Publication of the Division of Public Health Services

July/August 2004, Vol. 18, No. 4

Heat Related Deaths on the Rise in Arizona
By Christopher K. Mrela, Ph.D. & Will Humble, M.P.H

Five hundred seventy (570) peodeaths in males aged 20 to 44 years
ple died from heat exposure due to
old. Less than 1% of migrant deaths
excessive temperatures in
were more than 65 years old.
Arizona from 1992 to
The number of deaths
2002. A majority of
among migrants has
the deaths
climbed dramaticaloccurred among
ly in recent years.
Arizona resiThere were no
On average,
dents (55%).
migrant fatalities
29 Arizona
On average, 29
from heat exporesidents die
Arizona resisure in 1992, 13
every year from
dents die every
deaths in 1998
heatstroke
year from heatand 80 deaths in
or sunstroke.
stroke or sun2002.
stroke. Forty resiAll persons are
dents died from
at risk for hypertherheat exposure last
mia when exposed to a
year. Not surprisingly,
sustained period of excesnearly all of the deaths
sive heat. However, your highest
occurred between May and
risk patients are those over the age of
September, with a peak in July.
65, with underlying chronic medical
More than 70% of Arizona resiproblems. Behavioral risk factors for
dents that died from heat exposure
all patients include low fluid intake,
were over 45 years old, with 42%
excessive exercise, alcohol and/or
over the age of 65. In fact, deaths
drug use, and prolonged outdoor
from excessive heat ranked fifth
activity.
among the leading causes of acciHeat-related illness can begin as
dental death for Arizonans 65 and
sunburn and fatigue and progress to
older. Males accounted for more than
heat cramps, heat exhaustion, and
70% of the deaths among Arizona
heatstroke. The two most serious
residents. Children and adolescents
types of heat-related illness are heat
represented only 4% of the heat
exhaustion (heavy sweating, palerelated deaths.
ness, muscle cramps, tiredness or
By contrast, deaths among
weakness, dizziness or headache,
migrants are predominantly males
nausea or vomiting, and faintness)
less than 44 years old, with 65% of
and heatstroke (oral temperature of

> 39.4° C; rapid, strong pulse; red,
hot, and dry or sweaty skin; throbbing headache or dizziness; nausea;
confusion; and unconsciousness).
Untreated heat exhaustion can
progress to heatstroke, a medical
emergency. Even when treated, the
death rate for heatstroke may be as
high as 33%. Permanent neurologic
damage occurs in up to 17% of survivors, and its likelihood increases
with longer duration of heatstroke.
The Arizona Department of
Health Services offers the following
prevention tips to avoid heat-related
illness:
•

Never leave infants, children or
pets inside a parked vehicle.

•

Increase fluid intake, regardless
of activity level. Don’t wait until
thirsty to drink fluids; drink more
liquid than one’s thirst indicates.

•

Avoid "heat hangover." Continue
to drink fluids even after strenuous activity. This will enable the
body to maintain optimum hydration, and help prevent the after
effects of heat exposure such as
headaches and fatigue.

•

Avoid beverages containing alcohol, caffeine or large amounts of
sugar as they dehydrate the body.
Avoid very cold beverages as
they cause stomach cramps.
Continued on page 2

Visit the ADHS Web site at www.hs.state.az.us
EPA Issues
Advisory on
Eating Fish
Page 3
July/August 2004

West Nile Virus
Physicians’ Alert
Page 4

Dental Decay
Page 5

Communicable
Disease
Summary
Page 6

Immunization
Requirements
For School
Page 7

Pertussis
Increasing in
Maricopa Cty
Page 8
Prevention Bulletin

1

Heat Related Deaths
on the Rise in Arizona
continued from page 1

•

Limit exercise or outdoor activity between the hours
of 11 a.m. and 3 p.m. when the sun is at its peak
intensity. If active during this time frame, drink a minimum of 16 to 32 ounces of water each hour.

•

Some medications, both prescription and over-thecounter, may increase the risk of heat related illness.

