Can Utahns stifle a whooping cough surge?
Health • Officials create guidelines on how schools should tackle pertussis.
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Utah parents may soon receive letters from schools warning of a whooping cough "outbreak."

It's been an unusual year for the bacterial infection, with more than 1,100 cases in the state, almost double last year's count. In response, leaders of the state's 12 health districts, along with the Utah Department of Health, recently created guidelines on how to deal with the spread at schools and day cares.

The state has defined an "outbreak" as two or more cases within the same school or child care center within 20 days of each other. In some cases, unimmunized staff and children may be sent home.

"What we're trying to do is help parents of school-aged children understand very clearly what the process is, what we do, why we do it: To make sure we protect children from exposure and [to stop] the disease from spreading," said Gary House, director of the Weber-Morgan Health Department.

The primary goal is to reduce the disease and death of infants less than 1 year old. They are the most vulnerable because they aren't fully immunized. The DTaP vaccine series is typically given at 2, 4 and 6 months of age with boosters around 15 months and between ages 4 and 6.

Utah data shows infants have been hit hardest: Their rate of having pertussis is five times higher than the state rate, which is itself five times higher than the national rate.

Another goal is to reduce the amount of disease among all people, who could unknowingly pass it on to infants. The highly contagious disease starts as cold-like symptoms, such as a runny nose and an occasional cough that gradually becomes severe. Breathing may become so difficult that children may make a high-pitched whooping sound to get in air. They can also vomit from coughing.

Once a school or child-care center has two or more cases within 20 days, schools will likely send a letter to parents whose children have been exposed to the bacteria warning them to watch for signs of pertussis, to ensure their children are immunized and to keep sick children home.

School staff will be asked to report to the school nurse students who have a persistent cough, along with other symptoms such as vomiting or cold-like symptoms. Those sick students would be excluded from school until they take appropriate antibiotics for five days, or for 21 days to cover the incubation period if they decide not to take the drugs, or with a doctor's note showing they don't have pertussis.

Even students and staff who are not sick could be sent home. Those who are not immunized may be eight times more likely to develop pertussis than those who are vaccinated, according to the state health department. And they could also infect others. While the pertussis vaccines are required to enter kindergarten and 7th grade, parents can seek exemptions.

If there are two cases at a daycare that serves infants, unimmunized staff and children will have to stay home for the 21 days or until they take antibiotics as a prophylactic.

That will also happen among students and staff when there's a whooping cough outbreak in a classroom or club, sports or other small-group setting.

When the disease is more widespread — found in multiple classrooms or groups — all unimmunized students and staff could be sent home if more than 15 percent of the school has not been immunized.

Students would be able to return two weeks after being vaccinated.

House said health officials have some flexibility when using the guidelines, but the goal is to be consistent across the state. "We're going to try to follow them as much as possible," he said. —

Preparing for pertussis

Utah state health officials have defined a pertussis "outbreak" as two or more cases within the same school or child care center within 20 days of each other.

Warning letters

Schools with an outbreak will likely alert parents of exposed children to watch for symptoms, ensure their children are immunized and keep sick kids home.

Sick students

Students who have a persistent cough and other symptoms of pertussis will be excluded from school until they:

Take appropriate antibiotics for five days, or,

Stay out of school for 21 days to cover the incubation period, or,

Provide a doctor's note showing they don't have pertussis.

Sent home

Unimmunized staff and children may be sent home, for 21 days or until they take antibiotics, when:

There are two cases at a day care center that serves infants.

There is an outbreak in small setting, such as one classroom or a club.

The disease is widespread and more than 15 percent of the school has not been immunized.