From: BCPhens1 Sent: Friday, December 04, 2015 4:24 PM To: Rubock, Elizabeth Subject: FW: Public Health Advisory: 2015 Pertussis Case Investigations, Monmouth County ~~~~~~~~~~~LINCS/HAN Communication~~~~~~~ Local Information Network Communication System Bergen County Department of Health Services One Bergen County Plaza Hackensack, NJ 07601 Phone: 201-634-2860 Fax: 201-336-6088 http://www.bergenhealth.org ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Subject: 2015 Pertussis Case Investigations, Monmouth County Date: 12/4/2015; 13:32:25 Message#: 103005-12-4-2015-PHAD Contact Info: Allison Portney, NJDOH VPDP Phone: 609-826-5964; Email: Allison.Portney@doh.state.nj.us Elizabeth Zaremski, NJDOH VPDP Phone: 609-826-5964; Email: Elizabeth.Zaremski@doh.state.nj.us Attachments: None - An increase in the number of pertussis cases has been noted in Monmouth County. - Ensure that children are up to date with pertussis-containing vaccines. - Vaccinate all pregnant women with Tdap during every pregnancy. - Obtain diagnostic testing and report clinically suspect cases promptly to the local health department in the jurisdiction where the patient resides. - Provide early treatment and post-exposure prophylaxis to prevent ongoing transmission - Ensure that children are up to date with pertussis-containing vaccines. - Ensure that suspect cases remain at home while potentially infectious December 4, 2015 An increase in the number of pertussis cases has been noted in Monmouth County. As of 12/04/2015, 17 pertussis cases have been identified in the county with a number of additional cases currently under investigation. A regional high school was associated with some of the reports. As a result of public health investigations, additional suspected cases were identified. The New Jersey Department of Health (NJDOH) and local health officials are working to better describe the epidemiology of this increase. The recent pertussis cases are the most cases Monmouth County has identified since 2012, when 56 pertussis cases were reported. This is compared to 16 cases in 2013 and 12 cases in 2014. Other areas of the state have also seen an increase in cases throughout the year, however state totals have remained relatively stable. As of 12/04/2015, 315 pertussis cases have been reported to NJDOH in 2015 compared with 381 cases in 2013 and 340 cases in 2014, during the same time period. The total number of cases for 2015 is expected to increase as reports currently under investigation are finalized. Cases have occurred across all ages: 12% of cases occurred in those < 1 year of age, 6% in 1-4 years, 9% in 5-9 years, 37% in 10-19 years, 6% in 20-29 years, and 31% in >30 years of age. Cases have occurred across the state and in multiple schools. Clusters of cases have occurred in families. Pertussis is an endemic disease in the United States, with peaks in reported disease every 3 to 5 years and frequent outbreaks. Currently, CDC has received 16,337 reports of pertussis for 2015 which is a 34% decrease compared with last year at this same time when 24,711 cases were reported. Although national totals are currently lower than last year, some states are reporting increases in disease over the last several months. To prevent the spread of pertussis and to assist with characterization of this increase in pertussis activity, NJDOH urges all healthcare providers to: 1. Recall patients who are not up to date with DTaP and Tdap vaccines 2. Vaccinate pregnant women with Tdap during every pregnancy 3. Report all suspect cases 4. Work with public health officials to ensure that all suspect cases remain home while potentially infectious 4. Follow droplet precautions 5. Obtain optimal specimens for diagnostic testing 6. Provide prompt antibiotic treatment and/or post-exposure prophylaxis Young infants are at greatest risk of severe pertussis infection and its complications. Recommended strategies to protect these infants include ensuring that the mother receives Tdap during her pregnancy and that the infant starts the vaccine series on time at 2 months of age. Subsequent doses should be given 4, 6 and 15-18 months and at 4- 6 years of age. Pertussis-containing vaccines are required for children to attend both public and private licensed child care, preschool, kindergarten, and schools. Although pertussis vaccine is the best prevention against pertussis disease, cases of pertussis can occur in fully vaccinated individuals. The routine immunization schedule is available at www.cdc.gov/vaccines/schedules/index.html Providers, including primary care, Ob/Gyn, family practice and midwives, should ensure that pregnant women receive Tdap during each pregnancy, preferably between 27 and 36 weeks gestation. A strong provider recommendation is the most important factor associated with maternal vaccination and is critical to achieving high rates of vaccination coverage. Providers who care for pregnant women but do not stock Tdap vaccine should refer women for vaccination and follow up to ensure they were vaccinated. Providers should educate pregnant women that infants are at highest risk for serious complications and that vaccination during pregnancy provides for passive antibody transfer to the infant to protect the baby before they are old enough to develop protection from vaccination. Evidence indicates that maternal Tdap can prevent 90% of infant pertussis infections. Pertussis is a highly contagious bacterial infection that begins with nonspecific upper respiratory symptoms that last for 7-10 days, followed by onset of cough. The classic pertussis cough includes persistent paroxysms (coughing fits), an inspiratory "whoop", apnea, and/or post-tussive vomiting. Cough may last weeks to months if not treated early. People with prior history of disease or vaccination may have milder symptoms and lack classic features of disease, making diagnosis more difficult. Maintain a high level of suspicion of pertussis in all patients with a persistent cough. In infants, apnea can be a prominent feature and complications of pertussis include