Pertussis Toolkit for Schools

Transcription

1 Pertussis Toolkit for Schools Burlington County Health Department December

2 CONTENTS What to do if you suspect a case of pertussis in your school 3 Pertussis reporting form 5 Pertussis Fact sheet 6 Pertussis sample letter to parents 7 2

3 What to do if you suspect a case of pertussis in your school Burlington County Health Department Guidance Document Under New Jersey Administrative Code (NJAC 8:57), pertussis is an immediately reportable disease that should be reported to the local or state health department in which the individual resides. If you suspect a case of pertussis, the school nurse or school administrator, under NJAC 8:57, should contact the local health department to report the case and for further guidance on pertussis control and prevention. Below are some frequently asked questions to help guide you through the process? Why am I reporting the case? Shouldn t the doctor report the case? Under NJAC 8:57, physicians, hospitals, nurses, and laboratories are all required to report pertussis to the local health department. However, cases don t always get reported, or get reported a week later when lab results are confirmed. When the health department learns about a new case, the investigator always calls the school in which the child attends, to make sure the facility is properly informed, and receives all the information they need for disease control and prevention. If you discover you have a student/staff with pertussis in your school and you have not been contacted by the health department, you should contact the local health department to report the case. What do I do if a parent calls in saying their child has pertussis? It s important to realize that not all reports of pertussis from parents are accurate. If you receive a call from a parent, you should first call your local health department. The health department has a strong relationship with area hospitals, physicians, and laboratories. As soon as a case of pertussis is suspected, we will work with these entities to obtain accurate information, so schools can make a timely and appropriate response. What kind of information can I share with the health department? In matters of public health, such as a case of infectious disease, local health departments are exempt from HIPAA, and can obtain personal information necessary to perform case investigations. In order to conduct an appropriate case investigation, we will need the child s full name and date of birth. This will enable us to obtain accurate information from the child s physician on diagnosis, treatment, and testing. We will also require parent s contact information, so we can determine symptoms, symptom onset dates, and illness duration. What do I do if this is a real case of pertussis? Each case is different, so it is important to work with your Local Health Department on what steps are appropriate. Below is a basic list of several of the things we may recommend: 1. Determine who may have been exposed to the ill child (students, staff, etc.) a. Are any of the exposed individuals under the age of 1 or pregnant? Are any of the exposed individuals inadequately immunized against pertussis? Are any of the exposed individuals coughing? 2. If this is a case of pertussis, send out a letter and factsheet a. See below on tips regarding sending out letters 3. Reinforce policies with staff on hand and respiratory hygiene and staying home while potentially infectious 4. Conduct surveillance for symptomatic children and staff a. Sports teams with symptoms? Make sure teachers notify nurse of children with symptoms. Any teachers with symptoms? Refer anyone with symptoms to a physician/pediatrician. Review immunization records 3

4 How do I identify close contacts of cases? The following are some examples of close contacts of pertussis cases: Household contacts At least 10 hours of contact per week in the same classroom, extracurricular activities, bus or carpool, or socially. Any direct face to face contact regardless of hours if they are close friends, boyfriend/girlfriend, sport teammates, lunch partners, or babysitters. Regardless of length of exposure, the following are high risk groups: infants, underimmunized young children, immune compromised individuals, pregnant women, individuals with chronic respiratory issues (asthma) Who should receive the letter and fact sheet? Each school is different on how they handle sending out notifications to parents. It is important to make sure that the child or staff s identity remains confidential. It is often difficult to maintain confidentiality, when notifying only a select number of individuals. At a minimum, you should notify those individuals that are exposed (see above), and those in a high risk group (under the age of 1, pregnant, immune compromised). Many schools choose to send out notifications to the entire school, which helps to maintain confidentiality, while ensuring that all potential individuals exposed receive the information. Who should be excluded from school? First, you should develop policies in your school for future cases and outbreaks. At a minimum, they need to be as strict as New Jersey guidelines, which are as follows: Cases: should be excluded from school either (1) for 5 days after the start of antibiotics, or (2) when cough duration has been longer than 21 days. Symptomatic contacts: Should be referred to their health care provider, and should be excluded using the same criteria as a case if pertussis is suspected Asymptomatic contacts: no exclusion is recommended The child returned back to school after 5 days of antibiotics, but is still coughing. Pertussis was once referred to as the 100 days cough. Fortunately, the disease is only infectious during the first 3 weeks of coughing. The bacteria that cause whooping cough attach to the small hairs in the respiratory tract and release a toxin that destroys these hairs. In the process, the body reacts by coughing strongly. Even after the bacteria have been killed by antibiotics, the body will take time to recover and rebuild these hairs. Therefore, it is not unusual for a person to continue coughing long after taking antibiotics. How can I tell if a child has pertussis, or if it is just allergies, asthma or bronchitis? Confirmatory testing can really help identify if this is a real case of pertussis. If you suspect a child or staff member has pertussis, recommend they see their physician for testing. In regards to symptoms, individuals will have a prolonged cough for over 2 week s duration. Most pertussis cases have coughs lasting roughly 6 to 10 weeks. Fever is usually absent or minimal. Below are some screening questions provided by the State health department: Do you have cold symptoms (runny nose, sneezing); when did they start? Do you have a cough; when did it start? Describe your cough: Do you feel as if you are choking and cannot breathe? Do you cough at night or is coughing worse at night? Do you have coughing spells where you feel as if you cannot stop coughing? Do you vomit after coughing? 4

