Tag: post-exposure prophylaxis

Where Are the Latest Chickenpox Outbreaks?

Chicken pox is a now vaccine-preventable disease thanks to the chicken pox vaccine that was first licensed in 1995.

Despite being added to the childhood immunization schedule in 1996, and the addition of a booster dose in 2007, we do continue to see occasional outbreaks of chicken pox.

Chicken Pox

Although chicken pox is said to have been a rite of passage for kids, it was never something that any of us looked forward to.

At best, you had five to seven days of fever and an itchy rash that covered your body.

“My life changed forever on June 30, 1988, when I had to stand by helplessly as an infectious disease claimed the life of my oldest child, Christopher Aaron Chinnes, at the age of 12.”

Rebecca Cole on Chickenpox Claimed the Life of My Son Christopher

But of course, some people had much more severe cases of chicken pox and some people died.

Chicken Pox Outbreaks

In the pre-vaccine era, before the mid-1990s, most kids got chicken pox.

And chicken pox parties, while not as common as some folks imagine, were definitely a thing, because you didn’t want your child to become an adult and get chicken pox, when it was more dangerous. But since most kids got chicken pox so easily, most got it when they were kids, even without a chicken pox parties, and tragically, many learned that it wasn’t only dangerous to adults.

Why are we still seeing clusters of chicken pox in schools when a safe and effective vaccine is readily available?
Why are we still seeing clusters of chicken pox in schools when a safe and effective vaccine is readily available?

These days, most cases and outbreaks of chicken pox are in unvaccinated children and adults.

  • at least 28 cases at Asheville Waldorf School in West Asheville, North Carolina (Nov 2018)
  • at least 5 cases at Daybreak Primary School in Battle Ground in Clark County, Washington, leading to quarantine of at least 38 unvaccinated students who will be kept out of class for at least 21 days (Oct 2018)
  • at least 5 cases at two schools in Ottawa County, Michigan, including Waukazoo Elementary and Kids First – Early Childhood Center in Jenison, leading to the quarantine of at least 34 children (Oct 2018)
  • a cluster of chicken pox cases in Grant County, Washington at Park Orchard Elementary, North Elementary and Longview Elementary schools (Sept 2018)
  • at least 5 cases at the The Little Red School House Too daycare in Westbrook, Maine (May 2016)

These cases are just the tip of the iceberg though, as there are still about 7,000 to 10,000 chickenpox cases reported in the United States each year. And that’s with some states, like Oregon and Washington, not reporting cases of this Nationally Notifiable Condition to the CDC.

Cognitive dissonance helps explain how these folks try to explain that chicken pox isn't dangerous.
Cognitive dissonance helps explain how these folks try to explain that chicken pox isn’t dangerous.

Still, since chicken pox caused a few hundred deaths and at least 10,000 hospitalizations each year less than twenty-five years ago, that’s a lot of progress.

Getting Chicken Pox

How do you get chicken pox?

Since it is very contagious, if your child is exposed to someone with chicken pox or shingles, then they might develop chicken pox in about 10 to 21 days (incubation period).

Of course, if they vaccinated and protected, then they probably won’t, although mild, breakthrough chicken pox infections are still possible in vaccinated kids.

Their risk is higher if they:

  • are unvaccinated, either intentionally, because they have a true medical exemption, or because they are too young for the vaccine, which is first given when kids are 12-months-old
  • are partially vaccinated, with only one dose of the chicken pox vaccine
  • have a problem with their immune system, including kids getting chemotherapy

In addition to being at risk for chicken pox, non-immune pregnant women, newborns born to women who develop chicken pox at around the time of delivery, premature babies, and those are immunocompromised can be at risk for severe disease.

Avoiding Chicken Pox

Want to avoid chicken pox and the chance of ending up in a chicken pox quarantine and having to stay out of school for 3 weeks or more?

Get your kids vaccinated.

That’s not an option for some kids with true medical exemptions though, including most kids who are immunocompromised. When they get caught up in one of these outbreaks and get exposed to chicken pox, it becomes a matter of life and death to work to try and prevent their getting chicken pox.

More on Chicken Pox Outbreaks

 

Believe It or Not, Chicken Pox Parties Are Still a Thing

Do you remember having chicken pox?

Oh boy, I sure do!

I was about six or seven years old and it was bad. Still, I’m not sure if I remember because I had such a bad case or because it made me miss Halloween that year.

It was almost certainly both, as I remember being covered in spots from head to toe.

