KEYWORD1:
Pertussis, Outbreak, Polymerase Chain Reaction (PCR), Surveillance, Vaccine-Preventable Diseases, Local Health Department

BACKGROUND:
In September 2002, the Yavapai County Health Department (YCHD) declared their first outbreak of pertussis in over ten years. The first reported case was in an 8th grade student. Within two months, 328 cases of pertussis had been recorded and the outbreak spread to a local high school and an elementary school in a neighboring town. The YCHD responded aggressively to contain and control the outbreak.

OBJECTIVE:
To describe the strategies and challenges of investigating and controlling a school-related pertussis outbreak.

METHOD:
YCHD implemented disease control measures at three schools; these included conducting active surveillance, excluding those with a cough, evaluating case histories, collecting nasopharyngeal swabs, providing treatment to cases and prophylaxis to contacts and investigating cases. Strategies were developed to address resulting challenges of data management, increased staffing needs, quality assurance, communication to parents, media requests and medical community involvement. An accelerated immunization schedule was adopted in late October 2002.

RESULT:
By November 19, 2002, 1,007 suspected cases were investigated; 159 confirmed cases, 169 probable cases, and 396 were ruled out. Of the 159 confirmed cases, 13 were culture confirmed and 146 were epidemiologically linked. Of 8 positive by two PCR markers, 6 were culture positive. As of November 19, 2002, the attack rate among 8th graders at the middle school was 8.04 %.

CONCLUSION:
School pertussis outbreaks present specific challenges; however, an aggressive response may limit the spread of pertussis.
LEARNINGOBJECTIVES:
Participants will describe the challenges, strategies, and lessons learned from a school-related pertussis outbreak.