Douglas County is experiencing its largest outbreak of whooping cough in decades.
The county health department already has seen 125 cases this year. The last time it had more cases was in the 1930s — a decade before a vaccine for the illness was invented, and when the county's population was less than half of what it is now.
The nation is also seeing near-record outbreaks, especially in Iowa. The nationwide outbreak is the worst since 1959. Iowa has had the most diagnoses since it began tracking individual cases in 1990.
In Nebraska, cases are up in Sarpy and Cass Counties as well, although not as drastically as in Douglas County. In the rest of the state it's been a more mild year for the illness, medically known as pertussis.
Whooping cough usually starts as an occasional cough and progresses into a nagging hack. After a couple of weeks, the coughing fits can become violent enough to cause gagging or vomiting. Other times, people might turn purple or red during a coughing spell, according to the federal Centers for Disease Control and Prevention.
A high-pitched “whoop” can trail a coughing spell as well.
Kassaundra Hartley, a junior at Creighton University, recently had her second bout with whooping cough.
She first came down with the illness and got the vaccine around her freshman year of high school at Spalding Academy in Spalding, Neb.
About Sept. 20 of this year, she started coughing. Maybe it's the common cold that's going around campus, she thought. And she remembered her mom's philosophy: “Unless you're dying, you're not going to the doctor.”
She wore loose-collared shirts to accommodate the coughing. She hacked up mucus, and gagged so much her breathing was hindered. Classmates thought she was choking during spells that turned her face beet red.
She coughed for hours during the night, lost 10 pounds because she couldn't eat without coughing, and got sore abs from the constant spasms.
Finally, after losing her voice for four days and no longer being able to sit for five minutes without a coughing fit, she sought help. “Any time I would move, it would just set it off,” Hartley said. Her nurse's advice? “You probably should have come in earlier.”
Outbreaks that cause such conditions are cyclical, health officials said, happening every three to five years.
Why are some places hit harder than others? Officials say it's the luck of the draw, because the disease spreads easily through coughs or sneezes.
Maybe a couple of people in a locale get whooping cough, don't cover their mouths when they sneeze, and wind up spreading the disease to others. Some states' county health departments also may do a better job of confirming cases than others.
Officials also blame the illness' new vaccine, which has fewer side effects but a weaker dosage than the previous antidote.
Despite that, health officials are asking everyone, especially those around infants and children, to get vaccinated.
“The vaccine is really the best way to prevent what can be a really unpleasant and nasty infection, even for healthy adults, but a fatal infection for infants,” said Dr. Kari Simonsen, assistant professor of pediatrics at the University of Nebraska Medical Center.
Babies remain the most susceptible. They sometimes don't make the whooping noise adults do because the babies' breaths aren't forceful enough, Simonsen said. Infants can gag or stop breathing, she said.
Fifteen percent of the cases in Douglas County have been in infants 1 day to 11 months old. Six infants, all shy of their first birthdays, have been hospitalized this year, said Dr. Anne O'Keefe, Douglas County Health Department senior epidemiologist.
The old vaccine sometimes made children seize or get a fever. The vaccine was altered in 1997 to have less of the actual DNA from the bacteria that causes the illness, O'Keefe said.
But the change also weakened the vaccine — which is why some states encourage adults and teenagers to get booster shots, said Dr. Patricia Quinlisk, Iowa Department of Public Health medical director.
Schools have been affected as well: Omaha Public Schools have had at least 14 cases, and the Millard district has had about 10. Each time the illness is confirmed, the health department works with the schools and sends a letter to the parents of children who might have been around the diagnosed child, said Rebecca Kleeman, Millard spokeswoman.
Unlike the majority of measles cases, the pertussis vaccine reduces the likelihood that you'll get it again, but it doesn't eliminate it, Simonsen said. And unlike chickenpox, she said, if you've had whooping cough once, you can get it again.
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Pertussis vaccinations: What you should know
» A baby should get the pertussis vaccination in its second, fourth and sixth months. A fourth dose should be given between its 15th and 18th months, and a fifth shot at 4 to 6 years old.
» Kids ages 11 to 18 years old — preferably around 11 or 12 — and adults ages 19 through 64 should get a booster shot as well.
» Pregnant women should get the vaccine preferably during the last three months of pregnancy.
» Children under 18: Parents of uninsured children from low-income families can call the Douglas County Health Department's immunization clinic at 402-444-6163 to set up an appointment for a free shot. In Sarpy and Cass Counties, parents can set up an appointment with the Alegent Health Midlands Hospital by calling 402-593-3222.
» Adults: Uninsured and low-income adults age 64 or younger who will be around a newborn in the near future also can call the Douglas County Health Department's immunization clinic to set up an appointment for a free pertussis vaccine. The program was recently created because of the high number of cases in Douglas County.
Sources: U.S. Centers for Disease Control and Prevention, Douglas County Health Department, Sarpy/Cass County Department of Health & Wellness