What I don’t recall is having many visitors. Why didn’t my mom throw me a chicken pox party!

I also don’t remember going to a chicken pox party to get sick.

Believe It or Not, Chicken Pox Parties Are Still a Thing

Whether or not chicken pox parties were ever that popular, the approval of the chicken pox vaccine in 1995 should have put an end to the practice.

After all, why intentionally expose your child to a potentially life-threatening disease, when a safe and effective vaccine is readily available?

“Chickenpox (varicella) is generally a much milder illness in children than in adults, with considerably lower rates of severe disease and death. Varicella is also virtually universal in many populations, meaning that very few individuals escape infection over a lifetime. Thus, a sound logic underlies the idea of chickenpox parties, at which susceptible children can acquire the contagious causative pathogen, varicella zoster virus (VZV), from their peers. However, chickenpox is not without risks, even for children of this age; severe, complicated, and occasionally fatal varicella occur in previously healthy children, as well as the immunocompromised (who are at very considerable risk).”

Hambleton et al on Chickenpox Party or Varicella Vaccine?

Most folks understand that. They get their kids vaccinated and have helped get chicken pox under very good control, with outbreaks of chicken pox declining over 95%.

“Each year, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States”

CDC on Monitoring the Impact of Varicella Vaccination

Apparently, not everyone has gotten the message though.

Remember when CPS had to investigate the mom who was having chicken pox parties in Plano, Texas a few years ago?

“On the page, parents post where they live and ask if anyone with a child who has the chicken pox would be willing to send saliva, infected lollipops or clothing through the mail.”

CBS 5 Investigates mail order diseases

Or when anti-vaccine folks were selling and mailing lollipops contaminated with chicken pox to folks so that they could skip the trouble of finding a chicken pox party?

And then there’s that time that a family served chicken pox contaminated punch at their chicken pox party. Oh wait, that was The Simpsons

Chicken pox party - The Simpsons did it.
Chicken pox party – The Simpsons did it in the Milhouse of Sand and Fog episode in Season 17.

So what are they up to now?

Folks are still advertising chicken pox parties in anti-vaccine Facebook groups.
Folks are still advertising chicken pox parties in anti-vaccine Facebook groups.

More of the same…

Does she know that the chicken pox vaccine likely decreases your risk of getting shingles later in life?
Does she know that the chicken pox vaccine likely decreases your risk of getting shingles later in life?

Apparently, there are still plenty of folks looking for chicken pox parties to infect their kids.

Why?

It is easy to see a lot of cognitive biases at play in the decision to host or bring a child to a chicken pox party, including ambiguity aversion (prefer what they think are the known risks of getting the disease), bandwagoning (they think everyone else is doing it, because in their echo chambers of anti-vaccine propaganda, everyone might), and optimism bias, etc.

There is also a very poor perception of risks, as the risks from a natural chicken pox infection are far, far greater than any risk from the vaccine.

Don't forget to tent!!!
Don’t forget to tent and share breath!!!

In bigger news, Facebook has groups who’s mission is “finding pox,” so that parents can get their kids sick!

The mission of PX Colorado is finding pox!
The mission of PX Colorado is finding pox!

How many other PoX type groups are there on Facebook?

How many other parents are intentionally not vaccinating their kids and intentionally exposing them to chicken pox?

Do any of them quarantine or isolate their kids for 10 to 21 days after the chicken pox party, so as to not expose anyone who is too young to be vaccinated, too young to be fully vaccinated, or has a true medical exemption to getting vaccinated, including those who are immunocompromised?

Do they understand the consequences of having these pox parties?

The latest chicken pox party hostess is apparently a nurse - at least for now...
The latest chicken pox party hostess is apparently a nurse – at least for now…

Of course, an investigation from CPS, the health department, or a medical board isn’t the most serious consequence that should discourage folks from hosting or attending a chicken pox party.

Chicken pox can be a serious, even life-threatening infection. Sure, many kids just get a mild case, but others get more serious cases and have bad complications, including skin infections, encephalitis, sepsis, or stroke.

And some people do still die from chicken pox, which is supposed to be a mild, childhood illness.

“This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years.”

Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009

Fortunately, these deaths have been nearly eliminated thanks to the chicken pox vaccine.

And that’s why parents who are on a mission for “finding pox” should rethink things and switch to a mission to get their kids vaccinated and protected.

More on Chicken Pox Parties

Can You Treat Tetanus Without a Tetanus Shot?

