PERTUSSIS (WHOOPING COUGH) INFORMATION FOR DENTAL PRACTICES
The California Department of Public Health in July declared an epidemic of pertussis in the state. The number of pertussis cases as of mid August is seven times the number of cases over the same period in 2009. CDPH recommends that all health care personnel, particularly those who have direct contact with infants and pregnant women, be immunized with Tdap to protect their patients and themselves. CDPH states that a high level of community immunity is needed to reduce the incidence of pertussis, but immunity from immunization or disease wanes over time.
Pertussis, also known as whooping cough, is an infectious disease caused by a bacterium called bordetella pertussis. The early symptoms of the disease are indistinguishable from a common cold. The main symptoms of this disease are severe coughing spells that may end in vomiting. The cough can last several weeks. In small children there is a characteristic "whoop" that can be heard. This is sometimes absent in older patients. Adolescents and adults as well as children can get whooping cough. Even though most children are immunized against this disease, immunity only lasts a few years. Therefore, students in high school and in junior high are susceptible to the bacterium that causes whooping cough.
For additional information on current California cases and on vaccinations, refer to the CDPH links listed below.
Cal/OSHA has announced that effective September 1, 2010 all employers covered by the Aerosol Tranmissible Disease Standard are required to offer the Tdap vaccinations to employees who are potentially occupationally exposed to pertussis. A dental practice, however, is not required to comply with the standard if all the following conditions are met:
1. Dental procedures are not performed on patients identified with confirmed ATD or suspected ATD.
2. The practice’s Injury and Illness Prevention Program includes a written procedure for screening patients for ATDs that is consistent with current guidelines issued by the Centers for Disease Control and Prevention (CDC) for infection control in dental settings, and this procedure is followed before performing any dental procedure on a patient to determine whether the patient may present an ATD exposure risk.
3. Employees have been trained in the screening procedure in accordance with Injury and Illness Prevention Program Standard.
4. Aerosol generating dental procedures are not performed on a patient identified through the screening procedure as presenting a possible ATD exposure risk unless a licensed physician determines that the patient does not currently have an ATD.
To screen patients, dental personnel should notice if a patient appears to have a cold or is coughing. If the symptoms are apparent, dental personnel should ask the patient if he or she has been exposed to pertussis/whooping cough or has been diagnosed. Reschedule treatment as needed.
Dental personnel who are coughing or experiencing symptoms similar to pertussis should refrain from exposing patients and co-workers and not report to work. An employer may require a medical clearance for an employee before the employee returns to work.
August 2010
Resources
CDPH Pertussis Vaccination Recommendations 2010
CDPH Pertussis (Whooping Cough) page
CDC Guidelines for Control of Pertussis Outbreaks -- refer to Chapter 9
Cal/OSHA Aerosol Transmissible Disease Standard
CDA Sample Injury and Illness Prevention Plan (requires site registration)