Whooping Cough at Mary Ellen Henderson Middle School

By CHRISTINE KILGORE
Falls Church Times Staff

May 25, 2010

Fairfax County Health Department officials have been working over the past several weeks to prevent the spread of pertussis in Mary Ellen Henderson Middle School, urging parents to keep children with symptoms at home until seen by a doctor and encouraging preventive medication in some children deemed to have had close contact with an infected student.

Pertussis, or whooping cough, is a bacterial, communicable illness that can be especially serious for infants and young children who have not yet completed the primary series of DTaP vaccine that protects against infection.

It is a reportable illness (physician and hospitals are required to report diagnosed cases) that, at least in Fairfax County, uniformly generates a public health response.  And paradoxically, it’s a vaccine-preventable illness whose rates have been rising since the 1980s rather than falling.

And then there’s the fact that pinpointing suspect cases among  children who are coughing from allergies, asthma, colds, and other infections is no easy feat.

As my 11-year-old daughter said recently, “everyone is coughing!”

Her class—the 5^th-grade—has borne the brunt of this episode.  The medical community has learned over the years that the immunity created through vaccination wanes over time—and for the past 4 years, students have been required by state law to have a booster dose of pertussis vaccine to enter 6^th grade.

For at least some families, getting the booster is still on the ‘to-do’ list—and consequently, the 5^th grade overall is the most susceptible to waning immunity and the spread of infection.

“We used to see kids in the 6^th and 7^th grade getting pertussis, but now we’re seeing less of that,” said Fairfax County Health Department’s Dr. Peter Troell in an interview last week. “Now we see cases still among the 5^th graders, and among some of the older high school kids who didn’t have to meet a [6^th-grade booster] requirement.”

It’s “not uncommon” for the health department to investigate cases of pertussis in schools, said Dr. Troell, medical epidemiologist for the health department.  “Generally, when we see pertussis, we see 1, 2 or 3 cases [in any school].”

Pertussis in adolescents and other individuals who were vaccinated earlier in life often is mild, and according to Dr. Amin Barakat of Northern Virginia Pediatric Associates, may even go “unrecognized” in mild cases.

Often, Dr. Troell explained, “those who are vaccinated have only a little bit of feeling bad before the cough onset, maybe a bit of a runny nose, and then go into a cough that’s milder than what’s described for the classic case of pertussis.”

It can be difficult sometimes to distinguish pertussis from, say, allergies that aren’t well treated, but generally the cough associated with pertussis is more persistent, he said.

Classic pertussis is characterized by a period of cold-like symptoms that progresses to bursts or spasms of severe coughing and characteristic whooping that can be severe enough to induce vomiting. Before killed whole-cell pertussis vaccine was introduced in the 1940s, whooping cough was a major cause of infant death worldwide. (The safety of whole-cell pertussis vaccines prompted development of the acellular vaccines used today.)

Today, there are still reports of major complications—from hypoxia and pneumonia to encephalopathy and death–among children who are unvaccinated or too young to be vaccinated. Vaccination and preventing spread through communities are thus key public health goals.

MEH Principal Dr. Ann McCarty informed MEH parents in mid-April about a case of pertussis and asked that children with persistent cough see their physician and, if pertussis is confirmed or suspected, stay home until 5 days of an antibiotic regimen is completed. This month, parents of children who were deemed through “contact tracing” to have had close contact with an infected student were asked by the FCHD to “see a physician for preventive medication.”

(In this case, prophylaxis is identical to the treatment—the same antibiotic regimens. Though not without any controversy, judicious use of antibiotic prophylaxis for household and close contacts is a common public health recommendation.)

The most accurate test for pertussis involves a nasophayngeal swab, Dr. Barakat says. Results can be ready in 48-72 hours.

The increase in pertussis since 1980 has disproportionately affected adolescents and adults, and for several years now the Centers for Disease Control and Prevention has recommended “catch-up” use of a pertussis-containing booster vaccine in adolescents who did not receive a booster at 11-12 years old. Adults younger than 65 who haven’t had pertussis-containing vaccine as an adult can also substitute one of their tetanus-diphtheria boosters with  a Tdap vaccine.

