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California declares whooping cough epidemic again

In California, it is 2010 all over again. That was the last time that whooping cough, also called pertussis, was epidemic in the state. In a June 13, 2014 release, the California Department of Public Health (CDPH) declared that the contagious respiratory illness had reached epidemic levels again. As of June 10, the state had received report of 3,458 pertussis cases diagnosed in 2014.

Touro University medical student Shamis Fallah (R) prepares a Tdap vaccination during the Solano County health fair August 11, 2010 in Vallejo, California.
Photo by Justin Sullivan/Getty Images

California experienced a severe outbreak of whooping cough in 2010. Over 9,000 illnesses and 10 infant deaths were reported. The United States experienced over 27,000 total cases in that same year. The state instituted a number of reforms, based on the case data from that epidemic.

The major change in California's approach to pertussis was to require that all students entering seventh grade receive a booster. The year it was implemented, it included all students in middle and high school, so hundreds of thousands of children received the whooping cough booster. Since then, it is required to enter seventh grade. Middle school aged children had the second highest incidence of pertussis in the 2010 epidemic.

The state also adopted the national recommendation that pregnant women in their third trimester receive a pertussis booster. This booster passes a degree of immunization to the newborn and provides some protection against infection when infants are at their most vulnerable. Infants had the highest incidence of pertussis in the 2010 epidemic.

In 2012, California reported just 1,023 cases of pertussis.

California is one of 18 states that allow parents to exempt their children from school immunization requirements based upon a personal or philosophical belief. Those exemptions continue to be at the root of preventable illness outbreaks, such as the measles outbreak earlier this year in Southern California. The exemptions are in clusters as certain communities choose not to vaccinate more than others.

The 2013‐14 7th Grade Pertussis (Tdap) assessment is available on-line from the CDPH. It reveals that 16,013 seventh graders, 3.3 percent, in this school year had not complied with the whooping cough immunization requirement. It also discloses that the number of children in compliance has dropped an average of three percent per year in each of the last three years.

Compliance for children entering kindergarten was much worse. The report on the immunization status for those children revealed that 7.5 percent of public school kindergarteners and 11.6 percent of those in private schools had not received at least four of the recommended five immunizations against whooping cough.

The Centers for Disease Control describe the complications of pertussis as:

In infants younger than 1 year of age who get pertussis, about half are hospitalized. The younger the infant, the more likely treatment in the hospital will be needed. Of those infants who are hospitalized with pertussis about 1 in 4 (23%) get pneumonia (lung infection), 1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking), two thirds (67%) will have apnea (slowed or stopped breathing), 1 in 300 (0.4%) will have encephalopathy (disease of the brain) and 1 or 2 in 100 (1.6%) will die.

As of June 10, Texas had reported 903 pertussis cases to the CDC. Ohio, fighting the nation's largest outbreak of measles and the nation's largest outbreak of mumps, reported 750 cases of whooping cough. Colorado had reported 564 illnesses and Utah 432. All of these states allow the personal or philosophical belief exemption.

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