KEYWORDS:
Pertussis, Outbreak, Surveillance

BACKGROUND:
During the first nine months of 2001 fewer than 20 confirmed cases of pertussis were recorded at the Arkansas Department of Health (ADH). By early fall, ADH saw a dramatic increase in confirmed cases. In late September a rural town in southwest Arkansas reported suspected case in the Junior and Senior High Schools' football teams. Another town in the same county also began reporting suspected cases. Within two months over 40 of 75 counties were reporting cases.

OBJECTIVE(S):
To describe the procedures and challenges of a large pertussis outbreak.

METHOD(S):
During the onset of the outbreak, initial cases of pertussis were found in the southwestern part of the state through passive surveillance combined with case investigation and contact follow-up. Almost simultaneously, and particlarly after media coverage of the football teams' illness, non-epi linked cases were being reported in the central region of the state. Media coverage and weekly faxed health alerts from the Department's medical advisor prompted additional reports.

RESULT(S):
As of December 10, 2001, ADH has confirmed 589 cases. Fifty of these cases have been cultured-confirmed and the remainder have been epidemiologically linked. It is felt this outbreak has not peaked. Data will be analyzed once all surveillance has been completed. Thus far, the 2001 pertussis outbreak has already shown to be larger than any documented pertussis outbreak in the state since the mid-1960s.

CONCLUSIONS(S):
Follow-up of confirmed cases by field colleagues has been compounded by the public's fear of bioterrorism and the magnitude of a record breaking pertussis outbreak.

LEARNING OBJECTIVES:
Describe and share effective methods, protocols, and lessons learned for a statewide pertussis outbreak.