Carroll County Health officials said Wednesday a single confirmed case of pertussis, more commonly known as whooping cough, identified in a Century High School student this week is not a sign of an outbreak.
Troy Barnes, principal at the Eldersburg school, sent an email to parents Wednesday afternoon alerting them of the diagnosis.
"While the risk of contracting this illness is very low as most students have been vaccinated, there is still a slight chance your child could become infected with pertussis," Barnes wrote in the email.
Felipa Gomes, supervisor of health services for Carroll County Public Schools, said the student has been treated and is back in school.
"The nurse is going to keep an eye out for kids showing any signs or symptoms, and will be extra vigilant," Gomes said.
The highly contagious respiratory disease can affect those of any age, often causing serious problems in babies but more mild symptoms in children and adults, according to a Maryland Department of Health and Mental Hygiene fact sheet.
Symptoms include: low fever; runny nose; a cough that worsens into one characterized by deep, rapid coughing and a high-pitched whoop; and vomiting after coughing, according to the DHMH information. They can show up within five to 21 days after a person has been infected, although they normally occur seven to 10 days after, DHMH says.
This instance marks the first confirmed case of pertussis in Carroll County this year, according to Dr. Henry Taylor, acting health officer at the Carroll County Health Department.
"In surrounding counties: Howard had two cases at the beginning of the year; Frederick had one in January; and Baltimore had one this month," Taylor said. "It falls into the category of sporadic cases. At this point, my determination is that it is not an outbreak."
Pertussis is a reportable disease, one that triggers investigation by public health officials.
According to Taylor, the infected student had blood work done at the behest of his or her private physician, and when that blood work tested positive for pertussis antibodies, it triggered a cascade of electronic alerts.
"There was an electronic message sent to the National Electronic Disease Surveillance System, run by [the Centers for Disease Control and Prevention], from there to the state health department and then routed to us because the child lives in Carroll County," Taylor said.
The Carroll County Health Department received the report Friday morning.
When such an alert about a contagious disease comes through, Taylor said, communicable disease nurses from the health department contact the patient, the patient's family and their physician to conduct a questionnaire and determine what further action is warranted to protect public health.
The result of the nurses' interview with the student was a recommendation that a culture be taken for further analysis — by a nasal swab in this case — that Taylor said then confirmed that the student did in fact have pertussis. He said the student's physician has begun treating the student with the appropriate antibiotic.
The health department received the confirmation of the pertussis diagnosis Tuesday morning, according to Taylor, and shared this information with Century High School, which led to the email going out to parents.
A little after 6 p.m. on Wednesday, the health department also sent out a fax to area physicians notifying them of the situation at Century and alerting them to the possible presence of pertussis in the community, as well as making antibiotic treatment recommendations for those who might contract the illness.
Pertussis is a highly contagious, bacterial respiratory illness, according to the Centers for Disease Control and Prevention, with those infected capable of passing the disease to others for up to two weeks after the coughing phase begins.
While the illness often begins with mild, coldlike symptoms, it worsens over the course of one or two weeks until the patient exhibits uncontrollable bouts of coughing that are the characteristic symptom of the disease, according to the CDC. It is the deep breaths of a patient attempting to recover from these coughing fits that create the "whooping" sound that gives the disease its name.
Whooping cough is often less severe in adolescents and adults, according to the CDC, and the "whoop" might be missing from their coughing. Nevertheless, the entire course of the illness, from early coldlike symptoms through the slow recovery, can last as long as 12 weeks, with the severe coughing phase lasting as long as 10 weeks.
According to the CDC pertussis signs and symptoms website, the illness is known as the "100-day cough" in China.
The illness can be fatal, especially in infants and young children, according to the CDC, and is best prevented by the pertussis vaccine, given as one component of the diptheria, tetanus, acellular, pertussis, or DTaP, recommended for infants at 2-, 4- and 6-months old, between 15 and 18 months, as well as children between 4- and 6-years old and again between 11 and 12 years of age.
The parents of the Century student with pertussis contacted the Times to say they were strong believers in vaccination and wanted to the community to know that their child had been fully vaccinated against pertussis according to the recommended schedule but contracted the illness anyway. Because of concerns of medical privacy, they declined to be identified for this story.
In general, the pertussis vaccination fully protects roughly 70 percent of the people who receive it, according to Taylor, while the remaining 30 percent do gain partial protection. Protection from the vaccine also decreases as time passes since a person's last dose, which he said highlights the importance of getting all of the scheduled vaccinations, including a newer recommendation that adults and senior caregivers also get a booster.
"We found that adults have low immunity [to pertussis] and so they can get a cough and spread it to the school-age population," he said. "Even for those people who do not get full protection, they're are getting some protection. It's why we feel vaccination is so important."
The DTaP is one of the required vaccines for students entering Maryland public schools with kindergartners needing proof of at least four cumulative doses of the vaccine or similar variants. Students in grades eight through 12 are required to have at least three cumulative doses.
According to information provided to the Times in February by Filipa Gomes, Carroll County Public School's supervisor of health services, when new students enroll, a school nurse checks their immunization records and then contacts parents of any child who remains unvaccinated.
There are exceptions to the immunization requirement, however. According to Gomes, parents can also supply one of two kinds of exemptions — medical or religious — in lieu of an immunization record. Medical waivers require a physician's note explaining the reason for a permanent or temporary medical exemption, while a religious exemption requires parents fill out a form saying it is against the family's religious beliefs to vaccinate their children.
Carroll County Public Schools had 114 medical and 144 religious vaccination exemptions in the 2014-2015 school year, Gomes said in February. She was unable to be reached for comment by 6:30 p.m. Wednesday.
Despite the exemptions, Taylor said Carroll County is lucky to have a high rate of vaccination among its school-age population — a Maryland Department of Health and Mental Hygiene report on the 2013-2014 school year pegged the DTaP vaccination rate among Carroll kindergartners at 99.6 percent — and that while the health department will remain alert to any further information from area physicians, it is expected that the pertussis infection will be limited to the one current patient.
At the same time, Taylor said that it is worth it for members of the community to be mindful of lingering or worsening cold and cough like symptoms.
"The threshold is that if someone has had a persistent cough for two weeks or more, they should get evaluated for pertussis," he said.
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