The report “Deaths From Exposure to Excessive
Natural Heat Occurring in Arizona, 1992 – 2002” was
prepared as a supplement to injury mortality statistics for
Arizona residents. The full report on Arizona heat related
deaths is available on the Arizona Department of Health
Services website at http://www.hs.state.az.us/
plan/report/heat/heat02.pdf
Christopher Mrela Ph.D. is the Assistant Registrar of Vital Statistics for the
Arizona Department of Health Services and can be reached at 602.542.2955
or mrelac@hs.state.az.us.
Will Humble M.P.H. is the Bureau Chief for Epidemiology & Disease Control
and can be reached at 602.364.3855 or whumble@hs.state.az.us.

2

Prevention Bulletin

Show Low 4th Grader Wins
Diamondbacks Poster Contest
to Promote Good Hygiene
As part of a state campaign to
promote infection control, a Show
Low 4th grader’s depiction of a
baseball bat washing its hands has
won her tickets to see the Arizona
Diamondbacks, and have her
artwork displayed in health
provider offices and schools
around the state.
The winner of the contest is
Cheyenne Boales, 10, a student at
Show Low Intermediate School.
The Arizona Department of
Health Services and the
Association for Professionals in
Infection Control and Epidemiology teamed up with the
Arizona Diamondbacks to sponsor the “Strike Out Infection”
poster contest for school children throughout Arizona. The
purpose of the contest was to teach children, their parents,
and their teachers ways to prevent infections from spreading.

July/August 2004

EPA and FDA Issue an Advisory on Eating Fish
and Shellfish Containing High Levels of Mercury
By Bob Gomez, M.P.H.

Earlier this year, the
Environmental Protection Agency
(EPA) and Food and Drug
Administration (FDA)
issued an advisory for
women who may
become pregnant,
pregnant women,
nursing mothers,
and young children
to avoid certain
types of fish and
shellfish that may
contain high levels of
mercury. The advisory
also provided recommendations for
eating fish and shellfish that have
lower levels of mercury.
Considering fish and shellfish are
an important part of a healthy diet,
women and young children should
continue to include fish or shellfish
in their regular diet. By carefully following the EPA and FDA recommendations when selecting and eating
fish and shellfish, women and young
children can minimize their exposure
to high levels of mercury and the
harmful effects.
Mercury is found naturally in the
environment. However, activities of
the industrial age, including air emissions from power plants and waste
disposal, have had a notable impact
on the amount of mercury introduced into the environment. Once
in the environment, mercury can go

through certain chemical changes to
form an organic compound called
methylmercury. Methylmercury presents a significant hazard
to humans and other
mammals when consumed because it is
absorbed into tissue but it is
not easily eliminated.
Methylmercury accumulates in the
food chain particularly as a result of
predator fish and shellfish eating
other methylmercury contaminated
fish and shellfish with humans at the
end of this food chain.
Methylmercury is particularly
toxic in developing organisms. The
central nervous system is the most
sensitive organ to this toxin with
notable adverse effects on neurological function.
The following recommendations
for selecting and eating fish or shellfish were provided in the EPA and
FDA advisory to reduce women and
young children’s exposure to high
levels of mercury.
•

Do not eat shark, swordfish,
king mackerel, or tilefish
because they may contain high
levels of mercury;

•

Eat up to 12 ounces (2 average
meals) a week of a variety of
fish or shellfish that are lower
in mercury;

•

Five of the most commonly eaten
fish that are low in mercury are
shrimp, canned light tuna,
salmon, pollock, and catfish;

•

Another commonly eaten fish,
albacore (“white”) tuna has more
mercury than canned light tuna.
When choosing your two meals
of fish and shellfish, you may eat
up to 6 ounces (one average
meal) of albacore tuna each
week; and

•

Check local advisories about the
safety of fish caught by family
and friends in your local lakes,
rivers, or coastal areas. If no
advice is available, eat up to 6
ounces a week of fish you catch,
but do not consume any other
fish. (See sidebar below on the
Arizona advisory.)

These recommendations should
be followed using smaller portions
when feeding fish or shellfish to
young children.
By following these recommendations, women and young children
can maintain a healthy diet that
includes fish and shellfish while minimizing their exposure to mercury
and the potential harmful effects.
Bob Gomez is the Program Manager for Food
Safety and Environmental Services and can be
reached at 602.364.3140 or
gomezr@hs.state.az.us.

