Letter to fourth graders and bus riders

February 11, 2009 Two 4th grade students and one kindergarten student have been diagnosed with pertussis (whooping cough) and we suspect that at least one other kindergartener has had the illness as well. One 4th grader was diagnosed in early December and one was diagnosed in early February. The kindergartener was diagnosed this week. Parents of 4th graders have been asked to obtain preventative antibiotics* for their children. Many parents have complied. A significant number have not. Kindergarten parents will receive a letter today directing them to obtain preventative antibiotics for their children.

Since students on bus 223 were also exposed, parents of students on bus 223 have been directed to obtain preventative antibiotics as well. Some have complied, some have not.

Due to the continued transmission of pertussis within Carrboro Elementary, it has now been determined that close contacts to the February cases will be required to provide documentation of having taken an appropriate antibiotic to remain in school. This means that 4th graders, bus 223 riders and kindergarteners will be required to provide proof by Monday, February 16th that they have taken a preventative antibiotic since February 1 to help prevent pertussis.

North Carolina communicable disease law allows the Health Director of the county to require treatment for pertussis contacts. The decision 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 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.

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 persistent cough. 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.

Symptomatic children should be evaluated by a medical provider and stay at home until they:

  • Have had pertussis ruled out by a medical provider and have begun a preventative antibiotic or
  • Have completed 5 days of an antibiotic effective against pertussis
  • Proof of treatment that the school can accept include an empty labeled medication bottle, a prescription-specific receipt from the pharmacy or a note from the medical provider or pharmacist.

    Though the vast majority of the school is 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 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. Families who have already provided their children with appropriate antibiotics since February 1 will not need to re-treat their children, unless your child shows symptoms of pertussis. However, providing proof of treatment is required.

    If you have questions or concerns please 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

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