Why would anyone want to try and treat tetanus without a tetanus shot?

That’s a good question…

Misinformation about tetanus from the PIC.

Why would a doctor tell others that tetanus could be treated without a tetanus shot?

That might be a question for a state medical board…

Can You Treat Tetanus Without a Tetanus Shot?

As most people will notice, even looking at the ironically named Physicians for Informed Consent’s own post, you don’t treat tetanus without a tetanus shot.

“Tetanus is a medical emergency requiring hospitalization, immediate treatment with human tetanus immune globulin (TIG), agents to control muscle spasm, aggressive wound care, antibiotics, and a tetanus toxoid booster. If tetanus immune globulin is unavailable, Immune Globulin Intravenous (IGIV) can be used.”

CDC on Tetanus for Clinicians

Even in the study that they used as a reference clearly used both tetanus immune globulin and a tetanus shot.

What might be confusing to some folks, is that tetanus toxoid, is synonymous (has the same meaning) as:

  • tetanus vaccine
  • tetanus shot
  • Td (tetanus toxoid + diphtheria toxoid)

So like most people with tetanus, this patient received both tetanus immune globulin and a tetanus vaccine, a fact I tried to point out so that visitors to Physicians for Informed Consent could get true informed consent about their vaccine choices.

The comment that got me banned from posting on Phyicians for Informed Consent.
As often happens on anti-vaccine sites, my comment was quickly deleted and I was banned from posting further messages.

And fortunately, the patient, who’s previous immunization history was unknown, got better!

Treating Tetanus With a Tetanus Shot

Why did he have tetanus?

The case they are talking about occurred in Japan, and again, it isn’t known if the patient had ever received a tetanus vaccine.

“In Japan, tetanus toxoid was introduced in 1968, so elderly adults who were born before 1968 have high risk of tetanus.”

Tomoda et al. on Tetanus without apparent history of trauma

He was born in 1950 and although he had no history of recent trauma, “he grew vegetables in a field as his hobby.”

As most people know, gardening is a risk factor for getting tetanus.

And with such a long incubation period, it is very likely that he had a minor wound or injury while gardening, was exposed to tetanus spores, and later developed tetanus symptoms.

Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.
Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.

The long incubation period is also the reason that giving a tetanus vaccine works to prevent you from getting tetanus even after you have been exposed. Tetanus spores have to germinate, the bacteria have to grow and then produce exotoxins. And then the exotoxins have to travel to different sites in your nervous system, where they act as neurotoxins.

Hopefully, before they do, the dose of tetanus vaccine you got when you pricked your finger on a thorn, stepped on a nail, or cut your leg, etc., will have already induced you to start making antibodies against the exotoxins – antitoxin. Just in case they don’t, in a high risk case, you also would have gotten a dose of tetanus immune globulin for an immediate dose of antitoxin – antibodies against the exotoxins.

The same thing happens if you have already developed tetanus symptoms. A dose of tetanus immune globulin helps to neutralize neurotoxins that haven’t already started doing damage, and you get supportive care until you recover. Plus antibiotics to kill the bacteria so they won’t make more exotoxins and a tetanus shot.

Why not just give tetanus immune globulin, as the post from Physicians for Informed Consent implied you can do?

It is mostly because a tetanus infection doesn’t stimulate any natural immunity and the immunity you get from tetanus immune globulin is temporary, so won’t prevent a relapsing or recurrent case.

Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.
Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.

And because no one would substitute a treatment that is known to work well, a tetanus vaccine with tetanus immune globulin, and switch it out for one that might be riskier and have no extra benefits.

Using immune globulin alone was once the recommended treatment. That was before the tetanus vaccine was developed though. Back then, in the late 19th century and early 20th century, folks with suspected tetanus got treated with anti-tetanic serum that was made in horses. The main problem with this tetanus antitoxin was that it could sometimes trigger serum sickness.

Fortunately, a tetanus vaccine was soon developed and it’s use with tetanus immune globulin helped make deaths from tetanus very rare.

Of course, tetanus is still around. Although it is a vaccine-preventable disease, it will never be eradicated, like smallpox.

“This case had no apparent portal of entry; there was no history of trauma, and no site was found on physical examination. However, this is not uncommon; no obvious entry site was reported in approximately 26% of cases in Japan.”

Tomoda et al. on Tetanus without apparent history of trauma

And not specific to Japan, that you can get tetanus without a history of trauma should be what really concerns folks in this article that the Physicians for Informed Consent has decided to spotlight.

