The Great Whooping Cough Epidemic

In my first blog post I wrote I had some experience with caring for a group of people stuck in the midst of an epidemic. In my case the villain was whooping cough, a highly contagious bacterial infection caused by the bacterium Bortadella Pertussis. Once whooping cough was a common childhood illness, causing high fever, and persistent cough that can last up to four months or longer.  It is called whooping cough because of the whoop-like noise made by children who have whooping cough, or Pertussis, when they cough.

Fortunately there is a vaccine for Pertussis. It is the P in the DPT vaccination children begin getting at two months. But there are problems with the Pertussis vaccine. It does not impart life-long protection against whooping cough (in fact these days people in need of a tetanus booster shot also get Pertussis too.) And when my children, who are now in their 30s, were toddlers parents were often afraid to give the Pertussis vaccine to their children because, in some infants, the vaccination itself causes a high fever. The problem with this is infants who contract whooping cough usually don’t cough, but go into respiratory arrest.

My first encounter with the seriousness of whooping cough was in 1973, when I taught nursing at a hospital in Cincinnati, OH. One of my students had a newborn too young to be vaccinated and that baby died of whooping cough at a month. I can’t imagine the pain this must have caused her family.

My second encounter with whooping cough was as a camp nurse at Camp Hawthorne, a residential camp for about 150 kids ages eight to fifteen on the shores of beautiful Panther Pond in Raymond, Maine. I had the privilege of being Camp Nurse at Camp Hawthorne for the first summer session from June 1997-June 2004, an eight summer stint I remember with great fondness. The story I am about to relate happened around 2000. I don’t remember the precise dates, only the events.

            It started on July 6^th, a chilly, gray Monday morning. Not the kind in which any child in her right mind would voluntarily jump into a lake and swim 100 yards to pass a swim test. So when fourteen -year old Natasha came to me after breakfast, complaining of a sore throat, my initial response was to dismiss her complaints. Nevertheless, I took her temperature. It was 99.1°F, not high enough to qualify as a fever (>100.4 F.) Her throat was not red. She didn’t even sound stuffy, nor was she coughing. But two things kept me from completely dismissing Natasha’s complaints: I had never heard her grumble about anything before, and, she just didn’t look right. The nurse in me told her she was fine. The mother made her a cup of tea with honey and excused her from the day’s activities.

            At dinnertime Natasha felt about the same, but Chelsea, an asthmatic girl in the same bunk was using her rescue inhaler more than usual. Yet, Chelsea felt fine, blaming her need for the inhaler on pine pollen lying so thickly on every surface you could write your name in it.

 

            That evening I followed my usual routine, making the rounds of each of the five bunks for girls and five for boys, passing out bedtime medications, dispensing band aids and Tylenol, and, I hoped, a calming assurance that all would be well at Camp that night. Then I returned back to my own cabin, which also acted as the infirmary, where I sat on the screened-in porch knitting while listening to the Red Sox on the radio.

            A little after midnight Diane, the Camp Director’s wife, pounded on my door. “Barbara, can you get up, we’ve got a crisis.”

            I immediately snapped to attention, found my bathrobe, shoes and glasses, unlocked the screen door, and invited Diane inside. I expected her to have a child with her, but she was alone.

            “What’s up?”

            Diane handed me a sheath of papers. “Natasha’s parents just faxed these to Ron. And he just off the phone with them. Oh my God, what are we going to do?”

            A quick perusal of the papers showed they were an official notification from the Brookline, MA Board of Health informing Natasha’s parents that two weeks earlier Natasha had unwittingly been exposed to Pertussis-- whooping cough.

            “It’s nothing, right?”

            “I doubt if it’s a problem, Diane. Most kids were vaccinated against Pertussis when they were babies. It’s 1 AM. There’s nothing I can do about it now anyway. But I’ll call Brookline in the morning.”

            “Natasha’s not sick?”

            “Ah, that’s a problem,” I prevaricated. “Natasha is sick. Just a sore throat, not even a fever. She’s so OK she’s back in her bunk, not here with me. Let’s worry about this in the morning.”

            But after Diane left I pulled out my “advanced” pediatric nursing textbook and looked up Pertussis.