Arizona Fish Consumption Advisory Still In Effect
The Arizona Departments of Environmental Quality (ADEQ), Game and Fish, and Health Services recently
reminded Arizonans of a continuing advisory regarding the hazards associated with eating fish caught at several lakes
throughout Arizona due to high levels of mercury and other pollutants in certain types of fish.
The advisory is consistent with recommendations presented by the Environmental Protection Agency (EPA) and
Food and Drug Administration (FDA) earlier this year pertaining to the consumption of fish and shellfish by women
who may become pregnant, pregnant women, nursing mothers, and young children. EPA and FDA recommend checking with local authorities about the safety of fish caught by family and friends in local lakes, rivers, and coastal waters.
All Arizona lake advisory information is available at the ADEQ website at
www.adeq.state.az.us/function/news/2004/may.html#0525 or by calling 602.771.4142. These are fish consumption
advisories and the impacted lakes are currently safe for boating, swimming and other recreational activities.
July/August 2004

Prevention Bulletin

3

Noteworthy
West Nile Virus Hits Valley
As anticipated, an
outbreak of West Nile
virus (WNV) is well
underway in central
Arizona. As of June 24,
2004, thirty-seven (37) human cases of
WNV have been confirmed in
Maricopa County, and many new suspect cases are pending confirmation at
the Arizona State Health Laboratory.
The earliest onset of illness due to
West Nile virus was early May. The
age of those affected thus far ranges
from 21 – 86, with a median age of
53. Clinical presentations include
encephalitis (13), meningitis (16), and
WNV fever (5). No information is
available on three of the patients.
There has been one fatality, a 74 year
old female from Maricopa County.
Additionally, 7 viremic blood
donors have been identified through
the blood-screening program in
Maricopa County. This was expected
based on last year’s experiences elsewhere and given the number of blood
donors screened.
This is just the beginning of what
is predicted to be a long and serious
epidemic. The arbovirus transmission
season in Arizona extends well into
October. The worst months (July
through September) are yet to come.
As of June 24, 2004, the presence of
the virus in Maricopa County has been
detected in 59 mosquito pools, 21 sick
horses, 25 dead birds and 16 sentinel
chickens.
Surveillance efforts also identified
nine positive mosquito pools in Yuma
County and one in Cochise County.
Although WNV positive results have
primarily been identified in Maricopa
and Yuma counties thus far, WNV
activity is expected to be identified in
most of the state very soon. Health
care providers throughout Arizona
should be on the look-out for suspect
cases of WNV. Please report cases to
county epidemiology staff upon diagnosis.
For up-to-date information on
WNV please visit
www.westnileaz.com.
4

Prevention Bulletin

Hepatitis C Program
Outreach Going Strong

Rocky Mountain
Spotted Fever Advisory

Last November the state Hepatitis
C Program launched the “Live Longer
Project” designed to reach newly
reported hepatitis C positive individuals with hepatitis C information including the importance of getting vaccinated against hepatitis A and B and not
using alcohol or street drugs.
So far the program’s three health
educators have spoken to over 1,000
clients, collecting data, providing
health education information, referrals
and resources. While the project evaluation is on-going, anecdotally, many
clients were already informed of the
dangers of drinking alcohol, but most
did not know about the importance of
getting vaccinated against hepatitis A
and B. The Hepatitis C Program will
provide A and B vaccine for hep C
positive individuals who are uninsured or under-insured.
Future plans for the Hepatitis C
Program include the identification of
Hepatitis C testing sites throughout the
State. During the initial phase of the
new testing program, sites will be
selected based on ability to identify
and reach those folks with the greatest
risk of hepatitis C infection. At risk
individuals include: past or present
intravenous drug users, recipients of
blood transfusions before 1992, organ
transplant and/or dialysis patients, and
health care workers with blood exposure to skin or mucous membranes.
Contact the Hepatitis C Program at
602.364.3658 for a free, confidential
risk assessment, a speaker or trainer for
your next meeting or in-service, or
hepatitis C health education materials.