It is a great reminder that vaccines are necessary.

More on Treating Tetanus Without a Tetanus Shot

Costs of a Measles Outbreak

The endemic spread of measles was eliminated in the United States in 2000, but unfortunately, that hasn’t stopped us from having outbreaks of measles each year.

Since reaching a record low of just 37 cases of measles in 2004, other milestones in the measles timeline we should all know about include that there were:

  • 220 measles cases in 2011, a 15-year record and the highest number of cases since 1996 at least until 2014, when we had at least 667 cases
  • 58 cases in the 2013 New York City measles outbreak and for a short time, the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 382 cases in the 2014 measles outbreak in Ohio and now the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 170 measles cases in the first few months of 2015, including a large outbreak in California that was linked to Disneyland.
  • 188 cases and a measles death in 2015

That’s still far below where we used to be though, especially when you consider that before the first measles vaccine was licensed, there was an average of about 549,000 measles cases and 495 measles deaths in the United States each year.

Containing a Measles Outbreak

Several factors help to limit the measles outbreaks that we continue to see in the United States. Most important is that fact that despite the talk of personal belief vaccine exemptions and vaccine-hesitant parents not getting their kids vaccinated, we still have high population immunity.

In the United States, 90.8% of children get at least one dose of the MMR vaccine by the time they are 35 months old and 91.1% of teens have two doses. While not perfect, that is still far higher than the 81% immunization rates the UK saw from 2002 to 2004, when Andrew Wakefield started the scare about the MMR vaccine. Instead of overall low immunization rates, in the U.S., we have “clusters of intentionally under-vaccinated children.”

It also helps that the measles vaccine is highly effective. One dose of a measles vaccine provides about 95% protection against measles infection. A second, “booster” dose helps to improve the effectiveness of the measles vaccine to over 99%.

To further help limit the spread of measles, there are a lot of immediate control measures that go into effect once a case of measles has been suspected, from initiating contact investigations and identifying the source of the measles infection to offering postexposure prophylaxis or quarantining close contacts.

That’s an awful lot of work.

A 2013 measles outbreak in Texas required 1,122 staff hours and 222 volunteer hours from the local health department to contain.

Costs of a Measles Outbreak

In addition to requiring a lot of work, containing a measles outbreak is expensive.

A study reviewing the impact of 16 outbreaks in the United States in 2011 concluded that “investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts.”

We still don’t know what it cost to contain many big outbreaks, like the one in Ohio, but we do know that it cost:

  • over $2.3 million to contain the 2017 outbreak in Minnesota – 75 people got measles, 71 were unvaccinated, and more than 500 people were quarantined over a 5 month period
  • up to an estimated $3.91 million (but likely much more) to contain the 2015 outbreaks in California
  • $394,448 and 10,054 personnel hours in total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene responding to and controlling the 2013 outbreak in NYC
  • two unrelated cases in Colorado in 2016 cost $49,769 and $18,423, respectively to investigate
  • $50,758.93 to contain an outbreak at a megachurch in Texas
  • $150,000 to contain (13 cases) an outbreak in Cook County, Illinois
  • $223,223 to contain (5 cases, almost all unvaccinated) to contain another outbreak in Clallam County, Washington, an outbreak that was linked to the death of an immunocompromised woman.
  • more than $190,000 of personnel costs in Alameda County, with 6 cases and >700 contacts, it is estimated that over 56 staff spent at least 3,770 hours working to contain the outbreak
  • $5,655 to respond to all of the people who were exposed when a 13-year-old with measles was seen in an ambulatory pediatric clinic in 2013
  • $130,000 to contain a 2011 measles outbreak in Utah
  • $24,569 to contain a 2010 measles outbreak in Kentucky
  • $800,000 to contain (14 cases, all unvaccinated) a 2008 measles outbreak at two hospitals in Tuscon, Arizona
  • $176,980 to contain a 2008 measles outbreak in California
  • $167,685 to contain a 2005 measles outbreak in Indiana – unvaccinated 17-year-old catches measles on church mission trip to Romania, leading to 34 people getting sick, including an under-vaccinated hospital worker who ends up on a ventilator for 6 days
  • $181,679 (state and local health department costs) to contain a 2004 measles outbreak in Iowa triggered by a unvaccinated college student’s trip to India
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994. How much did these outbreaks cost to contain?

