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Marin health officials report whooping cough spike

Marin Independent Journal - 3/25/2024

Mar. 26—An outbreak of whooping cough has hit southern Marin, including Tamalpais High School in Mill Valley.

As of Monday, the Marin public health division reported 93 cases overall since mid-December, including 65 at the high school, said Lindsey Termini, a public health nurse for the county. No one has been hospitalized, she said.

Whooping cough, also known as pertussis, is a highly contagious, vaccine-preventable bacterial respiratory infection that spreads from person to person through droplets in the air, Termini said. The infected droplets contain the Bordetella pertussis bacteria, which can cause symptoms of pertussis in five to 21 days.

"It is spread by one person coughing into the air, and then someone else breathing in those droplets," she said.

Symptoms can start like a common cold with fatigue, a low-grade fever, runny nose, sore throat or sneezing. Then, infected people develop a "severe cough that can last for weeks or months, sometimes leading to coughing fits and vomiting," she said.

The classic high-pitched whooping cough in the latter stage of pertussis is caused by "having a coughing fit so long that you have to gasp for air," Termini said. Teens, especially, can gag or vomit after a long coughing fit, she said.

Testing for pertussis is available through a physician's office — either by an evaluation or through a nasal swab test. If a person tests or is diagnosed positive, the physician can prescribe the antibiotic azithromycin for five days during a required isolation period.

Generally, people are not infectious after five days on the antibiotic. Without treatment, the infectious period could last 21 days, Termini said. Sometimes, even with antibiotic treatment, the cough can persist for as long as 100 days, she said.

Marin's last surge of pertussis was in 2018, when 300 cases were reported, said Laurel Johnson, a public health nurse.

"Pertussis does typically surge every three to five years," she said.

County public health officials started to notice the beginning of the current surge "in early to mid December," Termini said.

"Tamalpais High School had its first case in January," Termini said.

Since then, more cases have been reported, mostly in southern Marin.

"Tam High seems to be the most affected," she said.

Tara Taupier, superintendent of the Tamalpais Union High School District, said notices from the county's public health division have been sent to all parents at Tam High in both English and Spanish.

A copy of the notice is available at

Taupier said the school is "working with each student on a case-by-case basis" as far as helping them arrange to catch up with classes missed during the isolation period or other special needs.

"We are not mandating any masks be worn," she said.

Masks, while not required, can be a helpful preventative, as can staying 6 feet away from someone with symptoms. The person coughing should only cough into his or her sleeve or elbow to keep the droplets out of the air, Termini said.

Hand-washing is also important to prevent transmitting any droplets through touching hands or the face.

Generally, prevention involves getting a shot of the Tdap vaccine, which is part of the regimen for all public school students in California. Tdap stands for tetanus, diptheria and acellular pertussis.

Almost all high school students got their last mandated dose of Tdap in seventh grade. That means that the vaccine potency has likely lessened by the time they get to high school, Termini said.

"Marin seventh-graders in 2023-24 had a 99% vaccination rate," she added.

"We are seeing kids at the high school level getting pertussis," Johnson said. "They've been vaccinated, but it wanes in effectiveness over a couple years."

Even if teens do get pertussis, "they are protected from serious illness," because of the remaining vaccine immunity, Johnson said. While it's "not fun" to be ill and have a cough long term, it's generally not a life-threatening condition if the teens are healthy and have been vaccinated, she added.

After the seventh-grade dose, teens and adults are on a 10-year schedule for another dose of Tdap.

The exception is the case of a person living where there is an infant in the house or a pregnant woman. In that case, the Centers for Disease Control and Prevention are recommending teens and adults in the same household get another dose of the Tdap vaccine, since the illness can be severe — and even fatal — in infants, Termini said.

Infants are not able to receive their first vaccine dose for two months after birth. Even after that, they still need two more doses to be fully protected, Termini said. Mothers in their third trimester of pregnancy should also get vaccinated to avoid contracting pertussis and spreading it to their newborn.


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