KEYWORDS:
Pertussis Outbreak
Incident Command System (ICS)

BACKGROUND:
Outbreaks of pertussis are rarely documented among adolescents and adults. Of the 378 investigations conducted in Burnet County, Texas in 2002, data indicate 54% (204) were over 10 years old.

OBJECTIVE:
Identify disease incidence out of normal age range.
Determine educational and training needs to address new trends.
Recognize need to implement ICS to organize an event.

METHOD:
Multiple outbreaks investigated: schools, daycare centers, businesses, institutions.
Press releases and media alerts in English and Spanish to school officials and physicians.
Special community-wide vaccination clinics at two sites.

RESULT:
Rapid reporting of pertussis cases and assessment of data signaled the need to educate local providers concerning the increased ages. Staff from multiple programs were trained on the principles of the ICS and it was subsequently field tested in Burnet County clinics. Patients were educated, vaccinated, tested and treated for pertussis.
Paramedics who had previously taken "Immunization Education for Health Care Professionals" completed preceptorship at the clinics, allowing services in non-traditional settings.

CONCLUSION:
Pertussis outbreaks affect the older population. Through education and media, this message affected change.
Lessons learned from these experiences will be invaluable as these, and other new planning and operating concepts are applied in preparation for future needs.

LEARNING OBJECTIVES:
Knowledge and insights gained while investigating these pertussis cases focused on the need to re-educate professionals to consider the incidence of disease among this older age group. Affecting change in the medical practices took extensive educational campaigns.
In addition to the basic roles of public health in outbreak control, the ICS was taught and field-tested in an actual clinic setting. Using the basic principles of the ICS allowed both cross training of staff from other programs and prepared staff to practice a system that would be used in an actual emergency.