It is important to keep in mind that these costs are often only for the direct public health costs to the county health department, including staff hours and the value of volunteer hours, etc. Additional costs that come with a measles outbreak can also include direct medical charges to care for sick ($14,000 to $16,000) and exposed people, direct and indirect costs for quarantined families (up to $775 per child), and outbreak–response costs to schools and hospitals, etc.

We should also consider what happens when our state and local health departments have to divert so much time and resources to deal with these types of vaccine-preventable diseases instead of other public health matters in the community. Do other public health matters take a back seat as they spend a few months responding to a measles outbreak?

There were 220 cases of measles in the United States in 2011. To contain just 107 of those cases in 16 outbreaks, “the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

In contrast, it will costs about $77 to $102 to get a dose of the MMR vaccine if you don’t have insurance. So not only do vaccines work, they are also cost effective.

What to Know About the Costs of a Measles Outbreak

Containing a measles outbreak is expensive – far more expensive than simply getting vaccinated and protected.

More on the Costs of a Measles Outbreak

When Was the Last Time Someone Died from Being Bitten by a Rabid Dog in the United States?

Most people aren’t overly worried about rabies these days, at least not in the United States.

In the mid-1950s, rabies control programs began to get more and more dogs vaccinated against rabies.
In the mid-1950s, rabies control programs began to get more and more dogs vaccinated against rabies.

Is that because rabies isn’t around anymore?

Of course not. It is because a rabies vaccine has long been available both to prevent our pets from getting rabies from wild animals and to protect us if we are ever bitten by an animal that might have rabies.

Hopefully, especially after the recent rabies death of the 6-year-old in Florida, everyone understands that rabies is still around.

When Was the Last Time Someone Died from Being Bitten by a Rabid Dog in the United States?

Since 2008, at least 21 people have died of rabies in the United States, mostly after getting exposed to rabid bats.

There were more than a few exposures from dogs with rabies too. In fact, the last rabies death after a dog bite was not very long ago – it was in May 2017.

Exposure to rabid dogs typically happened while the person was out of the United States.
Exposure to rabid dogs typically happened while the person was out of the United States.

Does that mean that something isn’t working with our rabies prevention plans?

When you take a closer look at the statistics about rabies deaths after dog bites, it becomes clear where the problem is.

“In 1950, for example, 4,979 cases of rabies were reported among dogs, and 18 cases were reported among humans. Between 1980 and 1997, 95 to 247 cases were reported each year among dogs, and on average only two human cases were reported each year in which rabies was attributable to variants of the virus associated with indigenous dogs . Thus, the likelihood of human exposure to a rabid domestic animal in the United States has decreased greatly.”

Human Rabies Prevention – United States, 1999 Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Most rabies deaths in the United States from dogs occur in people who get bitten while they are traveling outside the country.

So when was the last human rabies death from a rabid domestic dog in the United States?

A 7-year-old girl died after she was bitten by a rabid dog in Texas in June 1979. Before that, in 1968, a 13-year-old boy died after getting bit by a rabid dog in Kansas.

That’s a long time ago.

Does that mean the rabies vaccine isn’t necessary anymore?

Rabies Vaccines Work

Of course not! That means the rabies vaccines works!

Two Indonesian boys proudly show off their puppy and her vaccination record.
Two Indonesian boys proudly show off their puppy and her vaccination record. Photo by the rabiesalliance.org.

There are two reasons that we don’t see human rabies deaths from dog bites in the United States anymore, unless the bites occur in another country:

  1. Most of us vaccinate our pets – fewer dogs and cats with rabies means that there are fewer chances for us to get bit and get rabies.
  2. Most folks get proper treatment if they are exposed to an animal that could possibly have rabies, whether it is an unvaccinated dog or cat, or a raccoon, skunk, fox, coyote, or bat. In fact, about 40,000 to 50,000 people in the United States get rabies post-exposure prophylaxis each year.

If you don’t believe this, just look back at what rabies was like in the pre-vaccine era, when dogs and cats would get rabies, and so would their owners. In the early 1960s and 1950s, rabies deaths from dog bites were more common, about 10 each year.

“The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one or two per year in the 1990’s. Modern day prophylaxis has proven nearly 100% successful.”

CDC on Rabies in the U.S.

To understand just why rabies vaccines still so necessary,  you can also look at what is still happening around the world where rabies vaccines aren’t used as commonly as they are in more industrialized countries.

