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Sick

With 131 confirmed cases of whooping cough in Missoula County, the public health department is scrambling to provide staff to cover the outbreak.

As of Tuesday, Missoula is leading Montana in the number of whooping cough cases — also known as pertussis — with almost half of the 265 cases reported to the state epidemiologist’s office as of Friday.

Ellen Leahy, director of the Missoula City-County Health Department, said they’ve hired 10 nurses to help chase down people who may have been in contact with the confirmed cases, and on Tuesday she asked the county commissioners for the ability to pay four nurse managers for their overtime work. Leahy estimated that at this point those four have accumulated about 65 overtime hours, which usually would be taken as comp time but can’t be due to the additional work.

“I don’t know when they will be done working extra hours, because they need to catch up on all the things they’re not doing now,” Leahy said. “We have done this before, but not for this long and this amount of staff.”

The four nurse managers will not be paid time-and-a-half, since they’re supervisors, Leahy said. Instead, it will be straight time, as would any comp time for them. All of the additional funding is coming out of the public health emergency preparedness fund and cash reserves in the health department.

“At this time last year, in 2018 we only had 21 cases in Montana,” said Stacey Anderson, a state epidemiologist. “We’re seeing elevated numbers in Gallatin, Park, Lake and Lewis and Clark counties.”

The 10 nurses hired by the health department are a mix of part-time and full-time temporary positions, who are working with schools to track down students and staff who may have been exposed to pertussis. For each confirmed case, those nurses go back 21 days looking for people who may have been within 3 feet of the ill person for one hour or longer.

The disease is spread when an infected person coughs and sneezes, and others breathe in the airborne bacteria.

The nurses notify individuals of the potential contact, and offer instructions for any action that’s needed, typically through three standard form letters from the Missoula City-County Health Department. One notifies a parent or guardian that the youth has been identified as a close contact to a confirmed case of pertussis, and requests that the child be monitored for symptoms. Those children can return to school.

The second letter is bright pink, and advises the parent or guardian that the child must stay home until they are seen by a health care provider and get a release to return to school. If the adult and doctor choose not to test and treat for pertussis, the child must be monitored for symptoms for 21 days after the most recent exposure.

The third letter informs parents or guardians that a child may need antibiotics to prevent getting and spreading the disease. Information is faxed to the health care providers, but children can continue to go to school if they are asymptomatic.

Leahy isn’t sure how long the outbreak will last. They consider it ended 42 days after the last reported case; the incubation period is 21 days, and to ensure the outbreak is finished, protocol calls for waiting for two incubation periods just to be certain.

Pertussis begins with cold-like symptoms including a runny nose, a mild, occasional cough, sneezing and a low-grade fever. Later symptoms include a persistent cough severe enough to cause exhaustion, vomiting or a whooping sound as patients try to catch their breaths.

Some infants with pertussis don’t cough; instead, it causes them to stop breathing and turn blue.

Those at high risk include infants, people with respiratory or cardiovascular conditions, pregnant women, and people with compromised immune systems.

“We want to keep this on folks’ radar; if you have symptoms, please go visit your health care provider and be assessed,” Anderson said. “In many of the cases we are seeing this year, especially in Missoula, the average age is 13 to 17 years old.”

That’s due in part to a change in vaccines to one with fewer side effects but is being found to be less effective in preventing pertussis over time. Anderson said health officials also are getting better at diagnosing pertussis, which might explain some of the spikes in cases in certain locations.

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