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Whooping Cough on the Rise

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By Claire Walla

It may just seem like a cough. But, if you notice it sounding particularly, uh, “whoop-y,” and if it’s not going away, there’s a very good chance it could be pertussis, or what’s known colloquially as Whooping Cough.

According to a letter sent last month to medical practitioners by Dennis Russo of the Suffolk County Division of Public Health, Suffolk County is seeing an increase in pertussis, a “highly contagious” bacterial disease that’s spread through the air by cough.

In fact, there have already been two suspected cases of Whooping Cough affecting students in the Sag Harbor School District. According to the parents, while the students were not formally tested and diagnosed with the illness, doctors said pertussis was likely and, in both cases, the students and their immediate family members were issued antibiotics.

Sag Harbor Elementary School Nurse Margaret Pulkingham also noted one case in the school district, for which the student was not officially diagnosed, but was also treated with antibiotics as if he or she had pertussis.

While there is a vaccine and antibiotics to help combat the illness, Whooping Cough is of particular concern now because, as Russo writes, “Children and adults may still develop pertussis even if they are up to date with their vaccinations as immunity to pertussis wanes over the years.”

This is a most crucial point, according to Dr. Gail Schonfeld, a pediatrician at East End Pediatrics in East Hampton. She explained that it was only recently discovered that the a-cellular vaccine used against pertussis today does not last as long as the original whole-cell vaccine did. (Though more expensive, the a-cellular vaccine is used in the United States because it carries fewer side effects than the whole-cell vaccine.)

This can be a problem, Schonfeld continued, particularly when teenagers and adults aren’t up-to-date on their boosters. While those with weaker immune systems (namely infants) are most critically affected by the disease and therefore receive mandatory vaccinations, they can easily contract pertussis from surrounding teenagers and adults — those for whom Whooping Cough immunity is likely to wane over time.

The legal requirement in New York State is for children to get a total of six doses of the pertussis vaccination: the first three of the five dose series must be given before entrance into kindergarten, and children are to receive a booster in the sixth grade. Adults are further recommended to receive a booster, called Tdap, every 10 years when they get their tetanus shot.

However, Dr. Schonfeld said the reality of vaccinated adults is significantly lower than the recommended amount.

“Nationwide, 3 percent of adults have gotten the booster,” she said. “Preventative healthcare is not something that’s done for adults as much as it’s done for children. It’s not usually something adults think about.”

What’s more, Schonfeld said it’s estimated that about one-third of adults actually contract pertussis at some point without knowing about it.

“That is why the disease is still around,” she added.

And while these adults often have the immune system to fight the disease, infants and the elderly don’t.

“An adult can break a rib from coughing, but that’s not the same as stopping breathing and dying,” she said.

Schonfeld admitted the disease is “under-diagnosed.” To illustrate her point, she pointed to a recent case of her own.

“I saw a six-week-old over the summer who had a horrible cough; the child stopped breathing and turned blue — right in the office.”

Schonfeld went on to say that the infant had been in contact with an aunt who had been visiting from California, and happened to have “bronchitis.” The aunt was later diagnosed with pertussis instead.

According to Schonfeld, the low number of adults receiving booster shots has to do primarily with a lack of awareness that the booster is available. The adult booster went on the market in New York State in 2005, but evidence that the current pertussis vaccine does not last as long as the whole-cell vaccine did was only recently discovered.

In fact, Treatment Guidelines from a non-profit medical organization The Medical Letter mentions the fact that, in the past, adults were specifically not issued a booster.

“Adults were not re-immunized against pertussis because of concerns about reactions to the whole-cell vaccine, but many pertussis cases occur each year in adults in whom vaccine-induced immunity has waned over time,” the document, which was issued in December 2011, reads. However, “Now two vaccines containing protein components of a-cellular pertussis combined with diphtheria and tetanus toxoids (Tdap) are FDA-approved as a one-time booster for adults.”

“The rationale for use of Tdap in adults is that waning immunity in adults has led to transmission of Pertussis to un-and under-immunized infants, with some deaths.”

Dr. Fang Chen, who has a medical practice on Noyac Road, said she began issuing vaccinations to adults who had never received the vaccination about three to four years ago. However, at this time, she said guidelines from the Center for Disease Control (CDC) do not recommend issuing more than one vaccination. She does not currently offer the adult booster.

Schonfeld said her office has the adult booster on hand, although it is not covered by insurance. However, she indicated that the consequences of teenagers and adults not getting re-immunized could be devastating.

“Unfortunately, parents who choose not to vaccinate themselves are endangering the health of the people around them,” she said. “The problem with contagious illnesses is that they don’t just affect the person making the choice.”