Provider alert from BCHHS Public Health: Pertussis outbreak in Henderson County

December 6, 2017

As you are likely aware, an outbreak of pertussis is currently happening in Henderson County – as of last night, 10 cases have been identified, affecting numerous schools. Investigation and contact tracing by Henderson County Department of Public Health is ongoing. Additionally, other surrounding counties have confirmed cases. While we are not currently aware of any pertussis cases in Buncombe County, we expect that to change as it spreads throughout WNC. Please remain vigilant and continue to promote immunization against pertussis.

As a reminder, if you suspect someone of having pertussis, please do all 4 of the following steps:

1.       Test

  •          Collect both a PCR and culture for Bordetella pertussis.
    • For the PCR test, a newer and quicker option is a Respiratory Panel PCR -- results are available in 90 minutes. This test costs $380 through Mission Lab.
      •   For comparison, the standard Bordetella pertussis PCR through Mission costs $351 and takes 1-4 days for results as it is sent to an outside reference lab.
      •   Having results same-day can help you manage antibiotic choice appropriately and assist in more quickly identifying cases and stopping the spread of pertussis.
  •          Please note that we do NOT perform testing for pertussis at Buncombe County Health and Human Services.

2.       Treat

  •          Macrolides are first-line treatment. For adults, the easiest option is Azithromycin 500 mg PO x 1 day, then 250 mg PO daily on days 2-5.
  •          If allergic to macrolides, prescribe TMP/SMX (160 mg/800 mg) PO BID x 14 days.
  •          See Table 4 at this link for dosing regimens for children as well as other macrolide dosing https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4

3.       Exclude

  •          Symptomatic persons should refrain from public activities and stay home from school or work for the first 5 days of a full course of antimicrobial treatment.
  •          Symptomatic persons who do not take antimicrobial treatment should refrain from public activities and stay home from school or work for 21 days from onset of cough.

4.Report all suspected cases to your local health department immediately. For Buncombe County, call our Communicable Disease nurses at 250-5109 (available 24/7).

Our Communicable Disease nurses are also available for consultation if you are uncertain of how to proceed or want to talk through a scenario. Please call them at 250-5109 anytime you have questions.

I also want to make you aware of a newly available resource through Mission for persons who potentially have been exposed to pertussis. We have heard from several providers recently that they have been inundated with phone calls from patients who are seeking evaluation for pertussis post-exposure prophylaxis. As a family doctor, I know the value of continuity of care. However, this is a possible option for you to recommend to those patients if your clinic is unable or struggling to meet the demand.

  •          Mission Virtual Clinic (https://mission.zipnosis.com) enables anyone with exposure to whooping cough to complete a quick, online questionnaire which will determine whether a prescription for prophylaxis is warranted. 
  •          Once the questionnaire is completed, a Virtual Clinic provider will review the case and provide a response to the patient within 1 hour.
    •    If it is determined that they need treatment, the provider will issue a prescription to the pharmacy of the patient’s choice.
    •    If treatment is not warranted, the patient will be provided education about whooping cough.
  •          At the end of the questionnaire, the patient will be prompted to pay $25 with a credit card, but they will only be charged if the provider determines they need a prescription. 
  •          Persons who report symptoms of pertussis or who have certain high-risk conditions will be instructed to see their primary care provider or urgent care for evaluation.
  •          Patients must be located in NC to use this resource.
  •          A patient chart is generated by the virtual clinic and kept in Mission's EHR.
  •          The Virtual Clinic is staffed by a provider from 7am-11pm, 7 days/week.
  •          Please contact Dr. Steve North, the Medical Director for Mission Virtual Health, at steve.north@msj.org for additional information.

Thank you for all you do to protect and care for our community.

Jennifer Mullendore, MD, MSPH
Medical Director
Buncombe County Health and Human Services

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