5 PERTUSSIS REPORTING FORM FOR SCHOOLS Under NJ Administrative Code (NJAC 8:57), Pertussis is an immediately reportable disease, that should be reported to the Local or State Health Department in which the individual resides. If a case of pertussis is suspected, a school nurse or school administrator, under NJAC 8:57, may report the case to the local health department. Contact information of person reporting Name: School: Telephone Number: Ill Student/Staff Information Name of Patient (Last) (First) Date of Birth Gender Name of Parent/guardian Address City Zip code Telephone number Physician Information Treating Physician/Practice Physician Telephone Number Date Physician Saw (if known) Did the physician prescribe antibiotics? Type of antibiotic Date antibiotic started Onset Date of Illness Any Cough? Clinical Information (if known) Cough duration Any episodes of a violent cough attack? Whoop sound? Any vomiting after coughing? Apnea? Other symptoms: Has there been any recent trips to the nurses office in the past few months? If so, describe Does the patient have a history of asthma, allergy, or other immune compromised condition? Explain. Please list the date and type for each pertussis containing vaccine. Please fax a copy of the immunization record along with this form. Immunization History Date Type Date Type Date Type Date Type Date Type Date Type Are there other children in the same class/activity with symptoms? Investigation Information What grade do they belong? How many children in class? Any children in class not completely vaccinated or with vaccine exemptions? Any high risk individuals that may have been exposed? (Pregnant, under the age of 1, or immune compromised?) Does the child ride a school bus? How long was the child in school during illness? Does the individual have any ill relatives at home? Other sports, activities, or groups the child belongs Provide any additional comments.

6 Burlington County Health Department Whooping cough, another name for pertussis, is a very contagious respiratory disease caused by bacteria, Bordetella pertussis. It can be serious for anyone, but life threatening for newborns and infants. Pertussis often begins like the common cold, with symptoms such as runny nose, sneezing, and a mild cough. After 1 or 2 weeks, the symptoms become more severe, and include violent coughing spells, vomiting during cough, and a whoop sound from trying to gasp for breath. Babies and young children can turn blue while coughing from lack of oxygen. Young babies may also stop breathing for short periods. Pertussis is spread through the air by infectious droplets, while an infected person sneezes, coughs, or talks. Other people nearby can then breathe in the bacteria. The incubation period can be anywhere from 7 to 21 days. This disease is most dangerous for babies and young children. More than half of babies younger than 1 year old who get the disease need care in the hospital. About 1 in 5 babies will get pneumonia. Whooping cough can also result in seizures, brain damage, or death. Do not send your child to school if you suspect they have pertussis. Remember that your child may have classmates or teachers with infants at home that could develop a serious form of the disease. If you suspect you, your child, or anyone in your family has pertussis, you should consult your physician. A physician will most likely take a specimen by swabbing the back of your throat. If your child is diagnosed with pertussis, your physician will prescribe antibiotics. Since pertussis is contagious, the physician will also prescribe antibiotics to the entire household, regardless of vaccination status. Your physician might also recommend a booster dose of vaccine for your child or other family members. You should also contact the school nurse. It is important that the child remain home from school until 5 days after the start of antibiotics. Make sure everyone in your household is properly vaccinated. DTaP is generally given to children 6 weeks to 6 years old. Tdap can be given to adolescents and adults, including those that are pregnant or elderly. Burlington County Health Department 15 Pioneer Blvd. Westampton, NJ Telephone (609) Fax (609)

7 [date] Dear Parent or Guardian: We learned today that one of our students/staff has been diagnosed with pertussis, also known as whooping cough. This is a contagious respiratory illness that spreads from person to person when the infected individual coughs or sneezes. Children under one year of age are at the greatest risk for serious complications. Therefore, it is very important to limit the spread of this infection. Pertussis begins with cold symptoms and a cough, which become much worse over 1 2 weeks. Symptoms usually include a long series of coughing fits followed by a whooping noise. However, older children, adults and very young infants may not develop the whoop. People with pertussis may have a series of severe coughing fits followed immediately by vomiting, turning blue, or difficulty catching breath. The cough is often worse at night, and cough medicines usually do not help alleviate the cough. To help reduce the spread of pertussis, and to prevent your child from developing the disease, the New Jersey Department of Health recommends the following: Keep infants away from anyone with a cough. If an infant develops a coughing illness, have them see their pediatrician. Parents, children, and any friends and relatives in contact with your children should be immunized against pertussis. If anyone in your family has not been completely vaccinated, speak with your physician regarding immunization. If your child develops cold symptoms, including several days of cough, talk to your child s physician immediately. You can let them know that a student/staff at your school was diagnosed with pertussis. Do not send your child to school if s/he has any signs or symptoms of pertussis. Please see the attached FAQ sheet for more information on pertussis and pertussis vaccine. If you have any questions, please contact your child s doctor, your school nurse, or the Burlington County Health Department at (609) Sincerely, 7