Caring for Populations: Assessment and Diagnosis
Pertussis, also known as the “whooping cough”, is a highly contagious respiratory illness that is passed from person to person through coughing and sneezing (Gregory, 2013). Early symptoms are similar to those from common colds, but when Pertussis progresses, it can turn to deep cough and potentially vomiting with little or no fever. It is caused by the bacterium Bordetella pertussis. The disease can be very serious in children less than 1 year of age where it can cause lung infections and, less often, seizures or inflammation of the brain.
In rare cases, pertussis can result in death, especially in infants (VDH, 2012). The purpose of this investigation is to help people understand the potential risk of having Pertussis, urge people take necessary actions to prevent the disease, and cite recommendations from CDC for health professionals to follow in their work. Community The Richmond tri-city Metro area. The area covers the city of Richmond, surrounded by 2 counties, Chesterfield and Henrico. This area has relative dense population with over 200 schools, which creates an ideal environment for the break of a contagious illness such as Pertussis.
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While it is desired to focus on the topic to a smaller area, the data for Pertussis isn’t readily available at county or city level, so for this discussion, the community of interest is the entire Virginia state. Demographic and Epidemiological data Virginia has just over 7 million in population from the 2000 census. If we follow the recommendation from The Centers for Disease Control and Prevention: pertussis vaccine for persons 65 or older who have close contact with infants, pregnant women, new mothers who are breastfeeding and health care or childcare professionals who have direct contact with infants and young children, there’re about 1. million people that fall under this category just by age, and it is estimated that over 4 million people will have direct and indirect contact with those who’re under high risk of catching pertussis. The overall trend for Pertussis in recent year is on increase, which is also the trend across the country. There were more than 41,000 reported cases in the United States in 2012, up from 18,719 for the previous year (Gregory, 2013). Virginia reported 566 cases, compared to 384 in 2010 and 127 in 2007 (VDH, 2012). In fact, 2012 was worst year for whooping cough since 1955 (Foxnews, 2013).
Like it was indicated previously, while I intended to focus on the central Virginia area, due to lack of data, I had to expand the scope to the entire state. The windshield survey however is limited to the central Virginia area. In fact, only part of the area that I am familiar with. The place I live and commonly drive around is Midlothian, it’s part of the Chesterfield county, and was founded over 300 years ago as a coal mining village. The demographics are predominantly European American. The median household income in 2005 was $80,381. It was ranked #37 in CNN Money’s list of “The best places to live” in 2005, and #99 in 2008.
The unemployment rate is relatively low at around 5%, compared to the nation’s average. Most of areas are suburban, with some rural areas as well. Given the weather, when I was driving around the neighborhood, I did not see many people, other than a few here and there walking their dogs. In a few shopping places, I noticed that most of them are white, which matched the demographic data found from other resources. Home I observed are mostly small family houses, the median home price is around $200K; while certain neighborhood, it can go up to $400K. $1MM+ properties exist, though not very common in this area.
Many people are employed by the state, and Richmond is the Capital of Virginia, there’re several big private employers in this areas, including Capital One, CarMax, Genworth etc. We have 3 big hospital systems in the region: The Bon Secours Hospital System, Virginia Commonwealth University System and HCA Virginia. Overall health resources are abundant, for example, I can easily find 100+ dentists within 5 miles from my home. There’re no serious environment issues in this region. Problem and Historical Significance Pertussis is a highly contagious and potentially fatal illness.
Pertussis is most severe for babies; about half of infants younger than 1 year of age who get the disease are hospitalized. About 1 in 4 infants with pertussis get pneumonia (lung infection), and about two thirds will have slowed or stopped breathing. Pertussis can be deadly for 1 or 2 infants per 100 who are hospitalized (CDC, 2012). The good news is that Pertussis is preventable. The single most effective way is to get vaccinated. Parents can also help protect infants by keeping them away as much as possible from anyone who has cold symptoms or is coughing.
