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Whooping cough cases surge

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Whooping cough is coming back with a vengeance.

Washington state has a chronically lower-than-average rate of immunization against the disease, officially known as pertussis and, with more than 800 cases last year, the state continues to be ranked as one of the worst nationwide for this respiratory illness.

In Seattle and King County alone, public health officials last year saw an 82 percent increase in whooping cough numbers, from 155 to 282.

Some say the disturbing numbers partially reflect a better, more aggressive disease surveillance and reporting system here.

Other experts contend that whooping cough often goes unrecognized and as many as 90 percent of all cases are not being reported.

What everyone agrees is that we've let down our guard against pertussis. And infants are paying the heaviest price.

"He sounded like he was choking on fluids," said Krista Armstrong of Enumclaw. Armstrong's infant son, Cole, had developed a persistent cough a few months ago.

The initial examination at the local hospital, which included a test for pertussis, found nothing to indicate the boy had anything more than a routine cough.

But 2-month-old Cole kept getting worse.

He coughed almost 24 hours a day, often turning purple as he struggled to clear his lungs of fluid and then tried to gulp back in enough oxygen to compensate for the asphyxiating bacterial infection.

"It was really frightening," Armstrong said.

After a month of watching her son spend almost every waking hour of every day struggling to breathe, she took him to Mary Bridge Children's Hospital in Tacoma. The infant was admitted into the intensive care ward as physicians tried to determine the cause of the severe and mysterious respiratory disease. More blood and lab cultures were run. More chest X-rays were taken. What was happening here?

Was it some exotic kind of pneumonia? Tuberculosis? SARS? Hantavirus?

Three days into his hospitalization, Cole was retested for boring, old pertussis. This time, the test came back positive. He was put on the correct type of antibiotics and quickly improved. Armstrong was relieved but also upset that such a mundane, easily preventable disease could have so threatened her son and gone unrecognized for more than a month.

"He got infected before he was old enough to get the vaccine," Armstrong noted. "People need to be aware that this disease is out there."

Dr. Marcia Goldoft, an epidemiologist at the state Public Health Laboratory in Seattle, said many people -- including many physicians -- don't always recognize whooping cough or take it seriously as a re-emerging public health threat.

"Tragically, we've even had a few deaths in the last few years from pertussis," Goldoft said. This state, she said, has remained above average for whooping cough disease for years -- in part because some parents here may have an unreasonable fear that this vaccine poses a greater risk of serious adverse side effects.

"This is a vaccine that gets a lot of negative publicity," Goldoft said.

The bad PR stems from the old "whole cell" vaccine, which was based on killed microbes to stimulate immunity. The vaccine caused transient fevers and, on rare occasions, seizures in a small number of children (but still no evidence of lasting harm, experts say).

The current "acellular" pertussis vaccine used in combination with vaccines against diphtheria and tetanus (called DTaP) is believed to pose no more risk from side effects than most other vaccines.

Infants, though at highest risk from pertussis, cannot be fully protected against the infection until they have received a series of four vaccines by age 15 to 18 months. A fifth "booster" dose is given children ages 4 to 6 before entering school.

For reasons that aren't clear, pertussis appears to be on the increase in the general population, said Dr. Jeffrey Duchin, chief of communicable diseases at Public Health -- Seattle & King County.

"We know for sure that we're seeing more infant cases," he said. "But there are also indicators that there's lots of unrecognized pertussis in adults and older children."

Some of the cases may be due to some parents not getting their children immunized, Duchin said, which can contribute to the spread of disease. But some of this, he said, is attributable to the fact that the vaccine's effectiveness wears off over time.

Given the situation, the federal government is considering a recommendation by immunization experts to approve the pertussis vaccine for use as a "booster" shot for adults and older children.

"It's been licensed for that use in Canada for some time," said Duchin, who is among those advocating for the change. "Boosting immunity could turn this trend around."

The Food and Drug Administration would have to approve the new use for the vaccine. Such booster pertussis shots are already in use also in Germany, France and Australia.

Whatever happens at the federal level in terms of the new booster shot idea, the state Department of Health plans to launch a pertussis education and vaccine promotion campaign later this year to try to turn around our poor pertussis report card.

"We'll be working to get the word out," said Carlos Quintanilla, the state's public-health adviser on immunization.

Basic vaccines are provided free to doctors in this state, Quintanilla noted, in recognition that many people have no health insurance.

For more information on obtaining pertussis vaccines, Quintanilla said, parents should contact their health care provider, their local health department or call the state's toll-free number for the Healthy Mothers, Healthy Babies program at 800-322- 2588.

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