Highly Contagious: Pertussis Makes Its Rounds in Crawford County

At the end of last summer, The Pennsylvania Department of Health issued a health advisory regarding the potential outbreak of pertussis, commonly known as whooping cough. Although several months have since passed, the health department is still seeing increased cases of the disease, which can spread rapidly throughout the population with little to no warning.
According to the Centers for Disease Control and Prevention, pertussis is a common disease that often shows up in outbreaks every 3 to 5 years. In 2009, nearly 17,000 cases were reported to the CDC, and just last year in California, 19 children under age 2 died from the disease. In fact, California saw the largest number of reported pertussis cases (8,383) since 1947, when 9,935 people contracted the disease. In Pennsylvania, 508 people had suffered from pertussis, according to a 2010 report from the Pennsylvania Health Department.

In Crawford County, the number of reported pertussis cases continues to rise.  While the county is not in an official “outbreak,” the region is not immune to localized outbreaks by municipality or school district.  In a 2010 report, 27 cases of pertussis were reported in the county, which is at a rate of 10.1 per 100,000 people. As we move into 2011, the health department notes that more cases are routinely being identified.
Furthermore, to our southeast, neighboring Venango County is suffering from double the incidence rate of pertussis than reported in Crawford over the past few months. The health department statistics show that Venango County saw 5 cases in the past year and previously had not seen any.  While the number of cases doesn’t seem like many, this number when compared to the total population of Venango County puts the county’s pertussis incidence rate at 20 per 100,000 people. To our south in Mercer County, 85 people were diagnosed with the disease, which is a rate of 24.1 per 100,000, and to our north, Erie County has seen 48 cases with a rate of 5.7 per 100,000 people.
Considering the highly contagious nature of pertussis, the disease could very quickly infect the residents of Crawford County. Pertussis is caused by a bacterium called Bordetella Pertussis, which attaches to the cilia in the lungs causing damage and inflammation. It’s quickly transmitted through close contact with others through sneezing or coughing – much like the common cold or influenza. Symptoms are often not noticeable for 7-10 days after the initial infection and often mimic a cold or the flu. The difference is that these symptoms last for 1-2 weeks and cause coughing fits that sound like a high-pitched “whoop.” In infants, the disease can cause apnea associated with serious breathing difficulties that lead to death.
There is an easy way to prevent pertussis infection – being vaccinated with Tdap, which protects against tetanus, diphtheria-acellular, pertussis . Because of the urgency to halt any further spread of the disease, the CDC’s Advisory Committee on Immunization Practices recently issued new guidelines for vaccine administration. Here is a quick status report:

·        Children ages 7-9 should receive a one-time dose of the vaccine if they have never completed the original series begun at infancy.

·        Adolescents ages 10-18 years should receive a one-time dose of the vaccine.

·        Adults ages 19 through 65 years should receive a one-time dose – especially if prior immunization records against pertussis are unknown.

·        Adults age 65 and older who come in contact with infants and children should receive a one-time dose.

The traditional immunization schedule for children under age 7 for pertussis involves a series of four doses of vaccine, given at 2, 4 and 6 months of age. The fourth dose is given at least 6 months after the third, usually at 12-15 months of age.  A booster dose is given between the ages of 4-6 years, prior to school entry. 
If you are uncertain about your vaccination history or needs, check with your primary care physician.  You can find out more details on pertussis and immunization schedules at the CDC’s website: www/cdc.gov.

References

 Centers for Disease Control and Prevention. (2011). Pertussis (Whooping Cough). Retrieved February 2, 2011 from http://www.cdc.gov/pertussis/outbreaks.html.

Centers for Disease Control and Prevention. (2011). Recommended immunization schedule for persons aged 0-6 years: United States 2011. Retrieved February 2, 2011 http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2011/11_0-6yrs-schedule-pr.pdf.

