More whooping cough diagnosed in Blaine County

More than a month after three cases of whooping cough, or pertussis, were diagnosed in Blaine County, the number has nearly tripled — with the last case diagnosed early this month — giving Blaine County the second highest incident rate for pertussis in the state.

“While there are definitely more cases than are normal right now, it’s not something that is a reason for panic,” Blaine County Health Supervisor Jana McPherson-Hauer said Monday.

The Department of Public Health and Human Services website says that as of July 5 Blaine County has diagnosed 11 cases of pertussis. Single cases have been diagnosed in both Liberty and Chouteau counties, isolated cases more than a month old. 

Although counties such as Missoula County — which diagnosed 155 cases — and Flathead County — which diagnosed 79 cases — have more diagnosed cases, Blaine County has the second-highest incident rate by population. The highest incident rate was in Petroleum County, which has two diagnosed cases but a higher incident rate due to its smaller population of 498 people.

“I don’t know if it’s necessarily that we are dealing with an issue in Blaine County that isn’t being experienced throughout the state,” McPherson-Hauer said. “I think we have just identified a case and, because of the investigation process that occurs when a reported communicable disease is identified, we’ve identified other cases.”

She said that with more-and-more cases of pertussis appearing in the nation and in Montana, health care providers are working hard to pick up on how the disease is moving and catch instances early to prevent the disease from being transmitted further.

The investigation

Centers for Disease Control and Prevention and the Montana Department of Public Health and Human Services recommend that once a case has been identified the county public health officials launch an investigation, McPherson-Hauer said. The person who was diagnosed is asked to identify close contacts. A close contact is someone who has been exposed to the person with pertussis for a specific duration of time and at a specific distance — the general rule of thumb is a person at arm’s length for over an hour of exposure.

The close contact is then assessed for symptoms, if they have symptoms of whooping cough — they are recommended to be tested and treated, she said. If they are not they are asked to speak with their provider about prophylactic antibiotics to keep them from developing the disease.

Public health looks at two specific time frames when investigating a pertussis case, an incubation period — which is the average period of time from exposure to the development of symptoms — and then an infectious period — how long the bacteria can be spread person-to-person. 

With one case of pertussis the disease can touch multiple people, she said. She added that is why public health works with providers of the people who are identified to make sure the investigation is consistent and people are properly taken care of.

“At this point the majority of our cases are absolutely related,” McPherson-Hauer said. “They can be connected to each other, and from a public health standpoint that is reassuring that we don’t have a widespread transmission — localized transmission where we are missing things.”

Pertussis is highly contagious, but it is passed through droplets, not like other diseases which can be airborne, so for someone to be infected they have to be in close proximity for an extended period of time, she said. She added that other diseases are more contagious and for pertussis no quarantine or isolation period is generally recommended. But once a person who has the disease starts coughing, it can spread.

If a person is exposed but shows no symptoms, the person is recommended to get on an antibiotic to prevent illness, she said. Once the person has completed their course of antibiotics recommended by their provider, the health department sees the person as no risk of becoming infectious and they are not considered contagious, she said.

McPherson-Hauer said because Blaine County had a case diagnosed earlier this month, Blaine County Health Department is still actively investigating cases.

“It is ongoing and the reason for that is we have those certain time frames — the infectious period, incubation period,” she said.

The department will continue the investigation until both of those periods are over to allow every person who has been exposed enough time to either show or not show symptoms, she said. After the time periods finish their course they allow extra time to make sure no one is displaying symptoms before the investigation is closed. 

How to prevent pertussis

Other than people who have been exposed to pertussis using antibiotics, to avoid catching the disease people need make sure to keep up-to-date on their vaccinations, McPherson-Hauer said. She added that people should also always stay home if they are sick and stay away from people to prevent spreading illness to others.

Liberty County Health Nurse Melissa Kantorowicz said adults should have one pertussis vaccine in their lifetime, children should get vaccines at 2, 4 and 6 months of age and after 1 year. They should also get a booster at the ages of 4 and 6.

She said people need to be careful if they are exposed

“It spreads really fast and if someone has an ongoing cough, get it checked,” she said.

Hill County Public Health Director Kim Larson said the pertussis vaccine is included in a multiple vaccination.

The DPT vaccination also vaccinates for diphtheria and tetanus.

“I feel like no matter what, you have to be vigilant about it. The best protection is to get a vaccination to protect you from it,” she said.

She added that although people may be vaccinated, they can still theoretically contract the disease, but if the person is vaccinated, the symptoms will be much less severe.

Preventing the spread of pertussis could be as easy as a person staying home from work when they are sick, washing their hands or covering their mouth when they cough, she said.

McPherson-Hauer said pertussis, while treatable, can be very serious for vulnerable groups. 

“We pay especially close attention to vulnerable populations,” she said. “So people with underlying health conditions, elderly and infants are really the groups that could be at higher risk if they are exposed.”

What is available

Larson said the Hill County Public Health Department offers immunizations one day a week, typically Tuesdays, and if Tuesday doesn’t work for someone they can make an appointment with the nurse. The service is typically billed to the patient’s insurance, however the department does have a program for children who are on Medicaid, don’t have insurance or have insurance that doesn’t cover the vaccination.

“Because of that program we do not turn any child away due to inability to pay,” she added.

Friday, Aug. 9, the department is also holding its Lil’ Shots Carnival, which offers immunizations for back-to-school purposes but is offered to anyone at no cost to the patient, she said. The event is done through a partnership with Montana Blue Cross Blue Shield.

Hill County has had no cases of pertussis this year according to the DPHHS website.

“We are always looking and keeping an eye on what is being tested for and making sure we are not going to have an outbreak sneak up on us,” Larson said.