Cases of whooping cough are affecting some Palo Alto middle and high school students, prompting school officials to send students with any type of cough home and to the doctor for testing, a school district spokesman said this week.
The highly contagious disease, also called pertussis, has been confirmed in students at three schools: Jordan Middle School and Palo Alto and Gunn high schools. Students who have already been vaccinated have been confirmed with whooping cough, underlining the importance of receiving booster shots since the shot does not provide lifetime immunity.
The school district has worked closely with public health officials since October, when the first cases were reported at two different schools, said Jorge Quintana, Palo Alto Unified’s communications coordinator. Out of an abundance of caution, any student with a cough has been sent home with instructions to be tested by a physician. Students are not allowed back to school until they have tested negative for the disease or received appropriate antibiotics.
The local outbreak is marked by students who have already been vaccinated, according to the Santa Clara County Public Health Department. The vast majority of cases are part of outbreaks among vaccinated middle and high school students “because immunity from the vaccines wanes rapidly, leading to cyclical increases in pertussis cases every few years,” county officials said in a Dec. 8 advisory. Booster doses are needed throughout life.
Whooping cough is marked by weeks of severe spasmodic coughing, vomiting and gasping for breath with a deep “whooping” inhalation. Pertussis has three stages, which include with what is called a catarrhal stage of flu-like symptoms, sneezing and occasional cough, (but rarely a fever) lasting one to two weeks, according to the California Department of Public Health. The coughing gradually becomes more severe and the patient enters a second, or paroxysmal, stage characterized by spasms of severe coughing and whooping.
Coughing, whooping and vomiting decrease over time, but they may return with subsequent respiratory infections. This third, or convalescent, stage typically lasts six to 10 weeks, according to the state public health department.
The disease is especially harmful to very young children, and deaths do occur in some cases. Infants less than a year old might have a shorter first stage, but they might gag, gasp or stop breathing, according to the public health department. Their face might also turn blue, purple or red. They might not have the the noticeable cough or whoop, officials said.
Because pertussis is spread by coughing, Quintana said any report of a possible case is taken seriously. The district follows county health department protocol and has communicated the health risks to parents, sending letters to parents at the three schools about the outbreak and a more general message to parents of students at all other schools, he said.
The school district and public health department are currently working to address “numerous” cases, but Quintana did not provide a specific number. Santa Clara County had 44 cases of suspected whooping cough between Oct. and Dec. 6. As of Dec. 14, 22 cases were confirmed, according to Santa Clara County Public Health Department officials. That number is not much higher than last year at this time, however, when 17 cases were confirmed, department spokeswoman Joy Alexiou said. But the number could rise once the probable and suspected cases are confirmed, she added.
The state health department recommends that infants start receiving the whooping cough vaccination series, or DTaP, as early as 6 weeks old. Even one dose of the vaccine may offer some protection against fatal whooping cough disease in infants, the department noted. Young children need five doses of vaccine by kindergarten. Students in seventh grade need to have a booster (Tdap), but adults should also receive a booster shot, especially if they are in contact with infants or are health care workers. Most adults have not yet received Tdap, the health department said.
Pregnant women should also receive the booster in their third trimester at the earliest opportunity. Officials recommend the booster during each pregnancy, even when a woman has received the shot beforehand. The booster will help babies during the most vulnerable period after birth until they are old enough to receive the vaccine, officials said.
The latest information on whooping cough can be found on the California Department of Public Health webpage.
Please provide info on local efforts to provide boosters. I’d like to go in and get one but don’t want to flood the system with less urgent requests above childcare workers.
The ‘community immunity’ theory, practiced by so many, appears to be chalking up another point in the complete fail column.
@Eric – More like the “free rider” problem – I’ll let you vaccinate your kids you don’t get my unvaccinated kids sick.
How are the high school handling sending kids home during Finals Week?
Immunization is the term used for the process of both getting the vaccine and becoming immune to the disease as a result of the vaccine.
My student always got a cough starting in October when attending Palo Alto schools because of school environmental problems.. There is a lot the district can do to improve the facilities to make them less a part of the problem so that kids are less susceptible to whatever is going around, especially respiratory. I hope the paper reports how many coughs in total were sent home to give a benchmark for future improvement. People should be concerned that this was an outbreak of vaccinated kids. It’s unclear how much was vaccinated kids whose vaccination schedule was not up to date, but it sounds like it could have been substantial. I hope the health department figures out what might prevent such lapses, or if this is a problem of the vaccines these kids got being subpotent, etc.
I’d like to blame it all on anti-Vaxxers, who are largely to blame.
However, we just found out that some of the vaccines my daughter was given turned out to be DUDS! She currently has a bad cough that started two months ago, and will be tested this week for Pertussis– one of the vaccines that turned out to be duds.
My husband had to go to Thailand, Vietnam and Malaysia on business recently. Before he went, he was required to get certain vaccinations. We just received notice that all four of those vaccinations were duds!
What’s up with PAMF, and why won’t they let us know who the vaccine manufacturers are??
If my vaccinated children turn out to be sick with a preventable disease they were immunized for, I may wish to get compensation from the manufacturer of the faulty vaccines!