pneumonia, encephalitis, and death. In adults, complications of pertussis include post- tussive syncope and rib fracture, in addition to persistent cough. Individuals are infectious for up to three weeks or until 5 days after the start of effective antimicrobial treatment. Potentially infectious patients should be placed on droplet precautions. If pertussis is suspected based on clinical presentation or known exposure to a pertussis case, clinicians should perform appropriate laboratory testing. Several types of laboratory tests are commonly used for the diagnosis of Bordetella pertussis. Specimens are most likely to be positive when patients have a clinically compatible illness and specimens are collected within the first three weeks of cough onset and before completion of antibiotics. Culture is considered the gold standard because it is the only 100% specific method for identification. Other tests that can be performed include polymerase chain reaction (PCR) and serology. Healthcare providers should collect a nasopharyngeal (NP) swab and send it to a commercial laboratory for polymerase chain reaction (PCR) testing. At this time, since we are trying to better characterize these cases of cough illness, NJDOH is requesting that healthcare providers send pertussis cultures. NJDOH does not recommend serologic testing for pertussis because standardized tests are not available, making the results of commercially available tests difficult to interpret. More information about pertussis diagnostics can be found at: www.cdc.gov/pertussis/clinical/downloads/diagnosis-pcr-bestpractices.pdf and http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html All suspect cases must be reported to the local health department in the jurisdiction in which the patient resides. To prevent further spread of pertussis with the community, healthcare providers and public health officials must work together to ensure that persons suspected to have pertussis remain at home until they are no longer infectious. Provide treatment after collecting diagnostic specimens. Do not wait for the results. Waiting for results facilitates disease transmission. Antibiotic treatment can alleviate symptoms and reduce pertussis transmission if given early in the course of illness. Treatment should be provided to persons aged >1 year within 3 weeks of cough onset and to infants <1 year and pregnant women within 6 weeks of cough onset. Children receiving treatment must stay home and cannot attend child care or school until they have received 5 days of antibiotics: similarly, adults should also stay home for the same time period. Treatment beyond this period is not thought to alter the duration of cough nor transmission to others and is not recommended. Physicians should prescribe either a macrolide or, for macrolide allergic patients, trimethoprim-sulfamethoxazole. Antibiotics should also be provided to close contacts (e.g. household members) of confirmed pertussis cases as post-exposure prophylaxis (PEP) to prevent illness and transmission. The antibiotics and dosing for treatment and prophylaxis are the same. If pertussis is strongly suspected, then PEP should begin while awaiting laboratory confirmation. For antibiotic details, see Table 4 at www.cdc.gov/mmwr/PDF/rr/rr5414.pdf In healthcare facilities, a dose of Tdap is routinely recommended for all healthcare personnel (HCP). HCPs should observe droplet precautions, such as wearing surgical masks, while evaluating suspect pertussis cases. Precautions should be observed regardless of the vaccination status of HCP. HCP with known unprotected exposure to pertussis and who are likely to expose pregnant women or neonates should receive PEP. Other HCP should either receive PEP or be monitored daily for 21 days after pertussis exposure and treated if pertussis symptoms develop. Clinicians should report all suspected cases of pertussis to the local health department. Do not wait until laboratory confirmation to report. Early reporting allows public health officials to investigate cases and assist the facility in identifying those who need post- exposure prophylaxis to prevent further infections. Additional information and resources: http://www.cdc.gov/pertussis/ http://www.state.nj.us/health/cd/pertussis/index.shtml As always, your cooperation is appreciated. This information has been distributed to: DOH Senior Staff; DOH Staff; LINCS Health Officers; LINCS Health Officer Assistants; LINCS Coordinators; LINCS Coordinator Backups; LINCS Epidemiologists; LINCS Health Educators; LINCS Health Planners; LINCS Public Health Nurses; LINCS Regional Health Planners; LINCS REHS; LOCAL Health Officers; LOCAL Public Health; LOCAL CD Investigators; LOCAL Health Educators; LOCAL Public Health Nurses; LOCAL REHS; LOCAL Epidemiologists; Blood Banks; Health Care Organizations; Hospitals / Veterans; LINCS Health Officers (Secondary Email Address); Local Health Officers (Secondary Email Address); Occupational Health Organizations Further distribution of this message should be directed to: Day Care Centers / Preschools; Educational Institutions; Community Health Centers (FQHCs); Emergency Medical Services / First Responders; Health Care Facilities / Other; Health Care Providers; Hospital Emerg Preparedness Coords; Hospital ER Medical Directors; Hospital Infection Control Practitioners; Hospital Medical Directors; Hospital Nursing Directors; Hospitals / Other; Labs / Non-Sentinel; Labs / Sentinel; and other partners in your region, as appropriate. IMPORTANT NOTE: Please do not use reply feature of your email system. If you have questions about the content of this email or any of its attachments, please call your County/City LINCS agency for assistance. LINCS agencies are instructed to contact the individual listed in message above or on the attachment for questions concerning content. Elizabeth B. Rubock, DrPH Bergen County Department of Health Services Strategic Planning & Emergency Response One Bergen County Plaza Hackensack, NJ 07601 201-634-2847 (office) 201-314-2823 (cell) 201-336-6088 (fax) erubock@co.bergen.nj.us