North Dakota Pertussis Epidemic

1
North Dakota Pertussis Epidemic

• Terry L Dwelle MD MPHTM

2
Reasons for Timely Testing

• Main point is to prevent serious infection in
  un-immunized or under-immunized infants
• To appropriately institute therapy to decrease
  transmission
• To identify infectious cases, their contacts and
  institute antibiotic prophylaxis

3
Pertussis Epidemic

• A pertussis epidemic will likely never if ever
  reach the level of a state declared emergency

4
ND 2004 Epidemic

• Normal weekly lab testing load is 30-60 specimens
  / week (avg 46)
• Our testing load started increasing on the week
  of 7/5/04 243 specimens
• Between 7/5/04 and 9/27/04 (13 weeks) the average
  weekly load was 469 (1000 increase over normal)
• The peak weekly load occurred the week of 8/16/04
  at 734 specimens (1500 increase)
• Normally about 30 of specimens tested are
  positive yet during the epidemic that dropped to
  only 10

5
ND 2004 Epidemic

• 75 of our lab and epidemiologic resources were
  devoted to this epidemic
• Needed to add an additional Smart Cycler testing
  block
• The in house courier system increased lab
  deliveries from 1to four times per day
• Daily testing was prioritized
• All other routine lab tests were delayed except
  for TB and STD/HIV
• Priortized tests based on specimens from patients
  meeting the criteria of potential pertussis
• A significant increase in overtime hours was
  noted
• A significant increase in employee stress was
  noted

6
Summary

• It would have been nice to have a system in place
  to access regional support services in epidemic
  situations that dont result in emergency
  declarations.