Sensitive topic--Pertussis

Babyboss 19, MSN, APRN · Dec 5, 2018

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!)

Good to know. I've never done school nursing, so I was unsure of their process. Definitely, NOT advocating pulling children with winter coughs willy nilly out of school. Just that the PEP guidelines are very clear. Maybe OP should sit with school principle and review CDC website info together to eliminate the confusion. Health literacy is not automatic with educational level. Maybe I'm just being naive. Lol.

ruby_jane, BSN, RN · Dec 5, 2018

Good to know. I've never done school nursing, so I was unsure of their process. Definitely, NOT advocating pulling children with winter coughs willy nilly out of school. Just that the PEP guidelines are very clear. Maybe OP should sit with school principle and review CDC website info together to eliminate the confusion. Health literacy is not automatic with educational level. Maybe I'm just being naive. Lol.

You're not being naive...you just hope for best practice!!

ERschoolRN · Dec 5, 2018

Guidelines did come down from the DoH. The communicable diseases CNS is the one that told me i had to keep my son home based on "he has a cough and a direct exposure in his classroom". I do think they jumped the gun and did not let me really talk about his symptoms, vaccine status etc.

I honestly on a health level am not worried. I just hate the missing school and scapegoating of it all.

ruby_jane, BSN, RN · Dec 5, 2018

Guidelines did come down from the DoH. The communicable diseases CNS is the one that told me i had to keep my son home based on "he has a cough and a direct exposure in his classroom". I do think they jumped the gun and did not let me really talk about his symptoms, vaccine status etc.
I honestly on a health level am not worried. I just hate the missing school and scapegoating of it all.

I feel you. So...did you have to exclude the non-vaccinated kids around the student? What about the women who are pregnant or new moms? Or new dads?

ERschoolRN · Dec 5, 2018

I feel you. So...did you have to exclude the non-vaccinated kids around the student? What about the women who are pregnant or new moms? Or new dads?

No that's my bigger frustration. I got the original call about 2:30 monday afternoon and we get out at 3:00. Kids were in an assembly so i couldn't really go and observe the class like they wanted me to so we agreed id do that in the morning. I hung up and thought about my kid (went into mom mode when i saw that child that was positive was in his class) and called my boss to say "hey my kid has a dry cough should i take him in" and then she called the CNS with DOH and it escalated into he has a cough, he stays home. I feel like that criteria is NOT being used for other students (unless we note a child with a terrible cough) and other than that no precuations are being advised. Per CDC after 21 plus days of a cough they dont' even recommend treatment or testing or class exclusion and my son has had this dry cough for a couple of months just like i have.

Anyway, sorry to keep beating a dead horse here but i am so frustrated and mad that i even said anything. It was late in the day and I just was trying to ask on a "i'm a nurse, you're a nurse, what would you do if it was your kid" level. My mistake.

Duranie · Dec 5, 2018

I guess your boss, as a nurse, did what they'd do if it were their kids.... they called and reported him.

I guess that sets the expectation. Report the kids with coughs. Period.

And I don't understand the 21 day thing.... I thought most milder cases aren't even detected until after 21 days.... especially in adults.

And they aren't recommending un-vaxxed kids not be in school :bored: ? That's just strange to me.

OldDude · Dec 5, 2018

Reading this is causing my eyes to glaze over...it still doesn't make sense.

ERschoolRN · Dec 5, 2018

I guess your boss, as a nurse, did what they'd do if it were their kids.... they called and reported him.
I guess that sets the expectation. Report the kids with coughs. Period.
And I don't understand the 21 day thing.... I thought most milder cases aren't even detected until after 21 days.... especially in adults.
And they aren't recommending un-vaxxed kids not be in school ? That's just strange to me.

thankfully i have no unvaxed or exemption kids. that made it easier. But they are only telling me to report "severe cough" at this point which my child did not fall into the category.

Eleven011 · Dec 6, 2018

Sorry I didn't see this earlier - I JUST went through this in my school. 2 kids, brother and sister, were diagnosed with Pertussis. The Dept of Health called and informed me of that fact. They interviewed both kids, and with that info, called other families that were in direct contact with the infected 2. If any of those kids were sick, they were told to go to the dr, then dr would decide to test and treat if needed. If they did, they were excluded for 5 days. If no test/treatment, they were ok to come back to school with dr. note. As more kids got sick/tested/exposed - my list of exclusions grew. Luckily it was over Thanksgiving break, so many that were excluded didn't actually miss 5 school days. It has finally died down, but it was a process, I tell ya! My own daughter was close contact with patient 0, and she was sick, so she got treated and missed 3 days of school (+weekend). She tested negative. I'm glad its over, but really, DOH was in charge the whole time - we just followed their direction.

ERschoolRN · Dec 6, 2018

Sorry I didn't see this earlier - I JUST went through this in my school. 2 kids, brother and sister, were diagnosed with Pertussis. The Dept of Health called and informed me of that fact. They interviewed both kids, and with that info, called other families that were in direct contact with the infected 2. If any of those kids were sick, they were told to go to the dr, then dr would decide to test and treat if needed. If they did, they were excluded for 5 days. If no test/treatment, they were ok to come back to school with dr. note. As more kids got sick/tested/exposed - my list of exclusions grew. Luckily it was over Thanksgiving break, so many that were excluded didn't actually miss 5 school days. It has finally died down, but it was a process, I tell ya! My own daughter was close contact with patient 0, and she was sick, so she got treated and missed 3 days of school (+weekend). She tested negative. I'm glad its over, but really, DOH was in charge the whole time - we just followed their direction.

