Letter to kindergarten students

February 11, 2009 A kindergarten student has been diagnosed with pertussis (whooping cough) and we suspect that at least one other kindergartener has had the illness as well. Since the kindergarten classes have been participating in joint activities over the past few weeks, it is very likely your child has been exposed. Your child is considered a close contact to the child with pertussis and is required to take a preventative antibiotic* in order to remain in school.

WHAT YOU NEED TO KNOW: School-aged children do not always have typical symptoms of pertussis. Symptoms usually start with a runny nose or cold-like symptoms, but some kids will only have a cough that lasts a long time. The cough may progress to a severe cough (that is when the child can't catch their breath during a coughing fit or gags or vomits after coughing). This severe coughing stage can last for up to 3 months! Giving antibiotics after the symptoms begin will not prevent the illness. It does, however, shorten the period of time the child can infect others. That is why we recommend giving antibiotics before your child has symptoms. Once a child with pertussis has been on an effective antibiotic for 5 days, he/she is no longer contagious.

If your child is a kindergartener at Carrboro Elementary who:

Does not have symptoms of pertussis, your child needs a preventative antibiotic to help prevent him/her from developing the disease. Please call your child's medical provider for a prescription. Send proof of your child's treatment to the school no later than Monday, February 16th.

Has symptoms of pertussis (runny nose, cold-like symptoms and/or a cough) your child needs to be evaluated for pertussis before returning to school. If your child's medical provider considers pertussis to be a possible diagnosis (especially if your child is coughing), your child will need to be tested for whooping cough and will need to begin a preventative antibiotic. Your child cannot come back to school until he/she has proof of a negative pertussis test and is on a preventative antibiotic or has been on a preventative antibiotic for at least 5 days (if the medical provider has determined your child's cold-like symptoms to be from a cause other than pertussis). Send proof of treatment to school no later than Monday, February 16th.

Rides Bus 223 and took a preventative antibiotic earlier this month, your child does not have to be re-treated with antibiotics. You do, however, need to provide proof of treatment to the school no later than Monday, February 16th.

Adults (teachers or volunteers) in the classroom: If you are a teacher or have volunteered in any Kindergarten classroom from Jan. 29th through Feb. 9th , you should contact your medical provider for preventative antibiotics as well.

Though almost all of the kindergarteners are fully immunized against pertussis, vaccines are not 100% effective, as our recent cases indicate. Despite being fully immunized, you must provide proof that your child has taken an appropriate antibiotic to remain in school. Children whose parents choose not to have them take an appropriate antibiotic will need to remain out of school until 21 days have elapsed since their last exposure to pertussis. The last exposure kindergarteners had to pertussis was February 9th. Without antibiotics your child will need to stay out of school until March 3.

Proof of treatment that the school can accept will include an empty medication bottle, a prescription receipt from the pharmacy that shows the antibiotic and the child's name, a note from the medical provider or a note from the pharmacist. Please bring this to school no later than Monday, February 16.

The decision to require preventative treatment was not made lightly. A significant number of parents chose not to treat their children with preventative antibiotics following the case in early February. With this second case following closely, it is very important to break this cycle of transmission of the disease. Continued transmission of pertussis not only in the school but also in the community creates additional expense and inconvenience for parents who continue to treat their children and it also places persons at risk for a serious disease. Pertussis can be extremely dangerous, even fatal, to young infants. There are many children at Carrboro Elementary who have young siblings at home who are placed at increased risk with each new pertussis case.

North Carolina communicable disease law allows the Health Director of the county to require treatment for pertussis contacts. The decision by the Orange County Health Director to require treatment was made in consultation with the North Carolina Communicable Disease Branch, the North Carolina Immunization Branch and administrators with the Chapel Hill/Carrboro Schools. This decision is made totally for the purpose of protecting the health of the community.

The Health Department and local medical providers are working with the Chapel Hill-Carrboro City School System and Carrboro Elementary School to prevent further cases of pertussis. Your local medical providers have been alerted to this situation and the Health Department's requirement for antibiotics.

Families who have already provided their children with appropriate antibiotics since last week will not need to re-treat the child, but will need to provide proof of treatment.

If you have questions or concerns please do not hesitate to call either Sue Rankin, RN at 919-968-2022, ext. 275, Cathy York, RN at 919-968-2022, ext. 314, Judy Butler, RN at 245-2425 or your school nurse, Rita Crain, RN at 919-968-3652.

Thank you. Rosemary Summers, DrPH, MPH Michael Fisher, MD, MPH Health Director Medical Director