Tag Archive | "Gail Schonfeld"

Whooping Cough on the Rise

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bordetella_pertussis

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.”

‘Tis the Flu Season

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Mary Schiavoni rarely gets sick, but on Thursday, February 5, she had a dry cough. The following day, Schiavoni, a teaching assistant at Sag Harbor Elementary school, “started feeling like garbage,” and was plagued with congestion and fever. That evening she mustered up the strength to attend a performance of “The Wizard of Oz” at the Pierson Middle School and High School, but soon felt like leaving.

“I just thought, ‘I have to get out of here’,” said Schiavoni.

By Saturday, Schiavoni was feeling so lousy her husband Ted drove her to Dr. Mark Kot in Southampton. After completing a swab test, Dr. Kot confirmed that Schiavoni had a bad case of influenza. Oddly enough, Schiavoni had visited Dr. Kot weeks before to get a flu shot.

“After Dr. Kot gave me the test, he told me I was the third person who had had a flu shot, but later got the flu,” said Schiavoni.

Dr. Kot put Schiavoni on a battery of medications, including Tamiflu, the classic influenza medicine prescribed in the first 48 hours of initial symptoms, and several antibiotics.

Schiavoni spent the next week holed up in her bedroom, weak with fatigue. On the rare occasions that she left her bed and moved around the house, she would start sweating and feel ill in a matter of minutes. It took nearly a week for Schiavoni to recuperate, and even now, she still has a cough.

Although Schiavoni isn’t certain where she contracted the flu, it is likely that she was exposed to it at the school. According to Pierson nurse Barbara Schmitz, a record number of schoolchildren have confirmed cases of influenza, or reported experiencing flu-like symptoms. In the past month and a half, said Schmitz, nearly eight middleschoolers where diagnosed with the flu by their doctors, and scores of children also have bronchitis and pneumonia.

“I think [the number of sick students] is definitely up from last year. We sent a lot of kids home. I haven’t seen so many sick students ever,” said Schmitz, who added that the elementary school was experiencing a similar situation.

Local physicians have also taken note of this medical phenomena. Dr. John Oppenheimer, who practices in Sag Harbor, believes the number of cases of influenza in the village is more than usual.

“[In the winter] there is always something going around. There was a coughing bug and then a vomiting bug, but the flu is now surfacing,” said Oppenheimer. “The flu hasn’t really hit out here in a long time, but now we are seeing it.”

On Friday, Oppenheimer had diagnosed five patients with the flu within 24 hours. By the time these patients saw Oppenheimer, their illnesses had become pretty debilitating. One female patient told Oppenheimer that she felt as if she had walked into a brick wall. In addition to her overall body ache, the patient displayed all the classic symptoms of influenza, like a high fever, runny nose, cough and extreme fatigue.

Pediatrician Gail Schonfeld, who heads East End Pediatrics in East Hampton, started seeing patients test positive for the flu two weeks ago, but says many who are sick simply stay at home to wait out the illness. Three of her patients contracted the ‘b’ strain of the flu, which is the rarer type, although they had gotten flu shots before becoming sick. Marsha Kenny, of Southampton Hospital, added that the influenza shot doesn’t fight against every strain of the virus.

According to the Centers for Disease Control and Prevention (CDCP), influenza has been widespread in New York State for the past two weeks. Every year, it’s estimated that five to twenty percent of the population contract influenza, more than 200,000 people are hospitalized from influenza complications and 36,000 people die from the flu, reported the CDCP. However, young children, pregnant women, seniors and people with chronic conditions are more likely to contract the flu.

Schonfeld believes it will soon be mandatory for all school age children to get an annual flu shot. This policy has already been enacted in New Jersey. She added that a new way of administering the vaccination, through a nose spray, will help make this a reality in New York State.

As the sniffles, cough and general sickness seem to spread throughout the village, local doctors recommend residents wash their hands frequently, steer clear of those who are already ill and still get a flu shot, if they haven’t already become ill.