Whooping Cough Kills 5 in California; State Declares an Epidemic

Whooping Cough Kills 5 in California; State Declares an Epidemic
By JESSE McKINLEY
Copyright by The New York Times
Published: June 23, 2010
http://www.nytimes.com/2010/06/24/us/24cough.html?th&emc=th


SAN FRANCISCO — After the deaths of five infants, California health authorities declared an epidemic of whooping cough in the state on Wednesday, urging residents — particularly those of Latino background — to get vaccinated against the disease.

The announcement came after authorities noticed a sharp spike in reports of pertussis, the scientific name for whooping cough, which often is mistaken for a cold or the flu and is highly contagious. All told, 910 cases have been confirmed, with several hundred more under investigation. If the pace keeps up, the outbreak could be the largest in the state in 50 years, the California Department of Public Health reported.

Dr. Gilberto Chavez, the deputy director of the department’s Center for Infectious Disease, said health officials had seen a fourfold increase compared with 2009. And the worst may be to come.

“The peak season starts in the summer,” Dr. Chavez said, noting that July and August usually have the highest number of cases. “And we expect to see a much larger number of cases if we don’t intervene quickly.”

For five families, however, the state’s warning has come too late. Five children — all Latino and all under the age of 3 months — have died since the beginning of the year, Dr. Chavez said.

Dr. Chavez said that lack of information and inoculations in agricultural regions in the state’s Central Valley — home to many Latino farm workers — might be a culprit in the high incidence in that community. And indeed, Fresno County — in the heart of the valley — has the highest number of cases in the state, with 72 reported in May alone.

Periodic outbreaks of pertussis are not uncommon. The disease is endemic worldwide, and some 5,000 to 7,000 cases are reported in the United States in a normal year, according to the Centers for Disease Control and Prevention. Epidemics occur every three to five years in the United States, with the most recent in 2005, when there were more than 25,000 reported cases nationwide, and nearly 3,200 in California, where 7 people died.

Jeff Dimond, a spokesman for the C.D.C., said that California was the only state reporting an epidemic of pertussis at this point, though reporting of the disease can be spotty or delayed.

Infants are typically inoculated against pertussis at two months, but adequate protection does not occur until six months, leaving them susceptible. Boosters are recommended in middle school, adolescence and through adulthood as immunity — either from inoculation or having had the disease — diminishes over time.

Pertussis usually manifests itself slowly, like a mild cold, said Dr. Chavez, with a runny nose or mild cough, but can steadily progress into coughing fits resulting in its telltale “whoop.”

David Luchini, a spokesman for the Fresno County Department of Public Health, said health officials there were still pushing to get the word out, online and in person, particularly to adolescents and adults who might transmit the disease to infants and whose vaccinations may have waned. “That way,” he said, “you cocoon them from this.”