It s all about the Whoop

Transcription

1 It s all about the Whoop Pertussis On Campus By Rebecca DiSaia Minus, MSN, RN, CNL

2 Hear what Whooping cough sounds like

3 Stages of Pertussis Catarrhal Stage Paroxysmal Stage Convalescent Stage (Recovery) Duration: 1-2 weeks Duration: normally 1-6 weeks but may be as long as 10 weeks Duration: Cough Lessens usually over 2-3 weeks Symptoms: URI including runny nose, sneezing, fever (low-grade), mild cough Very contagious during this stage Symptoms: Worsening cough, post-tussive emesis and inspiratory whooping, cyanosis, exhaustion, leukocytosis, lymphocytosis, decreased weight Symptoms may return or worsen, if patient develops a second respiratory infection while still in this stage Yahoo images

4 Cause Bordetella pertussis, a gram-negative bacterium Multiple antigenic/biologically active products include: 1. Pertussis toxin 2. Filamentous hemagglutinin Responsible for: 3. Agglutinogens Clinical Features 4. Pertactin Immunity 5. Tracheal cytotoxin CDC: Pertussis 8/7/2017

5 Bordetella pertussis bacteria Yahoo images

6 Pathogenesis Toxin mediated Disease Bacteria attach to cilia, produce toxins that paralyze cilia/cause inflammation Paralysis/swelling interferes with the clearing of pulmonary secretions CDC: Pertussis 8/7/2017

7 Transmission Spreads person to person by cough, sneeze, sharing air space Most contagious up to 2 weeks after cough begins Antibiotics may shorten the time someone is contagious (Azithromycin) Cough can last for 10 weeks or more CDC: Pertussis 8/7/2017

8 CDC: Clinical Case Definition Cough lasting 2 weeks or more with one of the following symptoms: 1. Paroxysms of coughing, OR 2. Inspiratory whoop, OR 3. Post-tussive vomiting, OR 4. Apnea (infants less than one year) CDC: Pertussis 8/7/2017

9 Confirmed Case Acute cough illness of any duration with isolation of B. pertussis from a clinical specimen, OR Meets the clinical case definition AND is PCR positive for pertussis, OR Meets the clinical case definition AND had contact with a laboratory-confirmed case of pertussis CDC: Pertussis 8/7/2017

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11 Prophylaxis Household contacts High risk people exposed to case-patient { People with pre-existing health conditions { People who have contact with infants/pregnant women { People in high risk settings (NICU, child care, etc) CDC: Pertussis 8/7/2017

12 Effectiveness of Pertussis vaccine 80% effective 15 days to 1 year 84% effective 1 to 3 years 62% effective 4 to 7 years 41% effective 8 or more years Effectiveness of Pertussis vaccine (2016)

13 Pertussis at Brown Early September student presents with cough and history of exposure PCR test positive for pertussis 2 nd student positive, no apparent exposure to 1st case Mid October Brown staff member positive per outside provider, no apparent exposure to 1 st or 2 nd case

14 What did we do? 1. Department of Health Investigation { Identify contacts { Advise contacts to seek care with PCP Recommendations: ² Department of Health recommended testing continue for all students with longstanding, persistent cough or coughing spasms ² Students to self isolate until PCR resulted ² 28 specimens done at HS, 2 positive ² 1 staff member identified as positive at PCP

15 What else did we do? 1. Notified the Brown Community 2. Sent out secure messages to all students without a documented Tdap vaccine 3. Education for providers and RNs Disease characteristics/stages Testing procedure and handling of specimens Continued to keep providers and RNs up to date on number of tests done/outcomes (Chriss: Infection Prevention Nurse)

16 Good News!! Brown has hit the 21 day mark with no new cases!

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18 Summary Disease stages Causative Agent Transmission Contagious period Clinical/Confirmed Case Definition Treatment/Prophylaxis Vaccine effectiveness Brown Strategy

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20 References CDC: Pertussis, 8/7/17 retrieved on 10/15/17 from Nasal pharyngeal swab procedure retrieved on 10/15/17 from Youtube at Schwartz et al (2016). Effectiveness of pertussis vaccination and duration of immunity. CMAJ 188(16) Stages of pertussis retrieved on 10/15/2017 from Yahoo images at Whooping cough in an adult-youtube