“Despite substantial gains in tackling this neglected disease, more than 20,000 people still die from rabies every year, mostly in Asia and Africa.”

Schneider et al on Substantial reductions in rabies, but still a lot to be done

In addition to the deaths from folks traveling outside the United States, there are many more rabies deaths in people, mostly children, who live in areas where rabies is still endemic.

Hopefully these deaths will end soon too, as experts from WHO, Food and Agriculture Organization (FAO), International Organisation for Animal Health (OIE) and the Global Alliance for Rabies Control (GARC) work together in the United Against Rabies collaboration to achieve “Zero human Rabies deaths by 2030.”

Because it has an animal reservoir, the rabies virus will likely always be around, and won’t be eradicated like smallpox, but hopefully we can one day control rabies by having fewer rabies exposures (vaccinate more of our pets) and we can eliminate dog-transmitted rabies deaths.

We won’t get there if folks continue to push myths and propaganda about rabies and the rabies vaccine.

What to Know About Controlling Rabies and Rabies Deaths

It has been a long time since someone in the United States died with rabies from a domestic dog bite, but that is simply a testament to the fact that vaccines work.

More on Controlling Rabies and Rabies Deaths

What to Do If Your Child Is Exposed to Pertussis

Although things are much better than they were in the pre-vaccine era, we still have pertussis outbreaks in the United States.

How does that work?

Waning immunity and folks who are unvaccinated.

How Contagious is Pertussis?

Pertussis is very contagious, but not quite as contagious as other vaccine-preventable diseases, such as measles.

That’s why the focus on controlling pertussis outbreaks is usually looking at close contacts – those who were within about 3 feet for at least 10 hours a week or who had direct face-to-face contact with the person when they were contagious.

Have you gotten a letter from your child's school about pertussis yet?
Have you gotten a letter from your child’s school about pertussis yet?

So when you get a letter about a possible case of pertussis in your child’s school, it may be a a general warning and not that your child is at risk.

How do you get pertussis?

“Persons with pertussis are infectious from the beginning of the catarrhal stage through the third week after the onset of paroxysms or until 5 days after the start of effective antimicrobial treatment.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Spread by respiratory droplets (coughing and sneezing), pertussis symptoms usually start about 5 to 10 days after being exposed to someone else who is in the early stage of their pertussis infection.

While pertussis symptoms can linger for up to 10 weeks, someone who has pertussis is most contagious during the first 2 or 3 weeks of symptoms.

Is Your Child Protected Against Pertussis?

Two pertussis vaccines, DTaP and Tdap, help protect us against pertussis.

In the Unites States, they are routinely given as a primary series (DTaP) at 2, 4, and 6, and 15 to 18 months, with a booster dose at age 4 years. And then a booster of Tdap at age 11 to 12 years. Later, Tdap is given again during each pregnancy, between 27 and 36 weeks gestation. Adults who have never had a dose of Tdap should get caught up, especially if they will be around a baby.

Protection from the pertussis vaccines wanes or wears off, so even fully vaccinated children and adults can still get pertussis. Of course, you are much more likely to get pertussis if you are unvaccinated and you will likely have more severe illness if you are unvaccinated.

Postexposure Antimicrobial Prophylaxis for Pertussis

Fortunately, as with meningitis was caused by Neisseria meningitidis and Haemophilus influenzae type b (Hib), taking antibiotics after being exposed to someone with pertussis can help prevent you from getting sick.

There are only specific situations for which this type of postexposure antimicrobial prophylaxis is recommended though, so for example, you wouldn’t usually give everyone in a school antibiotics because a few kids had pertussis.

Why not give antibiotics to everyone who might have been exposed to someone with pertussis?

“…there are no data to indicate that widespread use of PEP among contacts effectively controls or limits the scope of pertussis outbreaks.”

Postexposure Antimicrobial Prophylaxis

In addition to the fact that it likely wouldn’t stop our pertussis outbreaks, overuse of antibiotics can have consequences.

Situations in which postexposure antibiotics (azithromycin, clarithromycin, and erythromycin, or Bactrim) likely would be a good idea include:

  • household contacts of a known pertussis case
  • to help control an outbreak in a limited closed setting, like a daycare
  • contacts of a pertussis cases who are at high risk for severe pertussis, including pregnant women, infants, especially infants less than 4 months old, and people with chronic medical problems
  • contacts of a pertussis cases who are also contacts of someone who is at high risk for severe pertussis

What if you were exposed to someone with pertussis and have already gotten sick?

