Photo Credit: Clare K / https://www.flickr.com/photos/clarebatemanking/
Baby with whooping cough in hospital

(JNi.media) The ultra-Orthodox Jewish communities of Crown Heights, Williamsburg and Borough Park, Brooklyn are experiencing an outbreak of Pertussis—also known as whooping cough or 100-day cough, the website Failed Messiah has revealed, based on an Health Alert Network email.

Pertussis is a highly contagious bacterial disease, with initial symptoms similar to the common cold—runny nose, fever, and mild cough. This is followed by weeks of severe coughing fits, with a high-pitched whoop sound or a gasp. The coughing may last for 10 or more weeks, hence the name “100-day cough.” Patients are known to cough so hard they vomit or break ribs. Children younger than one-year may have periods of not breathing. The lag time between infection and the onset of symptoms is seven to ten days. The disease may occur in patients who have been vaccinated, but the symptoms are typically milder.

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The email, sent by Jennifer Rosen, MD, Director of Epidemiology and Surveillance at the Bureau of Immunization, and Jane R. Zucker, MD, MSc, Assistant Commissioner, Bureau of Immunization, dated October 19, 2015, reads:

Dear Colleagues:

An outbreak of pertussis is ongoing among the Orthodox Jewish communities in Crown Heights, Williamsburg, and Borough Park, Brooklyn. From October 2014 through October 2015, 109 cases of pertussis have been reported to the New York City Department of Health and Mental Hygiene, with an increase in cases over the past four months. The majority of cases (90%) are children under 19 years old (median age 4 years), of whom 52% were unvaccinated or not up to date with pertussis-containing vaccine. Infants less than 1-year-old account for 34% (n=37) of cases. Of the 37 mothers of infants with pertussis, only 3 (8%) received the recommended tetanus-diphtheria-acellular pertussis (Tdap) vaccination during their most recent pregnancy.

Five infants were hospitalized, including one who had pneumonia.

Instructions to Health Alert Network (HAN) Subscribers included a request to distribute to all Primary Care, Infectious Disease, Emergency Medicine, Internal Medicine, Pediatrics, Family Medicine, Obstetrics and Gynecology, Laboratory Medicine, and Infection Control Staff the following message:

• An outbreak of pertussis continues to spread among Orthodox Jewish communities in Brooklyn.

• Ensure that children are up to date with pertussis-containing vaccines.

• Vaccinate all pregnant women with Tdap during every pregnancy.

• Obtain diagnostic testing and report clinically suspect cases promptly to the Health Department.

• Provide early treatment and post-exposure prophylaxis to prevent ongoing transmission.

To control the outbreak, health workers were urged to:

1. Recall patients who are not up to date with DTaP and Tdap vaccines

2. Vaccinate pregnant women with Tdap during every pregnancy

3. Report suspect cases

4. Follow droplet precautions

5. Obtain optimal specimens for diagnostic testing

6. Provide prompt antibiotic treatment and/or post-exposure prophylaxis

In healthcare facilities, a dose of Tdap is routinely recommended for all healthcare personnel (HCP). HCPs should observe droplet precautions, such as wearing surgical masks, while evaluating suspect pertussis cases. Precautions should be observed regardless of the vaccination status of HCP. HCP with known unprotected exposure to pertussis and who are likely to expose pregnant women or neonates should receive PEP. Other HCP should either receive PEP or be monitored daily for 21 days after pertussis exposure and treated if pertussis symptoms develop.

Clinicians should report all suspected cases of pertussis to DOHMH. Do not wait until laboratory confirmation to report. Early reporting allows DOHMH to investigate cases and assist the facility in identifying those who need post-exposure prophylaxis to prevent further infections. To report a suspected case, clinicians should call DOHMH at 866-692-3641.

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