Pertussis costs add up for Health Department

Flathead City-County Health Department documented $31,228 in staff time and lab tests spent responding to pertussis (whooping cough) from October to January — with no end in sight in February.

In a report to the Health Board on Thursday, Community Health Services Director Jody White said the staff handled contacts for 90 cases from October to January. During all of 2012, the staff worked on a total 139 cases, plus another 29 in January 2013.

White said the continued spread isn’t related to people exposed not following recommendations to take antibiotics. She said the last three cases this month had no connection to previous cases.

In response to a board member question, White said 70 percent all cases had been immunized for pertussis.

“Of the last three, all had been immunized to date for their age,” she said.

White said two teenagers had gotten a booster shot and an elementary school child had the shots required through kindergarten.

Board members talked about a new strain of the pertussis virus discovered in the United States. Researchers found the current vaccine doesn’t provide immunity from the new strain but it appears to shorten the length of illness.

At earlier meetings, board members had talked about problems with the vaccine not providing immunity for as long as expected.  Board member Dr. David Myerowitz said a recent study in California correlated infection with patients who had the longest period since vaccination or booster.

White told the board that the staff has noted a “very atypical presentation of pertussis” that reinforces that finding.

She said a child may have just a small cough but gets tested for pertussis as a precaution and comes up unexpectedly positive. She said health officials follow up these cases within a month to find out about the course of their illness.

“Usually we would expect that person to be symptomatic for two months,” White said. “What we’re finding, especially teenagers, is that they are only sick for a few weeks.”

White said that observation lends some support for immunizations at least shortening the course of the illness if they don’t prevent it.

Board members initially requested the report on the cost of pertussis contact work to use in discussions with local school officials and boards on more rigorous enforcement of vaccinations required by state law. Myerowitz said his personal opinion was the schools should “buy into this.”

“If we’re going to spend $30,000 to make sure there’s follow-up and treatment of contacts, the schools should share in this burden,” he said.

White said school officials “have been wonderful” in working with the health department staff on identifying people in contact with a sick student.

Myerowitz said he doesn’t expect the county pertussis problem to go away any time soon. An active advocate of immunizations, he said it’s difficult to motivate people to immunize against pertussis because, except for infants, the disease isn’t fatal like smallpox and doesn’t cause long-term damage like polio.

He mentioned an infant very ill with pertussis who was sent to Missoula for treatment.  

“I’ve said it before but it’s going to take some type of horrible tragedy to get people’s attention,” he said.

White said the staff keeps trudging away with contacts because they have sometimes discovered an infant living with those exposed and provided the antibiotics to render those people not contagious.

“That’s what keeps us going,” she said.

Reporter Candace Chase may be reached at 758-4436 or by email at cchase@dailyinterlake.com.