Pertussis outbreak in a rural county: Issues, interventions and outcomes

In 2012, upstate New York (NY) experienced a pertussis epidemic of over 2000 reported cases. The increase of pertussis cases strained local health departments (LHDs), especially rural counties, which have minimal staffing resources to thoroughly investigate and stop the spread of the disease. As a result, one rural county implemented changes to: increase knowledge and awareness to the general public; increase early identification, detection, and treatment/prophylaxis; and decrease the incidence and extent of the disease. Problems identified by one LHD included: knowledge deficit by medical providers in pertussis outbreak control guidelines and non-reporting of suspect cases to LHD, decreased public access to care due to limited or no health insurance coverage, public resistance to care because of personal belief systems, and decreased communication between contiguous counties and neighboring state. Multiple interventions implemented consisted of: development of an epidemic plan with community leaders and medical providers, education of the larger community, and the use of midlevel providers to conduct assessments. Lessons learned comprise: effective collaboration among employees and community partners who promoted early access to care and pertussis case load reduction; public awareness campaigns, which built community support; and the use of midlevel providers such as Nurse Practitioners to conduct assessments, provide prophylaxis of high risk people. Future recommendations consist of: education and public awareness campaigns, vaccination clinics, in-services with local medical providers and community partners, collaboration with contiguous governmental units, and supplementation of midlevel providers at primary care offices.