Thanks! That sounds way more organized than what i've gone through this week. I think the biggest issue was the doctor who is in charge at DoH was out on monday when the info came through. I guess it could be worse. So far I haven't heard of any more kids being out but i guess time will tell! My son and one of the siblings of the positive student were tested on tuesday so i imagine we won't hear until early next week.

Duranie · Dec 7, 2018

Thanks! That sounds way more organized than what i've gone through this week. I think the biggest issue was the doctor who is in charge at DoH was out on monday when the info came through. I guess it could be worse. So far I haven't heard of any more kids being out but i guess time will tell! My son and one of the siblings of the positive student were tested on tuesday so i imagine we won't hear until early next week.

It seemed like a big part of what caused the never-ending mess in my district, was that turnaround on testing was so s-l-o-w....

And of course, all of a sudden no hcp's wanted to treat empirically (like they've ever cared what the swab/culture showed any other time... nevermind any culture/sensitivities on +RST... :sarcastic: ... Normally it's like: [cue best Oprah voice] "And a bottle of bubblegum-flavored, pink liquid for you, and a Z-pack for you, and Augmentin chewables for you....." ) Heaven forbid any barely febrile kid with a sore throat stay home and eat chicken noodle soup, popsicles, and jello for a day or 2 before running to urgent care, or fast-track because "it's probably strep" :yawn:

But when there's actually an argument that could be made for beginning treatment while waiting for the cultures, suddenly everyone's stingy with the abx... :banghead:

ETA: At the time of the outbreak, it never occurred to me to question the way things were being handled. I felt bad for everyone going through it, and I shook my head that because of so many unvaxxed kids and adults, so much disruption could occur in such a localized area... but since neither my family, nor anyone we were directly associated with were seriously impacted, I just took for granted that everything was handled according to "best practices."

But today for the first time, I was curious-- I guess because as I've been reflecting back with this discussion, some things from back then just didn't seem to add up r/t timelines for exclusion, who was presumed to be infectious, etc.

Anyway, I am now sitting here realizing that unless I am missing some really strange, obscure, or bizarre pieces of the puzzle, the situation seriously turned into a case of the "inmates running the asylum." We were told that adults who had been infected for months were still contagious, and that adults could be carriers in that way, spreading pertussis virtually forever, until they were treated. I don't remember anything about not being contagious after 21 days, or about it being essentially self-limiting in older kids/teens/adults. Actually, I remember specifically that suspected cases had to either have a negative culture, or be treated to come back to school. 21 days was the amount of time that needed to elapse with no new cases in order for unvaxxed students/faculty to return to class. Kids who did eventually test positive were said to have had chronic "whoop-like" cough in the several weeks prior and had supposedly been "mis-dx'ed" with croup. Now, if I had to guess, I would bet that they actually had croup to begin with (or something like it), and developed pertussis later.... and to a parent who doesn't know any better they could sound enough alike, or maybe several illnesses just start to blur together.

And the CDC actually does suggest treating empirically during an outbreak if a patient presents with clinical signs and symptoms. There are also criteria for abx prophylaxis for exposed individuals.

Imagine, if instead of segregating several dozen children, they had been allowed to remain in class and given prophylactic abx if there had been any actual exposure.

The reality is, that these students were only effectively "quarantined" during the school day... the rest of the time, they were out in the community-at-large, where they could interact with the same people they needed protection from during school hours.... it seriously makes no sense when you really think about it. :unsure:

{Just thinking out loud:

I know my asthmatic son had episodes from infancy through early grade school when his "cough-variant RAD" was superimposed on (at separate times) RSV, epiglottitis, pneumonia, bronchiolitis, & bronchitis and I can't even count the number of times we spent in the ER or admitted to peds (and 2x to PICU) with the whoop-y, red-verging-on-purple-faced, gagging-on-secretions-to-the-point-of-vomiting, can't-seem-to-catch-his-breath type cough. Watching videos of young kids with whooping cough is like having flashbacks of my son circa 1996 to 2000-01.... but never once did anyone suggest he had pertussis-- although it's possible they tested him and it was negative, and I was so focused on what it was, that what it wasn't never even imprinted on my consciousness.... seriously, forget all the components of "room air"... he and I spent the great majority of his early years breathing more albuterol than anything else (I know, not really... but jeez, sometimes it seemed like it- at home, there were nights I slept sitting on the floor by his bed with a sheet over us (fort-style) and the nebulizer just "smoking" away.... and in the hospital, I had to build mini-forts that didn't fully cover him... except of course, there he was on O2 with his nebs.

FYI... sheet-forts are a great way to keep toddlers and preschoolers entertained and hide some of the scary, unfamiliar hospital atmosphere.

So... now I'm realizing that although the cough is indeed distinctive, but it's obviously not specific only to pertussis.}

Anyway... back to my point- I don't know how the epidemic in my area ended up being so seemingly mishandled. I really had no idea how far they seemed to veer away from EBP, and CDC guidelines. But looking back, it was seriously messed up. ðŸ˜

This whole discussion has really given me some food for thought.

Thanks for starting the topic ERschoolRN. :up: .

ERschoolRN · Dec 11, 2018

And drum roll please....his test was NEGATIVE

On the ironic side his sister is home this week with cough and high fever. It's always something. Haha