Pennsylvania Department of Health. (2010). Pennsylvania health profiles. Retrieved February 10, 2011 from http://www.portal.state.pa.us/portal/server.pt?open=space&name=Dir&psname=SearchResult&psid=12&cached=true&in_hi_userid=2&control=OpenSubFolder&subfolderID=156603&DirMode=1

Pennsylvania Department of Health. (2011). Pennsylvania pertussis incidence rates by county: 2010. Pennsylvania Epi Notes, 1(1), 2.

Excessive Drinking Prevalent Among the Elderly

Studies over the past decade have shown that excessive drinking as well as binge drinking (drinking more than seven drinks in one week) is commonplace among elderly individuals. While that may seem like a small amount to some, public health professionals are concerned for these senior citizens, who are more sensitive to alcohol than their younger counterparts.  In a recent study of nearly 13,000 Medicare beneficiaries aged 65 or older, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that 9 percent (about 1200 people) consumed unhealthy amounts of alcohol. Yet, according to a Pennsylvania State University study, less than half of those who are age 65 and older are diagnosed with alcoholism or alcohol-related problems. 

The NIAAA also revealed that the prevalence of alcoholism is steadily rising among the older population. Considering that the general population is also aging, this may not be surprising that the problems of alcoholism will grow along with them. Yet, here are some staggering revelations that worry public health professionals:

• 6-11 percent of elderly patients admitted to hospitals, 20 percent admitted to mental health facilities, and 14% seen in emergency rooms exhibit some sign of alcoholism.
• Within the hospital setting, rates of alcohol-related admissions of those ages 65 and older are similar to those for heart attacks.
• Incidence rates of hip fractures increase with alcohol consumption.
• Reaction times while driving slow in the elderly, and slow even further when alcohol is added to the mix.
• Moderate to heavy drinkers are 16 times more likely than nondrinkers to die of suicide, which is commonly associated with depression (exasperated by alcohol in the elderly).

Furthermore, alcoholism or alcohol-related problems in senior citizens is associated with poor mental health functioning, loss of physical brain tissue that may result in permanent brain damage, and increased risks of falls and injuries, according to a study done through Washington University in St. Louis, Missouri. Unfortunately, as people age, their interactions with others are limited; therefore, drinking alone or away from others can often go unnoticed by family and friends. The longer the problem exists, the more damage it can cause.

There are several behaviors that family members and caregivers should watch for to identify signs of elderly alcohol misuse. The National Center of Substance Abuse Treatment has identified 13 key areas to be watchful in senior citizens. These include memory loss (especially after taking medications or a drink), loss of coordination, changes in sleep habits, unexplained bruises, being unsure of themselves, irritability or sadness, unexplained chronic pain, changes in eating habits, an increasing desire to be alone, failing to maintain personal hygiene, difficulty concentrating, unable or unwilling to stay in touch with family and friends, and lack of interest in normal activities.

If any of these signs emerge in an elderly person, the first point of contact is with the person’s primary healthcare physician. Screening tests can be used to determine is alcohol is the culprit for the behaviors or if the cause points toward other health issues. Paying attention to the lives of the senior citizens around you is the key to keeping alcoholism and alcohol abuse from taking the life of a close friend or family member.

References:

National Institute on Alcohol Abuse and Alcoholism. (1998). Alcohol Alert. Retrieved January 14, 2011 from http://pubs.niaaa.nih.gov/publications/aa40.htm.

New York State Office of Alcoholism and Substance Abuse Services. (2011). Elderly alcohol and substance abuse. Retrieved January 14, 2011 from http://www.oasas.state.ny.us/AdMed/FYI/FYIInDepth-Elderly.cfm.

Sacco, P., Bucholz, K. K., & Spitznagel, E. L. (2009). Alcohol use among older adults in the National Epidemiologic Survey on Alcohol and Related Conditions: A latent class analysis. Journal of Studies on Alcohol and Drugs, November, 829-838.

Science Daily. (2008). New study sheds light on excessive drinking among the elderly. Retrieved January 14, 2011 from http://www.sciencedaily.com/releases/2008/03/080305173347.htm.