Update on California's Pertussis Epidemic Pertussis activity continues at epidemic levels in Orange County and statewide. As of 8/16/2014, 250 pertussis cases have been reported in Orange County, compared with 43 cases at this time last year. Pertussis peaks in incidence every 3-5 years as the number of susceptible people in the population increases; the last epidemic in California was in 2010. Infants under 12 months of age are at highest risk for severe infection and death. To protect this vulnerable population the following is recommended: Immunize pregnant women with Tdap during every pregnancy at 27-36 weeks gestation. This dose protects mom and provides the infant with high levels of protective transplacental antibodies. Encourage close contacts of infants to be up-to-date with their pertussis vaccine (cocooning). Vaccinate infants and children with DTaP followed by Tdap according to the childhood immunization schedule: http://www.cdc.gov/vaccines/vpdvac/pertussis/recssummary.htm Diagnostic Testing: Suspect pertussis cases should be tested by nasopharyngeal PCR. PCR is most sensitive within 3 weeks of the onset of the cough (up to 6 weeks for infants). Consider obtaining a CBC: a WBC count that is ≥ 20,000/mm3 with ≥ 10,000 lymphocytes/mm3 in a young infant with a cough illness is strongly suggestive of pertussis infection. Management of Cases: Treatment: Antimicrobial treatment should begin as soon as possible after diagnosis, particularly in infants. Treatment may lessen symptoms if begun early during illness and will shorten the period of infectivity. Prophylaxis: The CDC and AAP recommend post-exposure prophylaxis for all close contacts of a pertussis case. However, during widespread community outbreaks, OCHCA will focus its efforts on postexposure prophylaxis for high-risk contacts, including infants under 1 year of age, pregnant women, and their contacts. Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis: http://www.cdc.gov/mmwr/PDF/rr/rr5414.pdf Infection control: Health care workers should use standard and droplet precautions, including a surgical or procedure mask and eye protection when evaluating suspect pertussis patients. Droplet precautions should be maintained until 5 days after the patient is placed on effective therapy, or if no treatment until 21 days after cough onset. Management of cases in school settings: Cases should be excluded from childcare settings until completion of 5 days of antibiotic treatment, from K-12 grade schools until completion of 3 days of antibiotics, and for 21 days if no antibiotic treatment. Resources: General pertussis info for clinicians: http://www.cdc.gov/pertussis/ Tdap for pregnant women: http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm Click here for full Pertussis Newsletter. Ebola Outbreak In West Africa West Africa has been experiencing a large outbreak of Ebola Virus Disease (EVD) since December of 2013. As of August 15, 2,127 confirmed or suspect cases of disease including 1,145 suspected case deaths have been reported in Guinea, Liberia, Sierra Leone and Nigeria. It was reported last night (August 19) that Kaiser Permanente in Sacramento is testing a patient for suspected Ebloa Virus, aside from that, two United States citizens were transported to Emory University for further care after contracting the disease while caring for patients with EVD in Liberia. Though the risk of Ebola to the United States or Orange County is small, the potential exists for imported disease in persons traveling from countries where EVD is active. Medical providers should keep up to date on this outbreak and know which patients merit evaluation for EVD. Providers should contact Orange County Public Health at 714-834-8180 (714-628-7008 after hours) immediately upon identifying any patient with potential EVD. Orange County Public Health can assist with assessment and testing of any case meeting the CDC-defined criteria for a Person Under Investigation, which includes: 1. Clinical criteria: a. Fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and b. Additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage AND 2. Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as: a. Contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD or b. Residence in-or travel to-an area where EVD transmission is active* or c. Direct handling of bats, rodents, or primates from disease-endemic areas. Persons who have had direct contact with Ebola cases through healthcare work or social exposure in West Africa are at particularly high risk for developing disease. For further description of risk factors and clinical recommendations to prepare for or manage Ebola, see www.cdc.gov/vhf/ebola/hcp/index.html . *As of August 15, countries where EVD is active include Guinea, Liberia, Sierra Leone and Nigeria. Infection Prevention and Control Standard, contact and droplet precautions are indicated for suspected EVD. Personal protective equipment (PPE) should include gloves, gown, eye protection (goggles or face shield) and facemask. Additional PPE is necessary if copious blood or other fluid is present in the environment, including double gloving, disposable shoe covering, and leg covering. PPE should be discarded on leaving room taking care to avoid contamination when removing. Laboratory Testing The diagnostic test of choice for EVD is PCR testing of the blood. The virus is generally PCR-detectable from 3-10 days post-onset of symptoms. If the onset of symptoms is less than 3 days prior to specimen collection, a subsequent specimen will be required to completely rule out EVD. Testing is available through the CDC. Orange County Public Health can assist with assuring appropriate transport of specimens. For updated information on the outbreak, including countries where EVD is active, go to: www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html . Contact Orange County Public Health at 714-834-8180 with any questions.