29). Retrieved April 05, 2016, from ■ Pertussis Prevention. (2015, September 08). Retrieved April 03, 2016, from ■ Wemmer, U. (1999). Pertussis – Whooping Cough: The Clinical Picture. Journal of Biomedical Therapy, 17(4), 127. ■ Why you still need Pertussis Vaccination. (2013). Harvard Women’s Health Watch, 20(7), 8.