If your child was exposed to pertussis and is now coughing, then in addition to antibiotics, pertussis PCR testing and/or culture will also likely be done to confirm that they have pertussis. And remember that their contacts might need postexposure antibiotics.

Kids who have been exposed to pertussis and who have been coughing for more than 3 weeks won’t need antibiotics or testing, as it is too late for the antibiotics to be helpful and likely too late for testing to be accurate. Fortunately, after 3 weeks, they should no longer be contagious.

What to Do If Your Unvaccinated Child Is Exposed to Pertussis

Unvaccinated kids who are exposed to pertussis should follow the postexposure antimicrobial prophylaxis guidelines.

They should also get caught up on their immunizations, including DTaP if they are between 2 months and 6 years, or Tdap if they are older.

What to Do If Your Vaccinated Child Is Exposed to Pertussis

Since protection from the pertussis vaccines wanes, even kids who are fully vaccinated should follow the postexposure antimicrobial prophylaxis guidelines if they are exposed to pertussis.

Then why get vaccinated?

Again, being vaccinated, your child will be much less likely to get pertussis than someone who is unvaccinated. Even though the pertussis vaccine isn’t perfect, it has been shown that children who had never received any doses of DTaP (unvaccinated children) faced odds of having pertussis at least eight times higher than children who received all five doses.

What to Know About Getting Exposed to Pertussis

Talk to your pediatrician if your child gets exposed to pertussis to make sure he doesn’t need post-exposure prophylaxis to keep him from getting sick, even if you think he is up-to-date on his vaccines.

More on Getting Exposed to Pertussis

How to Avoid a Quarantine During an Outbreak at Your School

Believe it or not, hundreds of kids get caught up in quarantines for vaccine-preventable diseases in the United States each year.

Quarantines were routine in the pre-vaccine era.
Quarantines were routine during pre-vaccine era epidemics.

Wait, what?

Caught up in quarantines for vaccine-preventable diseases?

Then why do we have vaccines?

How to Avoid a Quarantine During an Outbreak at Your School

Is it fair that unvaccinated students need to stay home when there is an outbreak of a vaccine-preventable disease?
Is it fair that unvaccinated students need to stay home when there is an outbreak of a vaccine-preventable disease?

As you have probably already guessed, these aren’t usually vaccinated kids that are getting sick or quarantined in these outbreaks of measles, meningococcemia, and chicken pox, etc.

That’s right, they are unvaccinated.

Typically intentionally unvaccinated, although they are sometimes too young to be vaccinated or may have a medical exemption.

And that brings up to a few very easy ways to avoid getting quarantined during an outbreak:

  1. make sure you are always up-to-date on all of your vaccines
  2. if you think that you have natural immunity (already had the disease) or were vaccinated, but don’t have your immunization records, then getting a titer test might keep you out of quarantine if you can prove that you are immune
  3. get vaccinated, if possible, at the first sign of the outbreak, which might help you avoid quarantine in the case of measles and chicken pox

“Persons who continue to be exempted from or who refuse measles vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

That’s right, especially in the case of measles, you can often avoid being quarantined if you simply get vaccinated.

Unvaccinated children exposed to measles are quarantined for at least 21 days.
Unvaccinated children exposed to measles are typically quarantined for at least 21 days.

Why are quarantines important?

Can’t you just isolate yourself if you get sick?

The problem with that strategy is that you are often contagious before you develop symptoms. That’s especially true of measles, when you likely won’t even realize that you have measles until you get the measles rash, after having a high fever for three to five days. That’s why people with measles are often seen at clinics and emergency rooms multiple times, exposing many people, before they are finally diagnosed. It is the classic signs of a rash with continued fever that helps to make the diagnosis.

Without quarantines of unvaccinated people, especially those who are known exposures to other cases, today’s outbreaks would be even bigger and harder to control.

If you don’t want to take the risk of being quarantined and missing weeks or months of school or work, then don’t take the risk of being unvaccinated. Tragically, that’s not the only risk you take when you skip or delay your vaccines. In addition to getting sick, you also risk getting others sick, including those who didn’t have a choice about getting vaccinated yet.

What to Know About Avoiding Quarantines During an Outbreak

The easiest way to avoid getting caught up in a quarantine for a vaccine-preventable disease is to simply make sure your kids are up-to-date on all of their vaccines.

More on Avoiding Quarantines During an Outbreak