Pertussiss Outbreak Among An Undervaccinated Community

Background: On June 1, 2009, an on-going outbreak of pertussis was first identified.  As of December 4, 2009, the Kansas Department of Health and Environment (KDHE) has identified over 75 cases in a community.

Setting: Religious community with concerns about vaccinations

Population: Under-vaccinated and unvaccinated school-aged children

Project Description: KDHE has worked with the staff at the local health departments (LHDs) to provide technical support and case investigational resources.  The attempted control of the outbreak required the participation of various entities: local health departments, child care inspectors, physicians, hospitals, and laboratories. Control measures included: exclusions of under-vaccinated children, post-exposure prophylaxis of exposed contacts, joint letter from KDHE and LHD Medical Directors to area physicians, review of all immunization records of children attending school, LHD Medical Directors presentation at grand rounds.  Vaccination of under-immunized contacts was also recommended as a control measure but adults in this community have religious objections and vaccine safety concerns.

Results/Lessons Learned: Several barriers prevented this outbreak from being controlled: limited staff resources at the local level; state and local resources were diverted to H1N1 activities; community distrustful of disease investigators, of vaccinations and community resources; lack of knowledge of laboratory resources at KDHE.  KDHE and LHDs had difficulty in educating physicians on the appropriate pertussis diagnostic tests and vaccinations.  Should an outbreak occur again in a similar community, KDHE would increase staffing resources and would employ the use of STD Disease Investigation Specialists who are familiar with interviewing reluctant cases.  KDHE would attempt to collect a culture specimen at the beginning of the outbreak. School officials cooperated during a review of immunization records of all students.  KDHE and LHD made recommendations for all missing vaccines.  This information was then sent to the parents via the school.