            Much of what I read I already knew: Pertussis, also known as whooping cough, is a bacterial respiratory infection. It earned its name for the distinctive whoop-like sound infected children make when they are coughing. Once a frightening childhood illness with the potential to cause serious complications or even death, Pertussis is no longer the scourge it once was. Today, thanks to the use of Pertussis vaccinations and the antibiotic Erythromycin or its grandchild Azithromycin, Pertussis is no longer to be feared. Satisfied the situation was not out of control I went back to bed and back to sleep.

            The following morning, after talking to Ron, the Camp Director, Natasha, her parents, and the Brookline Health Department, I felt less in control of the situation, even if I did have a plan.

            The first complicating matter was Natasha’s childhood history. Born in Russia she’d come to the US when she was five or six. Like most Russian children she had not be vaccinated against common childhood illnesses, including Pertussis. Nor had she contracted the illness as a very little girl. The second complication: although more than 10 days had passed since she’d been exposed I could not assume Natasha just had a cold. She needed to be tested for Pertussis. The third complication: neither Natasha nor Chelsea was any better.

            The final concern was the State of Maine. Should I tell them or not? Would they close the camp down, or not? And what would happen to the children whose parents were counting on us to be there for their offspring while they worked long hours or took well deserved vacations?

            With a great deal of anxiety I located the appropriate phone number for the health department in Augusta (I was rather hoping that since it was Fourth of July week everyone would be on vacation) and dialed. A kind person on the other end reassured me camp could stay open, and insisted I have the Natasha tested.

            By then I had been at Camp long enough to have convinced Ron that, as its only nurse, I ought to stay on site while one of the counselors trained in Emergency Medicine took the kids to the closest hospital in Bridgton. But this was no ordinary emergency. I had to go. And so, with the hope of speeding our time in the Emergency Department that happens to be the closest one to Sebago Lake (one of Maine’s most popular vacation spots) I called the E.D. to forewarn them of our arrival.

            Two hours later we were back home, after having spent our time at Lakes Region Hospital in a room by ourselves. Chelsea got a breathing treatment, which considerably helped her asthma. No other treatment was necessary since neither girl appeared impressively ill. But the staff also took the necessary throat cultures from both girls.

            That was Tuesday. At noon on Friday one of the counselors ran to my little house to breathlessly inform me that the Maine Department of Health was on the line.

            Both girls had tested positive. Both girls. How could that be? Chelsea had not been to the same party. She and Natasha had been bunk-makes just long enough for the incubation period to have been realized.

             The person with whom I spoke assured me Camp could stay open, but he was not at all sure what to do next.  

“What does Brookline say for antibiotics?”

“Erythomycin one to two grams per day for 10 days. Or a Z-pack,” I said, referring to a five day pre-packed container of Azythormycin.

“Who else has come into close exposure?”

“One or two other girls in the bunk next door, two of my friends—both nurses, who were visiting over the holiday—and me.”

“Do you have a doctor who will prescribe for you?”

“I’m not sure. I’ll call Bridgton. They know the story.”

“You’re going to have to send the two sick girls home for a few days. They can come back once the antibiotics have taken effect.”

The young doctor on duty in Bridgton’s E.D.  was unnerved. “Read me again what Brookline says about antibiotics.”

“One to two grams of Erythromycin a day. [We had ruled out the Z-packs as being too costly  for people who might not have good health insurance.]

I should have done a little more research. All medications given to children (and adults too for that matter) are weight related. Instead of prescribing a dose appropriate for a thin, athletic 14 year old, the doctor prescribed the maximum dose. One sufficiently large to treat Vince Wilfork. It was way too much Erythromycin for my campers who would have been much better with a gram a day, given in divided doses.

But I didn’t figure that out until after the first girl started throwing up.

That the girls threw up was a combination of their size, that stomach upset is the number one complication of antibiotic therapy, and that it happened to be particularly warn that July day. Not even the promise of freshly sliced watermelon any time they wanted it was sufficient enticement to get the girls to continue with the Erythromycin. Because the camp session was at its end the State turned a blind eye on the situation with the admonition to make sure parents knew their daughters needed continuing treatment.

There isn’t a lot more to tell about my first, and I hope only, encounter with whooping cough on a grand scale.  Later that summer there was another whooping cough scare at camp at about the same time there was an outbreak among the staff on the pediatric unit at Dartmouth-Hitchcock Medical Center in New Hampshire. Soon thereafter the CDC added a Pertussis booster to the Tetanus vaccine people get whenever they’ve experienced a deep cut. I sometimes think our experiences at Camp helped the CDC make that decision.