Whooping cough cases quadruple

An outbreak in the Amish community has caused the number of whooping cough cases in Delaware to nearly quadruple in the last year, and health officials have called for increased outreach.

Through August, there have been 202 reported cases of whooping cough, or pertussis, according to the Delaware Division of Public Health. In all of last year there were only 57.

About 187 of this year's cases were concentrated in the Amish community, starting with an outbreak in western Kent County that began in December, said Dr. Awe Madukah-Ezeh, medical director for the state's public health division.

It's the second largest whooping cough outbreak in the Amish community in the last 10 years; from 2004 to 2005, 345 Amish children and adults came down with the infection. The community does not shun modern medicine, but rather sees healing as a gift from God. Their religious beliefs exempt them from required vaccinations for school children.

Whooping cough, or pertussis, is a bacterial infection in the lungs that is airborne and is most commonly spread from person to person through coughing and sneezing. It's possible that one person can infect up to 15 others. It can even be fatal – according to the CDC, about 10 to 20 babies have died from pertussis each year since 2010 in the United States.

At the Cedar Grove Amish School, near Hartly, head teacher Freeman Yoder, 28, contemplated closing school for two weeks once 14 of his students caught whooping cough. A few parents chose to home-school their children to avoid infection, he said, but ultimately the community kept to their day-to-day activities.

Yoder said he appreciated the division of public health's efforts to contain the disease with free clinics for shots and antibiotics. Officials pushed the vaccine, but still let parents decide, he said, maintaining a welcome balance with the community.

"It's your choice. You don't have to if you don't want," he said of the vaccinations.

Amman Miller, a retired farmer and teacher in West Dover, said that while some families decided to vaccinate their children as an extra precaution, it does not signify any new trends for the community. Their cultural beliefs still stand when it comes to vaccinations.

"Some of these parents, they believe there's poison in that vaccine," Miller, 65, said. "They will just try and stay away from it (whooping cough) and and hope that the people that have it will just stay home."

The outbreak in the Amish community offers a cautionary tale to those who delay getting their full panel of vaccinations for whooping cough, health officials say.

Whooping cough can start off like a simple cold, with a runny nose and sniffles, but after about two weeks, the characteristic cough comes into play. A build up of mucus clogs lungs and causing violent coughs and rough inhaled gasps for air, known as the "whoop" sound.

Half the time, people might not even know they have the infection until they are really sick, Madukah-Ezeh said.

"It's not something that happens and it's sudden. It's on an indolent course compared to other respiratory illnesses," she said.

Four-month-old Elijah Collins of Wilmington is still battling the remnants of whooping cough. In mid-June, at only 9 weeks, Elijah was first diagnosed in a round of whopping cough that would go on to infect the entire family.

"I was not familiar with whooping cough," said his grandmother Angela Carpenter. "The cough was just not going away. It was an all-night process, he was up every half hour."

A week later, her 19-year-old son Brandon caught the cough. He was rushed to the hospital after he started throwing up from the mucus. Shortly after, Brandon's grandparents were diagnosed with whooping cough.

"You never know, you think it's a seasonal cold, you think it's the flu, you think it's bronchitis and then it goes untreated for so long it can be fatal," said Elijah's mother Brianna Collins, 23.

"I know a lot of people don't take it seriously, but when it hits home, it hits home, so it's really good to be prepared."

She paused to look at Elijah, "He was really lucky."

Even with antibiotic treatment, the cough can stay with you for a month or more.

The number of whooping cough cases has risen nationwide over the last four years, said Dr. Ravin, chief of infectious diseases at Nemours/Alfred I. duPont Hospital for Children.

In 2012 there were 48,277 cases across the country, the highest since the 1950s. According to the Centers for Disease Control and Prevention, there were 24,231 cases in 2013.

Ravin said that some physicians attribute that increase to the effectiveness of the whooping cough booster shots children receive before they are 6 years of age, known as DTap.

"That seems to have less long-lasting immunity," she said.

Immunity naturally declines after about two years, so it is imperative to keep up with shots, Ravin said, pointing out the shots are covered by insurance and Medicaid. The division of public health clinics offers free pertussis immunizations to children and youth under 19 if they are uninsured. The vaccine is also available at local pharmacies; without insurance it can cost around $63.

Babies begin their whopping cough vaccinations at 2 months. They should have four doses by the time they reach 2 years of age, Madukah-Ezeh said, reaching five doses by the time they are 6.

Ravin also said it is recommended that women receive a whooping cough vaccine each time they are pregnant. Anyone who is around a new baby should make sure they've had up-to-date vaccines, since immunity can begin to wane after two years.

Ravin calls it cocooning, or creating a "circle of protection" around the baby. One campaign has put billboards on state highways showing a baby refusing to be kissed because the kisser has not been vaccinated.

However, even with the vaccine it is possible to still catch the infection, Madukah-Ezeh said. The symptoms will just be less severe.

While the infection can attack anyone, at any time, it is most risky for babies and those with weakened immune systems.

Babies with whooping cough may turn blue from lack of oxygen, contract pneumonia or develop apnea, life-threatening pauses in breathing.

Jen Rini can be reached at 302-324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.

Pertussis outbreak

57: Number of Delaware cases in 2013

202: Number of cases through August of this year

187: Number of the 202 cases among the Amish