As hotter temperatures draw
Arizonans to the state’s high country,
residents are advised to
take precautions
against tick bites
because some ticks
carry germs that cause
disease, including
Rocky Mountain spotted fever.
Rocky Mountain spotted fever can
occur in the forested mountain areas
of Northern, Central and Eastern
Arizona.
The best way to prevent exposure
is to avoid areas where ticks live. Stay
on trails and avoid contact with logs,
tree trunks, fallen branches or tree
limbs in forests.
Four cases of Rocky Mountain
spotted fever have been reported in
the White Mountains region of
Arizona during the last three years,
including two cases recently confirmed in 2004. All four cases
involved children. One case in 2003
was fatal. Children are more commonly infected due to their propensity
to play in wooded areas.
Symptoms, which usually begin 3
to 14 days after a bite by an infected
tick, include moderate to high fever,
severe headache, nausea or vomiting
and muscle pain. In approximately
85% of cases, a rash appears about
three days after onset of illness.
People experiencing any of these
symptoms within two weeks of a possible tick bite should see a doctor
immediately. Rocky Mountain spotted
fever can be cured with specific
antibiotics if treated early.
The main vector (transmitter) of
Rocky Mountain spotted fever in the
west is the Rocky Mountain wood
tick, which may be encountered in
spring and summer months. The tick
must be attached and feeding for several hours for disease transmission to
occur. Check yourself and children
after recreating in wooded areas, and
remove ticks promptly and properly.

State Lab has moved
into new building
All State Laboratory Offices and
Sections now reside under one roof in
the new Bureau of State Laboratory
Services building. The address for the
new location is 250 N. 17th Avenue,
Phoenix AZ 85007-3231. Staff have
retained their current phone numbers
in the new building.

July/August 2004

Dental Decay Ranks Among
Top Childhood Chronic Diseases
Dental decay has
A child’s baby teeth
...35% of 3-year-old (primary teeth) are very
been reported by the
children and 49% of important. Healthy,
Centers for Disease
4-year-old children strong baby teeth look
Control and Prevention to
were
found to have nice, help the child
be perhaps the most
tooth decay or early chew food more easily
infectious chronic disease
childhood caries.
found in our nation’s
and help the child
children.
speak more clearly.
In an Arizona Department of
Baby teeth hold the space in the
Health Services survey of Arizona
mouth for the permanent teeth to
preschool children, 35% of 3-year-old
come in correctly. When these teeth
children and 49% of 4-year-old chilare lost too early or become diseased,
dren were found to have tooth decay
the child’s overall health can be
or early childhood caries.
harmed.
Almost 50% of children
Early dental visits are also
experience tooth decay by
important for a child. The
age four.
American Academy of
It has been shown that
Pediatrics, American Dental
dental decay is an infectious
Association, The American
disease, caused by bacteria that
Public Health Association and
is passed to the child in infancy.
The American Academy of
This bacteria is not present at
Pediatric Dentistry recombirth and must be acquired, usumends that children visit a dentist
ally from the mother or another
within 6 months after the first tooth
caregiver through close contact and
appears in the mouth or by 12
sharing eating utensils – cups,
months of age. At the dental visit,
glasses and spoons. This bacteria is
children will be checked for cavithought to be transferred to the child
ties and parents will learn how to
between the ages of 6 and 36
properly clean your child’s teeth
months of age. A high amount of
at home. Information can be
bacteria in the mother’s mouth
provided on how fluoride is
increases the rate of transfer to the
effective in preventing and
infant. The children that are infected
reversing the early signs of
at this early age usually have a higher
tooth decay as well as providamount of tooth decay though their
ing suggestions for nutrition
lifetime.
and diet, habits, and injury
The earliest sign of dental decay
prevention.
may appear as white, chalky spot
Dr. Gerald A. Caniglia is a pediatric
(“white spot”), near the gum line of
dentist in the Office of Oral Health
the upper front teeth. The “white
and Children’s Rehabilitative
Services responsible for clinical
spot” is a sign that the tooth enamel
dental consultation on issues and
has been weakened and could lead to
serves as a liaison to organized
a cavity. Unless steps are taken to
dentistry and other professional
reverse this process, the white spot
health organizations. He can be
reached at 602.542.2946 or
area on the enamel will continue to
caniglj@hs.state.az.us.
break down.
Parents of young children should
be told to use a “lift the lip” method
to exam their child’s mouth. The parent should gently lift the child’s lip to
look for these white spots which can
provide a signal of the beginning
of dental decay or cavities.
July/August 2004