Each vaccine has two limitations: (a) an associated efficacy (the power to produce a desired effect) and (b) an associated duration (vaccine-acquired immunity begins to wane immediately after vaccination). Vaccination cannot guarantee immunity b/c a percentage of those vaccinated do not acquire immunity from vaccination. The measles vaccine has a very high efficacy (95% after two shots) and a duration of ~10 yrs; the pertussis vaccine has a relatively low efficacy (40 to 60%) and a duration of ~5 yrs; the flu vaccine has a very low efficacy (less than 10% for those over 65 yrs) and a duration of less than one year. That is, those “vaccinated” who do not acquire immunity (40 to 60% of those receiving the pertussis vaccine, for example) AND those whose vaccine-acquired immunity has waned over time are as susceptible to becoming ill as those who have not received the vaccine.
@ Debbie – Do you have a citation for your claim that the flu vaccine is <10% effective in the elderly? CDC reports a range for the elderly between 58% and 32% depending on how well the vaccine ends up being matched to the flu on a given year.
Regardless, it helps when everyone is vaccinated.
john_alderman: I started here http://www.usatoday.com/story/news/health/2013/02/21/flu-vaccine-doesnt-work-over-65/1934651/, then went to the CDC WMMRs (weekly morbidity and mortality reports) and found https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a2.htm?s_cid=mm6207a2_w, which states in the box just above the graph, “VE [vaccine effectiveness] against influenza A (H3N2) [the most prevalent strain that year] was lower and not statistically significant among adults aged ≥65 years.” I eventually found http://www.cidrap.umn.edu/ongoing-programs/cidrap-comprehensive-influenza-vaccine-initiative-ccivi, downloaded and read the report. Fascinating stuff.
(I was actually researching the pneumococcal vaccine when I found, “… best way to prevent pneumonia is to get flu vaccine …” and switched to that.)
Additional point: You may have read that childhood vaccines no longer contain mercury. That’s true except that … the flu shot, which does contain mercury, IS recommended for children.
“Regardless, it helps when everyone is vaccinated.”
I’m not sure I agree with that. I think it’d help if those who are vaccinated knew whether or not they’d acquired immunity. If they had not, at least they’d know they were vulnerable. It’s an imperfect approach, at best. To protect the most people, especially those too fragile to receive the vaccine, I’d advocate safeguards to limit source(s) of infection, along with vaccination.
Deborah:
For those worried about Thimerosal in the flu vaccine, they can get the single-dose vials or pre-filled syringes, which do not have mercury: https://www.cdc.gov/flu/protect/vaccine/thimerosal.htm
Before children can enter kindergarten parents are required to show that their child’s immunizations are up to date. Why not have the same requirement for children entering middle school?
Up until the mid-1980s, a certificate of health, showing that a student had the appropriate boosters, WAS required at entrance to middle schools!
WHY this changed is something that the California State Superintendent needs to explain!
@No Longer,
Didn’t CA pass a law requiring vaccination for public school attendance, and eliminating the personal beliefs exceptions?
This outbreak was among vaccinated kids. How to prevent it from happening again must focus on the facts, not scapegoating.
@Angry,
Whether your child has pertussis or not, you should be aware of the CDC preliminary report on suicide – I’m not suggesting any risk to your child, but parents should be aware that illness-related absenteeism is one of the major factors the CDC identified in student mental distress and even suicidality. Hopefully not so much at the elementary level, but we don’t know. Please comunicate with other parents and the district about how well they handle absences as well as how it is impacting your child emotionally, and seek help if needed.
Palo Alto schools could be doing far more to reduce the likelihood that kids will come down with communicable illnesses in school. Whether your child has pertussis or not, getting the schools to address the known environmental factors will probably be the single most effective thing families can do to reduce such outbreaks in future. (I don’t think the schools admit kids whose vaccinations are not current anymore, unless they cannot be vaccinated for medical reasons. This outbreak is more a problem of vaccinated kids – but we have yet to hear whether it is because of lapsed boosters, dud vaccines, or some other cause.)
@jh and NoLonger:
Tdap (Tetanus, Diptheria, Pertussis) and MMR boosters are required for 7th grade.
One of my daughter’s close friends caught whooping cough in the Jordan outbreak even though she was vaccinated. There’s not much you can do other than vaccinate and hope you one of the lucky ones, and teach kids to cover their coughs and wash their hands.
@Erin,
In addition to what you mention, there actually is something major that schools can do, which is to follow environmental health best practices for schools, as recommended by the EPA, the CDC, and the CDE (among others). It is possible, according to conaiderable research, to significantly reduce illnesses going around, especially respiratory illnesses of all types, and reduce absenteeism, by following such practices. Parents can contact the EPA for information, or learn more through state and national PTA resolutions.
But it’s interesting that you bring up handwashing. There are many ways that could be improved in our schools, too.
If the schools kept the soap dispensers full, that would help general health. often has empty soap dispensers.
It seems that most of the kids in the Palo Alto School District are treated by either PAMF, Packard, or Stanford Medical Center.
Both Stanford and PAMF have had a history of giving immunizations that turned out to be “duds”, not discovered until months after the fact.
Has anyone at either facility received notification concerning ineffective immunizations? If so, they will give replacement immunizations at no cost, as they have done with previous episodes!