Big whoop: Pertussis hacks local schools

For one Hook staffer, holiday plans depended on test results that wouldn't be available until 4 o'clock the Wednesday before Thanksgiving. If her middle school son tested negative for whooping cough, they were off to North Carolina as planned for the holidays. If the test results were positive, it was off to the store to cobble together a last-minute turkey dinner.

Whooping cough, a.k.a. pertussis, is a disease for which children routinely are immunized. So how did Charlottesville get hit with an outbreak of the highly contagious malady that at one point sent home one-third of Covenant's upper school student body?

It turns out that whooping cough never really went away.

"It's a pretty tough little disease," says Roy Crewz, senior epidemiologist for the Thomas Jefferson Health District. "It is considered an endemic disease."

Every year there are "dozens and dozens of cases" in the district, which includes counties surrounding Albemarle, according to Crewz. Two years ago, Madison County had an outbreak that closed its public schools.

And while Covenant was the hardest hit this year, cases were also reported at Western Albemarle High School and Henley Middle School.

The outbreak started the second week in November. "We had one case, then three cases, then confirmed cases in each grade level," says Covenant headmaster Ron Sykes. "We literally sent anyone home with a cold or runny nose."

At its peak, 138 Covenant students were absent, including around 75 sent home on one day. Sykes credits the health department with successfully stanching the outbreak. "I think without them, it probably would have run on and on for months," he says.

The health department reports 55 probable or confirmed cases of whooping cough, according to Crewz, who says 70 or 80 cases in any given full year is normal.

"I've seen more cases in the last two weeks than in 22 years," says Dr. Harvey Laub, whose practice, Crozet Family Medicine, has had six confirmed cases.

Northridge Pediatrics has seen about two dozen cases, reports Dr. Jay Gillenwater, and the staff is wearing masks when they treat anyone who comes in complaining of a cough. "This year is atypical," he says. "Last year we saw none."

The disease is most dangerous to the very young, whom violent coughing can cause to turn blue and whoop as they gasp for breath. "They're more likely to die," says Gillenwater.

Before a vaccine was developed, between 5,000 and 10,000 people died each year from the disease in the United States.

The last pertussis booster shot is given around kindergarten. "The immunity tends to wane from there," says Gillenwater, making middle school children prime targets.

A vaccination is in the works for people over the age of seven but that's a couple of years away, says Crewz.

"What's interesting to me about this outbreak– not epidemic–" clarifies Laub, "is that we have not had the violent whooping cough associated with that illness, probably because of some partial immunity from immunizations as kids."

Cynthia McAleer was shocked when she heard her son, Patrick, an eighth grader at Henley, tested positive for pertussis. "All our kids were immunized, and you think all these diseases are gone," she says.

She thought he had a virus or strep throat. "He had a sore throat and then felt fine," she says. "He had a cough but no fever. He never whooped, but he'd have these spasms of coughing that would get your attention."

McAleer got a call from the Henley school nurse. "Everyone coughing was sent home and couldn't come back until they had a negative pertussis test or were on antibiotics for five days," says McAleer.

And because whooping cough is so contagious, the health department recommends antibiotics for family members and anyone in close contact, which Crewz defines as about an hour's duration.

"We're trying to get prophylactic treatment before they get symptoms, and we're trying to get them to stay home," he says.

The recommended antibiotic, azithromycin, popularly known as a Z-pack, causes sticker shock for parents without insurance. Five tablets cost around $100– for a family of four, that could ring up a whooping $400 bill.

"Unfortunately, there are not a lot of options," says Crewz. "We've given some to local physicians."

Headmaster Sykes credits the preventive use of antibiotics for nipping the outbreak. "At a schoolwide assembly before Thanksgiving, I didn't hear anyone cough," he says. And on Monday after the holiday, he says, "Actually, our attendance is up for this time of year."

It takes 24 hours to get back test results for whooping cough. The Hook staffer, whose son had been exposed to a confirmed case, sat by the phone Wednesday afternoon to learn what her holiday plans would be.

The results? Negative, making for an especially thankful family gathering in North Carolina on Turkey Day.