By Gerald A. Caniglia DDS, MSD

DENTAL TIPS
BIRTH TO 3 YEARS
• Mothers should have their dental
work completed to prevent passing of decay causing bacteria to
their baby.
• Hold infants while feeding. DO
NOT prop the bottle.
• Infants should be fed before putting to bed. DO NOT put the
bottle in bed with the baby.
• Infant gums should be cleaned
every day with a clean, damp
washcloth. Clean teeth with a
soft toothbrush. Toothpaste is
not needed during the first year.
• To clean a baby’s mouth, put the
baby’s head, face up, in your lap
to have both hands free to clean.
• Begin brushing teeth daily as
soon as they come into the
mouth.
• Use only a small pea size dab of
toothpaste.
• Lift the lip often to check for
white or brown spots on the front
teeth.
• Ask your doctor or dentist about
fluoride drops at 6 months.
• Wean a child from the bottle at
12-14 months.
• Encourage toddlers to drink
water in-between meals. DO
NOT allow toddlers to sip on the
sippy cup for long periods of
time when it contains milk,
juice, Koolaid, Gatoraid, or pop.
• Children should make their first
dental visit at one year.

Prevention Bulletin

5

SUMMARY OF SELECTED REPORTABLE DISEASES
Year to Date (January - May, 2004)1, 2
Jan - May
2004

Jan - May
2003

5 Year Median
Jan - May

VACCINE PREVENTABLE DISEASES:
Haemophilus influenzae, serotype b invasive disease (<5 years of age)
Measles
Mumps
Pertussis (<12 years of age)
Rubella (Congenital Rubella Syndrome)
FOODBORNE DISEASES:
Campylobacteriosis
E.coli O157:H7
Listeriosis
Salmonellosis
Shigellosis

0 (0)
0
0
50 (31)
0 (0)

6 (5)
1
0
52 (27)
0 (0)

4 (1)
0
0
33 (21)
0 (0)

298
8
5
278
160

320
12
4
218
186

197
10
6
223
137

133
106
N/A
0
N/A

102
126
464
4
3,687 (1,585)

185
75
483
8
2,589 (1,411)

338
119
19
6

406
110
15
20

475
108
14
19

5,942
1,657
69 (9)

6,308
1,669
71 (11)

5,918
1,669
71 (11)

8 (2)
579

1 (0)
445

4 (0)
435

0
0
30

0
0
29

0
0
35

234
85
215
164

963
62
219
203

1,343
69
219
203

VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B: acute
Hepatitis B: non-acute3
Hepatitis C: acute
Hepatitis C: non-acute3 (confirmed to date)
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
Meningococcal Infection
SEXUALLY TRANSMITTED DISEASES:
Chlamydia
Gonorrhea
P/S Syphilis (Congenital Syphilis)
DRUG-RESISTANT BACTERIA:
TB isolates resistant to at least INH (resistant to at least INH & Rifampin)
Vancomycin resistant Enterococci isolates
VECTOR-BORNE & ZOONOTIC DISEASES:
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies4
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
1
2
3
4

6

Data are provisional and reflect case reports during this period.
These counts reflect the year reported or tested and not the date infected.
Case counts for non-acute Hepatitis B and C are not available before 1998.
Based on animals submitted for rabies testing.

Prevention Bulletin

July/August 2004

Immunization Requirements For School
Entrance/Attendance 2004-2005
By Andie Denious

When school
resumes in the fall, students in kindergarten
through 11th grade will
be required to show
proof of two doses of
MMR and three doses
of hepatitis B in addition to age-appropriate
DTaP/DTP/DT/Td and
Polio vaccinations.
The MMR #2 and
hepatitis B requirements, originally
implemented for kindergarten and
first grade in 1997, were expanded in
2000 to include two additional
grades each year. This fall, sixth and
eleventh grades will be added. At the
onset of the 2005-2006 school year,
twelfth grade will be added, thus
completing the transition to include
all grades, K through 12th. As with
other immunization requirements of
the Arizona School Immunization
Law, exemptions for medical reasons or personal beliefs are
allowed.
In 2000, public health clinics
and private provider offices
encountered tremendous demand
from students who needed the
immunizations in order to enroll
and attend school. Health care
providers throughout the state are
commended for responding to the
demand placed upon their clinics
and offices at that time. Their hard
work is reflected in the high immunization coverage levels reached by
students enrolled in kindergarten,
seventh and tenth grades, assessed
annually by the Arizona
Immunization Program Office. The
graph below displays 2003-2004
school year assessment results for
MMR and Hepatitis B.
The Arizona Department of
Health Services (ADHS) has begun
the process to implement a varicella requirement. Although not finalized, implementation is expected to
July/August 2004

