PERSISTANT, PREVALENT, POSITIVE PERTUSSIS

Having finished two recent pertussis investigations, I was ready to begin clinical direct patient care training once again when returning to work after New Years Day.  Fortunately, I had reminded myself lately that complaining is counterproductive, lowers one’s self-esteem and greatly decreases enjoyment of the moment.  

Being one of two nurses in the clinic and the only one without my own patient load, I gladly accepted the fax from State Epidemiology letting us know that there was another lab-confirmed positive case of pertussis (whooping cough) in Barrow.  It was an eight month old boy, so my first concern was whether he was being treated with antibiotics.  Pertussis can be fatal in children, especially those under one.  

I wasn’t able to reach his mother until when in the mid-afternoon, she came to the clinic in response to my phone messages.  Her little son was on her back under her hood, smiling out at anyone nearby.  I invited her to my office where she allowed me to interview her.  She had taken her son to the hospital last week, suspecting that he might have pertussis.  He was tested and treated the same day, so had finished his course of Azithromycin by then and wasn’t considered contagious although she was concerned that he still didn’t seem well.  His cheeks were bright red from a rash that he was being treated for and he had a short coughing spell, but otherwise appeared to be very bright, happy and interactive during their visit.  I told her that symptoms of pertussis can linger, even after treatment, but that the antibiotics had killed the bacteria, so he should be free of symptoms soon.

The mother was asymptomatic of pertussis so hadn’t been tested or treated with antibiotics prophylactically.  She was current on her Tdap immunization.  I counseled her to be sure to visit her health care provider if symptoms did develop and about cough and hand hygiene being effective ways to prevent the spread of pertussis.

She stayed for close to 45 minutes giving me the names and telephone numbers of the other 11 people who had been in close contact with her son during the holidays.  One was her sister who is pregnant and another was a niece who had turned one in December, so both in high risk groups.  Talking with her in person made the beginning of the investigation so much more rewarding.  I was grateful and admired her initiative when she began calling family members from my office to let them know that if they were coughing to go to the hospital and that I’d be calling them while I was writing notes.

The rest of the afternoon and all of the next day were spent printing out health summaries and charts for all of the other contacts, determining if they were current on DTaP and Tdap immunizations and calling each home to assess symptoms, suggest actions and educate.  

The pregnant woman lives in Palmer, just outside of Anchorage, but is currently working at Prudhoe Bay.  She was experiencing possible symptoms of pertussis, so was encouraged to contact her health care provider ASAP for recommendations.  When following up with her later, her OB physician will treat her with Azithromycin and give her a Tdap booster next week when she returns to Anchorage.

In one of the households, all of the family members had either moderate to extreme symptoms of pertussis and because of the mother’s call when she was in my office, had gone to the hospital and were already treated.  I counseled them regarding cough and hand hygiene and about refraining from being around other people until their courses of antibiotics were completed and they were no longer contagious if they were positive for pertussis.  Being on break from school, this didn’t present a problem.  They were all current on their DTaP and Tdap immunizations.

Two households had no symptoms of pertussis and were all up to date with their immunizations as well, so counseled on hand and cough hygiene.       

Nurses here are wondering if there is a different strain of pertussis making the current vaccine ineffective.  It’s curious that all of the people who have tested positive for pertussis as well as most of the contact with symptoms have been current on their immunizations.

By 5:00 pm, the calls had all been made, and the State Epidemiology report had been filled out and faxed to their Anchorage office.   The only things left to do were to settle in, nurture hot cups of tea, prepare a detailed summary of each contact involved in the investigation for our records and information and do a hand written encounter form on each contact to be data entered and filed in their chart.  Wanting to be free to begin clinical training in the morning, I was happy to be leaving the clinic by 9  pm with the investigation completed. 

I tentatively entered the clinic the next morning being on guard for any new pertussis cases, but there were none = ).  A good day of checking in vaccines, observing well child checks, documenting competencies reached, doing paperwork related to upcoming village trips and strategizing about my continuing orientation.

I’m loving my new desk arrangement, having switched with Bertrand per our agreement before he left for two weeks.  Mine is now in his formerly very warm locale next to the baseboard and away from the window.  The surface configuration makes the work flow much more organized.  I’m hoping that all of the reverse is very true for Bertrand.  He returns on Monday and will find his desk and chair directly in front of the window and there are no baseboards heating up the area under his desk.  I can’t imagine having a better office mate and will be very glad that he’s back!