Then why we still have many cases every year, and the number of cases reported peak every 3-5 years. This leads me believe that many people are not vaccinated. The reasons could include the following: * People are not totally aware of the illness; or * If they do, they don’t feel like it’s so deadly that it’s necessary to get vaccinated; or * They choose not to get vaccinated because they have concerns about the safety; and eventually * Some people simply can’t afford it, as Virginia doesn’t provide it free to everybody unlike some other states like Vermont.
It is proposed in Health people 2020 to “Maintain an effective vaccination coverage level of 4 doses of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine among children by age 19 to 35 months”, with the target of 90%, up from the current 84%; and to “increase the vaccination coverage level of 1 dose of tetanus-diphtheria-acellular pertussis (Tdap) booster vaccine for adolescents by age 13 to 15 years” from 62% to 80% (Healthypeople, 2012) Summary Pertussis is such an illness that is often overlooked, partly because of its symptoms is so similar to the ones that come with flu or cold.
While its vaccine is being routinely administrated to infants during regular checkups, certain people still don’t get vaccinated. It is especially important for infants, and Pediatricians need to report when parents choose to opt out and not have their baby vaccinated. State law should only allow for health or religious reasons. For health professionals, CDC has made the following recommendations regarding vaccine (CDC, 2012): * For Infants and Children: In the US, the recommended pertussis vaccine for children is called DTaP.
This is a safe and effective combination vaccine that protects children against three diseases: diphtheria, tetanus, and pertussis. For maximum protection against pertussis, children need five DTaP shots. The first three shots are given at 2, 4, and 6 months of age. The fourth shot is given at 15 through 18 months of age, and a fifth shot is given when a child enters school, at 4 through 6 years of age. If a 7-10 year old is not up-to-date with DTaP vaccines, a dose of Tdap should be given before the 11-12 year old check up. For Preteens and Teens: Vaccine protection for pertussis, tetanus, and diphtheria can decrease with time. Preteens should get a booster vaccine, called Tdap, at 11 or 12 years of age. Teens and young adults who didn’t get a booster of Tdap as a preteen should get one dose when they visit their health care provider. * For Pregnant Women: Expectant mothers should get one dose of Tdap, preferably later in pregnancy. By getting Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines.
Tdap will also protect the mother at time of delivery, making her less likely to transmit pertussis to her infant. If not vaccinated during pregnancy, Tdap should be given immediately postpartum, before leaving the hospital or birthing center. * For Adults: Adults 19 years of age and older who didn’t get Tdap as a preteen or teen should get one dose of Tdap. Getting vaccinated with Tdap at least two weeks before coming into close contact with an infant is especially important for families with and caregivers of new infants.
Adults get Tdap in place of one of their regular tetanus boosters—the Td shot that is recommended for adults every 10 years. However, the dose of Tdap can be given no matter when the last Td shot was received. It’s a good idea for adults to talk to a health care provider about what’s best for their specific situation. While Pertussis is not as deadly as many other diseases, it is highly contagious and often gets ignored which makes it a dangerous illness to infants. However, the prevention is totally possible, as long as we the health professionals deliver the right information and services.
Gregory, D (2013, January 16). Whopping cough cases on the rise. Chesterfield Observer, pp.2.
Virginia Department of Health (2012). Pertussis Prevention in Virginia. Retrieved from http://www.vdh.virginia.gov/epidemiology/Immunization/Pertussis/index.htm.
Infoplease (2000). Demographic Statistics Virginia. Retrieved from http://www.infoplease.com/us/census/data/virginia/demographic.html.
Foxnews (2013). 2012 was worst year for whooping cough since 1955. Retrieved from http://www.myfoxatlanta.com/story/20505024/2013/01/04/2012-was-worst-year-for-whooping-cough-since-1955.
Centers for Disease Control and Prevention (2012). Retrieved from http://www.cdc.gov/features/pertussis/.
Healthypeople (2012). 2020 Topics & Objectives: Immunization and Infectious Diseases. Retrieved from http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=23.