Practice Contends With WA Pertussis Epidemic

Like most pediatric practices in Washington state, Pediatric Clinic, of Longview, has been working overtime, not only in protecting patients and their families from pertussis but also treating existing cases amid an outbreak that continues at a record pace.

In the weeks since the state declared an epidemic and made use of state emergency and federal funds to help curb the highly infectious respiratory disease, more than 2,000 cases have been reported – the highest number since the 1940s, when a whooping cough vaccine was not yet widely used.

In Washington, there have been 2,092 cases reported statewide through June 5, compared to 164 reported cases in 2011 during the same time period, officials at the federal Centers for Disease Control and Prevention have reported. There were 965 cases reported statewide in 2011 compared to 608 reported cases in 2010. No deaths have been reported.

“I can't remember a pertussis epidemic this big in the state of Washington,” said Dr. Karen Kato, one of five physicians at Pediatric Clinic, a PCC practice. “We're definitely seeing increasing numbers of cases at our practice.”

While the state deals with the big picture problem of containing the epidemic, practices like Dr. Kato's find themselves spread thin dealing with an increasing number of individual cases. If a patient presents with symptoms and the pertussis test confirms the disease, the office must now deal with the whole family unit.

“The biggest problem for us is the amount of time it takes to call the family, then start antibiotics for all of them,” Dr. Kato said.

Among the causes of this and past cyclical outbreaks of the early childhood disease, medical experts suggest, is a waning resistance to the disease among adolescents and adults whose initial childhood vaccine has lost its immunizing effects. Last month, the Washington state Department of Health bought more than 27,000 doses of Tdap booster for uninsured and underinsured adults.

Pediatricians have long advocated for adults to receive booster vaccines, said Dr. Kato. It's only recently that the state pushed to educate specialists, such as Ob/Gyns, on the importance of administering the Tdap to its patients.

The current epidemic as well as recent measles outbreaks in certain areas of the country have also been blamed on an increasing number of parents who exempt their children from some or all vaccinations. Washington state had the highest percentage of parents in the nation who declined to have their children immunized because of medical or philosophical concerns.

While Pediatric Clinic supports its parents' decisions on vaccine administration, said Dr. Kato, its clinicians urges that each patient receive the full schedule of recommended vaccines.

An increasing number of pediatric practices, however, are becoming vaccine-only zones, in which parents who refuse to vaccinate their children are asked to find another provider. One such practice is Chestnut Ridge Pediatric Associates, a PCC practice in New Jersey. While its clinicians are receptive to parental concerns and may alter a child's vaccine schedule in some cases, the practice's vaccine policy statement does not mince words:

“ … if you should absolutely refuse to vaccinate your child despite all our efforts, we will ask you to find another health care provider who shares your views. We do not keep a list of such providers, nor would we recommend any such physician. Please recognize that by not vaccinating you are putting your child at unnecessary risk for life threatening illness and disability, and even death.”