Sensitive topic--Pertussis

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Anyone had to deal with this in their schools?

It's my 1st year at an elementary school (1st year as school nurse at all) and my 2 boys come with. Last week all 3 of my kids had raging head lice (which is rampant in the school) and now this week a positive pertussis in my 4th graders class. I mentioned to my boss he's had a cough off and on and should i be concerned adn now it's escalated above her and hes excluded from school for 5 days of antibiotics or until a negative PCR comes back. Taking him to the doctor in about 30 mins to discuss. But he has been coughing for awhile and i had bronchitis supposedly and have had a cough myself for almost 2 months. Sorry this is rambly I'm just torn about him being out plus not getting a lot of direction for how to deal with the issue at the school level yet.

I feel like I'm missing something. Is this a boarding school?

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I feel like I'm missing something. Is this a boarding school?

No public elementary

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Specializes in Pediatrics Retired.
I know. Technically he doesn't have the symptoms with an occasional cough which has gotten better. I don't even think he's coughed once today. But the director had her son test positive with only a cough at night years ago and i think that clouds her objectivity.

They tested my son today and put him on antibiotics and he'll have to stay out until Monday.

We sent a letter out to the whole grade today that only said if they have a severe cough they should stay out and go to the doctor. I guess my hand are tied. My concern is they wouldn't put my younger son on antibiotics who is in the grade below. They sleep in the same room.:-/ I'm just hoping since he has no symptoms that i would t have to repeat all this on the off chance my son is positive.

Work wise though they are working with me so i do t have to eat all my paid time off which is amazing.

Geez, what a cluster of hysteria and misinformation. Your son doesn't have whooping cough.

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Yes exactly. I'm so mad i said a word about his occasional sporadic dry cough. He had 1 episode Saturday where he coughed to that gaging point. I wasn't expecting my boss to escalate it. I'm just mad at myself. And que the phone calls from 100 concerned parents.

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Specializes in Prior Auth, SNF, HH, Peds Off., School Health, LTC.

I think the admin needs to google whooping cough and listen to what it sounds like! It is very, very distinctive.... it's how it got the name whooping cough. Most pediatricians probably would laugh at the suggestion to bother testing a fully and properly immunized child. Of course, if it's the school that's requiring the test they'll do it, but still- they'd be :no:....

I would definitely reach out to the heath dept. Like a PP mentioned, it is reportable anyway, and DoH will have all the info regarding who it's appropriate to exclude, and they should also have the exact letter that should be sent home. Our DoH actually sends the letter, not the school.... and the school is instructed to refer all calls from parents to the health dept.

We had an epidemic in our district a couple years back.... it turned into a real clusterfudge ...... there were a LOT of kids throughout the grade ranges that had opted out of immunization for "religious, moral, or physical reasons" ... this meant that there were not only a bunch of kids who contracted it (oddly enough, it was traced back to several adults who hadn't had boosters... including a few teachers and some volunteers) but due to the widespread occurrences, all non-immunized kids throughout the district had to be excluded for 14 days after there were no new confirmed cases, and the confirmed ones were treated. There were new cases popping up every week for months... many kids but also a lot of adults, like I said... so after a few weeks, the district had to set up what was essentially a "one-room schoolhouse" (really a few rooms but that's splitting hairs) in the district offices and have substitute teachers come in to manage the schoolwork that was sent by the teachers for the kids. Classrooms that had video capability, the students watched on monitors and sent questions via instant message to teachers, so they were able to participate better. Otherwise, these poor kids, through no fault of their own, felt like they were in detention for months. They had lunch brought in, but they didn't have the same choices like they got at school, so often kids just didn't eat. Recess meant going out on the tiny patio and bouncing a four square ball, or jumping rope... eventually someone brought in sidewalk chalk, and I think one of the kids drew a hopscotch grid.... but the point is that even recess sucked for these kids :(... most of them were separated from all their friends, and many were only children, so they didn't even have siblings there with them. It was *really* depressing for them- more than one of them ended up dx'ed with depression by the end. I think all told, the kids ended up excluded for more than 4 months. Basically a full semester.

Originally the district put them on home bound instruction, and would send a teacher to the home for an hour or so daily, but that got to be too much when the number of kids kept going up and up. It was more cost effective to cohort the non-vaxxed kids together.

The district also began to check teacher immunization status as a condition of employment :facepalm: (for those who didn't want to vax, they were put on medical leave and excluded just like the kids were, it was in their contracts... but no one had actually checked for their status :blackeye: ) and volunteers had to submit immunization records before they could work in the school, even if it wasn't in direct contact with students, i.e. pta committees.

Man that ended up *much* longer than I intended... oops :writing: ...

Anyway, my original point, if you are still with me ;)-- call the DoH first thing in the morning, and get their input on the right way to handle the situation.... believe me, they want to keep kids in the classroom if it's safe. Unvaxxed kids in our district were allowed back to class if they were vaxxed-- they just had to wait a certain number of days... (14, I think, but it might have been 21... I can't remember for sure. :o) the DoH actually came out and did multiple community vax clinics in our area.... we don't normally get them out here, because we are a semi-affluent area, and generally don't qualify for free vax. So for the few that do, they have to go to the DoH offices or find a "shot-mobile" if they want the free vax.

