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Children's Health

Alamance County Responds to Whooping Cough Outbreak

More than 95 people in Alamance County have come down with whooping cough since December, prompting an aggressive response.

By Rose Hoban

microscope view of pertussis

Microscopic image of pertussis bacteria. Image courtesy CDC.

Last Friday, more than 200 people braved the cold drizzle and fog to come out to the Mebane Arts and Community Center. They didn’t come for a theater performance, or to see an art installation – they came to get vaccinated against whooping cough.

Since December, more than 95 people in Alamance County (population: 151,529, 2010 Census) have come down with whooping cough, a highly contagious disease marked by long periods of coughing and attempts to catch one’s breath in between coughs.

The disease, known to the medical community as pertussis, gets its common name from the sharp intake of breath required of infected infants and children who sometimes cough hard enough to break blood vessels in their eyes, or break ribs. Infants and toddlers are most likely to die as a result of the disease, but adults can also injure themselves coughing. A case of pertussis can last longer than a month.

“Primarily the cases have been kids,” said Alamance County spokesman Eric Nickers. “From what I’ve seen it’s between the ages of 6 and 10 years old, but not limited to that. We’ve seen a number of adults too.”

Nickers said employees at the Alamance County Health Department have been working full tilt since the initial outbreak in December.

“We’re chugging along, but it’s definitely a draining process,” Nickers said.

Nickers estimates workers at the county health clinic have given 500-600 vaccinations since December, on many days the immunization clinic is standing room only. Health department employees have also been kept busy contacting school officials, local doctors and families, and getting the word out that older kids and adults should get booster shots, especially if they will have contact with infants.

Most of the children in Alamance County have had their childhood shots against pertussis said Zach Moore, an epidemiologist from the North Carolina Division of Public Health. He explained there have been a number of outbreaks of pertussis throughout the US in the past few years, primarily in the 7-10-year-old age group .

“That’s the age when immunity from the childhood [vaccination] series are starting to wane,” Moore said. “It’s right before when people are getting the booster shot recommended for 11-12 year olds.”

Graph of pertussis cases 1990-2010

This graph shows incidence per 100,000 persons of reported pertussis in the United States from 1990-2010. The overall incidence of pertussis has been increasing steadily since 2007 and has now surpassed peak rates observed during 2004-2005. Courtesy, CDC

According to Stacey Martin, an expert on pertussis at the US Centers for Disease Control and Prevention in Atlanta, health officials think the new outbreaks are related to a change in the vaccine about a decade ago.

“The vaccine was a whole cell vaccine, but there were some concerns about that, so we transitioned to an acellular pertussis vaccine,” Martin said.

“Now the kids who got that as infants and toddlers are all 7 to 11 years old. The question is whether there are issues with the duration of protection and a waning of immunity because we are seeing more breakthrough of disease.”

Martin said because of the decrease in immunity over time, now pertussis vaccination is routinely given to adults when they get tetanus boosters. But Martin said that at present, there are no plans to change the timing of vaccines for elementary school-aged children.

“The concern is that when you move the schedule around, you can create pockets of risk in an age group,” Martin said. Instead, public health officials should keep an eye out for the possibility of outbreaks and respond aggressively, like in Alamance County. And the best thing for adults and older children to do in that case is to get a booster shot.

“People can get an antibiotic against whooping cough if they’ve been exposed, but vaccination is better,” Martin said. “Antibiotics only protect you for the time you’re taking the antibiotic. But it’s not a solution for long term prevention.”

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