Such advice holds weight for me: A friend of mine had pertussis last summer and it wasn’t easy. Before being diagnosed and treated, she had a difficult time with posttussive vomiting. According to an infectious disease report I recently read, numerous studies have suggested that pertussis comprises 20-30% of all cases of persistent cough among adults lasting two weeks or longer.

Interestingly, though, pertussis is no longer contagious after a person has been coughing for more than 21 days, Dr. Troell said.

And certainly, there are many questions still challenging physicians and researchers—about pertussis pathogenesis and immunity in adolescents and adults, for instance, as well as how to best prevent and control outbreaks.

Soccer Team Wins World Cup Promotion, South Africa Trip

By CHRISTINE KILGORE AND MINA NOWROOZI
Special to the Falls Church Times

This past soccer season was a season unlike any other for a group of Falls Church-area girls—one in which teamwork took on almost unimaginable meaning.

The girls of Premier AC’s 97 Fusion, a U-12 travel soccer team, not only played soccer — they spent hours each week after soccer practices learning the “Diski” dance — a special dance created for the FIFA 2010 World Cup to be held this summer in South Africa. The dance captures both the culture of South Africa and the moves and rhythm of the game.

Their filmed interpretation of the “Diski” won them 1^st place in a Diski Dancing video competition sponsored by South African Tourism –and an 8-day tour of the World Cup’s host nation. The 14 girls will take their trip in late March.

“At the beginning I thought, ‘we won’t win,’ said 11-year-old Rebecca Davis of Falls Church City. The dance moves also “seemed a bit odd at first,” she said. “But as we practiced we got to the point we could even do it without the music.”

When she learned through a text message that her team had won, she screamed. “I then called a teammate,” Davis recalled, “and my teammate was so happy she started crying.”

Stacey King, the team’s coach, learned of the competition in mid-October while perusing the U.S. Youth Soccer Association web site. The contest criteria (to submit about one minute of video, for instance, and to use a specific soundtrack) were simple, and the challenge of working creatively with the dance’s five main moves was enticing.

King’s mind raced.  She envisioned ways of tying together the dance moves to simulate the flow of an international soccer game.  She solicited initial reaction from the girls and their families by email, and then called the team to the Falls Church Community Center to present her ideas in detail.

Together, she and the girls and their parents watched a brief South African video demonstration of the Diski’s five main dance moves, and discussed the hours of teamwork and energy that would be required if they were to stand a chance of winning the competition.

The girls and their families promised their commitment and gave King input about moves and scenes to include and not include in the video.

From then on, through early December, the team practiced for two hours every week, immediately after their team training sessions.  They also practiced for several hours between the games of a fall tournament, in a nearby gym that a parent had arranged to use.

And when it came time to film, they met four times in various locations, including during the snowfall on December 5 and in Washington, D.C., in front of the Lincoln Memorial and in the shadows of the Washington Monument.

“Everybody made it work,” said King. “The parents helped with arranging locations to practice, with filming and editing and other ideas, and with grabbing coats and supplies, and the girls never complained — they were always excited.

“It was a complete and total team effort,” she said.

Evelyn Loeb, Rebecca’s mother and the parent manager of the team, said the girls were so committed to the project that when King came down with the flu before one of the last scheduled soccer/Diski dance practices, “the girls carried it through on their own, directing and going through everything themselves.”

The team’s goal, said King, was for the progression of scenes in the video to represent “the flow and feel” of an international soccer game.

“And I wanted to make sure we represented the feel and culture of South Africa as best we could,” she said.

Viewers hear the South African national anthem at the beginning and see a team photo mimicking the typical “starting 11” photo taken at major games as well as a kick-off.  One scene simulates the often underappreciated role of the goalkeeper, King notes, and almost everything in the dance is done as if each girl has or is about to make contact with a ball.

The video includes a photo of a red “vuvuzela,” a stadium horn commonly blown by fans at South African matches, and shots of the girls sporting the colors of the South African national team (as well as the pattern of the South African flag on their faces). Read more

H1N1 Reaches Falls Church City: Where’s the Vaccine?

Read more

Fairfax Health Director Speaks about H1N1 Flu Virus

Read more

Flu Virus Starting to Show in FC and Fairfax

Read more