Good luck. Make the call to DoH and they can instruct the admin on proper management, instead of relying on off-the-cuff-panic reactions that are not based in actiual principles of epidemiology... Show them that you operate on evidence-based practice, rather than reactionary farce. :yes:

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Wow that's wild it got that bad! The letter did come from DoH and did say to call

The health dept so hopefully i won't deal with too much of it. I've made it clear to his teacher that he really didn't have symptoms. I just mentioned the word cough and the DoH told me cough and being in a class with confirmed case he had to stay out. I'm frustrated for sure but trying to just let it go and move forward. His teacher told me she does have a few lids in the class that have concerning coughs...but it's cold and flu season so who knows

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Specializes in Prior Auth, SNF, HH, Peds Off., School Health, LTC.

If there hadn't been so many un-vaxxed kids (and adults) it would've been *much* easier to contain.... Or if anyone had thought to check the adults sooner.... or if those who were coming due for boosters were vaxxed early... because several cases happened in kids who were only a couple months from being due. I don't think there were any cases among anyone who was properly vaxxed or that were a year or more away from being due, ended up with it. I think eventually the decision was made to give boosters to those who would be due in the coming year....

it was such a comedy of errors ..... it was sad. :sorry:

And I felt so sorry for the "segregated" kids. All told, there were several dozen. Apparently some of them were begging their parents for the shot so they could go back to their regular classes... and of course the kids can't understand why mom/dad won't let them get a shot. Imagine, kids asking to have a shot. I thought that especially the teenagers should've had their opinion heard, and been allowed to have the shot. Starting at age 13, these kids can get reproductive health care without parent input, and they don't even have to be cogent in their request.... just their age qualifies them. If you are old enough to get an abortion, or get treatment for an STI, then you ought to be able to have a DTP shot. (Planned Parenthood, and similar clinics are able to give Gardisil to teens without parental permission, b/c it protects against an STI.... go figure :sarcastic:)

On the plus side, there were a few families that changed their "stance" on having their kids immunized after the whole mess got their kids segregated. Apparently, for some, their "objection" was based in laziness. It was less effort to fill out the opt-out form than to go get checkups & shots. And I think there *was* one or 2 teens whose parents did let them get vaxxed ... they were parents who knew it would someday be the kids own decision-- the situation just accelerated the process. So it did weed out the ones with real reasons to object.

Anyway, back to your situation, it's good that DoH is taking the reins. They should be applying the exclusion criteria evenly though, so that if your son is excluded for a nighttime cough- that no one else has even heard- then kids actively coughing at school should also be kept home until the same parameters you've had imposed on your son have been met by those students as well. I assume they are depending on you to send the coughers home, and report their names to the DoH. Whether or not you think the kids likely just have a cold (which is more than likely the case), it is important to follow the criteria they have set out, so that no parents end up feeling like their kids are being treated unfairly. As long as the rules are the same for everyone, then it is fair. Frustrating, even aggravating, but fair.

Do you have any unvaxxed kids in your student population? Are the parents being reasonable with them not being in school until it's safe? It never ceases to amaze me how many parents can't grasp why little Suzy can't be in school if there's an outbreak.... it's for their kids' protection, but somehow not everyone seems to understand the simple concept: No shots, no history, no service...

What about any immuno-compromised kids? They may have to stay home, too.

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I have had one case of positive pertussis, the parents did not notify the school, mom did keep the kid home for the required 5 days. We found out around 4 weeks after the kid had already been treated and was back in school - Health department called me and then emailed me a letter to send out to parents.

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Specializes in Pediatrics Retired.
I have had one case of positive pertussis, the parents did not notify the school, mom did keep the kid home for the required 5 days. We found out around 4 weeks after the kid had already been treated and was back in school - Health department called me and then emailed me a letter to send out to parents.

More bureaucratic objectivity and reason...closing the gate after the horse is out of the pen.

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Specializes in in primary care pediatrics and NICU.

I'm a little confused about the process in place for sporadic outbreaks in public school in OP's area. Isn't there a P & P in place, with an algorithm when certain conditions present? The CDC guidelines on PEP are available on their website. ? If not, OP, being an RN certainly has the education and authority to author one and put in place with board approval.

As a PNP, I saw a 10 year old in clinic last year that had a 2 month cough. Mild, but wouldn't go away and no asthma. He sounded like mild croup, but too old (and definitely not a whoop, it's sounds different!) He had latent pertussis. Only younger children present with whoop and emesis. Adults and adolescents often do not. So I understand the OP's director's feelings on the topic.

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Specializes in ICU/community health/school nursing.
I know. Technically he doesn't have the symptoms with an occasional cough which has gotten better. I don't even think he's coughed once today. But the director had her son test positive with only a cough at night years ago and i think that clouds her objectivity.

They tested my son today and put him on antibiotics and he'll have to stay out until Monday.

.

AAAAHHH. I see. We're not using the current best practice but we're using collective history. Hey - it's not a bad thing but I wish the director had consulted public health.

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Specializes in ICU/community health/school nursing.
I'm a little confused about the process in place for sporadic outbreaks in public school in OP's area. Isn't there a P & P in place, with an algorithm when certain conditions present? The CDC guidelines on PEP are available on their website. ? If not, OP, being an RN certainly has the education and authority to author one and put in place with board approval.

As a PNP, I saw a 10 year old in clinic last year that had a 2 month cough. Mild, but wouldn't go away and no asthma. He sounded like mild croup, but too old (and definitely not a whoop, it's sounds different!) He had latent pertussis. Only younger children present with whoop and emesis. Adults and adolescents often do not. So I understand the OP's director's feelings on the topic.

There is - but it resides at the local health jurisdiction and also depends on docs doing testing/culture rather than just treating empirically.

Cough of extensive duration is not a reason to exclude a kid from school unless there's fever along with it. It's up to the parent to take the kid to the provider and it's up to the provider to do that sleuthing that you did (good catch, btw!)

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