begin 2005 when
children attending
child care, Head
Start, K, 1st and 7th
grades will be
required to show
proof of immunization or history of
varicella infection; 2
grades will be added
each year thereafter
until 2010 when all
grades K-12 will be
included. ADHS is
working closely with immunization
providers and professional organizations to facilitate the requirement.
The requirement would be phased in
over a five-year period similar to the
implementation of the MMR and
hepatitis B requirement. The
National Immunization Survey results
indicate approximately 70% - 80% of
Arizona children under 5 years of

age have already received varicella
vaccine. Conversely, the incidence
of varicella infection in children 6 –7
years of age and older is common
and would negate immunization due
to immunity acquired from the disease (varicella vaccine was licensed
for use beginning in 1995, therefore
children over 7 years of age have
more likely had varicella infection
than the vaccine).
ADHS requests all health care
providers of children and adolescents
to document history of varicella
infection in the patient’s handheld
immunization record by writing in
“Hx of disease” under Varicella and
signing/dating the entry. ADHS will
accept parent report of disease, but,
if there is any question, the immunization should be administered.
Andie Denious is the Immunization Services
Manager for the Arizona Immunization
Program Office. She can be reached at
602.364.3626 or denioue@hs.state.az.us.

Hepatitis B and MMR Immunization Coverage by Grade
2003-2004 School Year

Prevention Bulletin

7

❍ Change of Address/Name
❍ Delete my name from your mailing list
❍ I received more than one copy

Arizona Department of Health Services
Public Information Office
150 North 18th Avenue
Phoenix, AZ 85007

Please include your mailing label with all
requests for changes. Fax changes to
602.364.3266 or call 602.364.3860

PRSRT STD
US Postage
PAID
Phoenix, AZ
Permit No. 957

Janet Napolitano, Governor
Catherine R. Eden, Ph.D., Director ADHS
Rose Conner, Assistant Director, Public Health Services
Editorial Board
Bob England, M.D., M.P.H., State Epidemiologist
Victorio Vaz, D.V.M., Ph.D.
Tim Flood, M.D.
Kathy Fredrickson, M.P.H.
Will Humble, M.P.H.
Karen Lewis, M.D.
Cheryl McRill, M.D.
Wesley Press, M.S.
Lisa Shumaker, M.A.
Managing Editor: Courtney Casillas
e-mail: ccasill@hs.state.az.us
Contributors: S. Robert Bailey, Andie Denious,
Kelli M. Donley, Bob Gomez, Will Humble,
Karen Lewis, Christopher K. Mrela
This publication is supported by the Preventive Health and Health Services Block
Grant from the Centers for Disease Control and Prevention (CDC).
Its contents do not necessarily represent the views of the CDC.
If you need this publication in alternative format, please contact the ADHS Public
Information Office at 602.364.1201 or 1.800.367.8939 (State TDD/TTY Relay).

Pertussis Increasing in Maricopa County
Editorial Note: Pertussis has been
gradually increasing for years, including
periodic outbreaks, and providers in any
county are reminded to call their local
health department if they suspect a case.
(For example, the Pima County Health
Department noticed an increase in pertussis in infants in May, and asks that suspects
be reported to them at 520-740-8315.)

There has been a recent increase
in the number of cases of pertussis
(“whooping cough”) reported to the
Maricopa County Department of
Public Health (MCDPH). These cases
represent an increase of 54% over the
number of cases reported at this time
last year.
Pertussis should be suspected in
all symptomatic children and adults
regardless of immunization status.
Fully immunized children can still
develop pertussis disease and present
with milder symptoms, as vaccine
efficacy is not 100% and wanes with
age. Typically, infected adults or
8

Prevention Bulletin

older children transmit disease to
infants in the household. Exposed
infants frequently become seriously ill
with complications requiring hospitalization.
You can help prevent the transmission of pertussis by taking the following actions:
• Consider pertussis in any patient
presenting with a severe or
episodic cough of seven days or
longer, and report these suspect
cases to the MCDPH. (Chances
of culture confirmation are
increased if specimens are
obtained prior to 14 days of
cough.)
• In accordance with State regulation immediately report all cases
or suspect cases within 24 hours
of recognition to the MCDPH
Office of Community Health
Nursing at 602.506.6767. After
regular business hours, weekends
and holidays call 602.747.7111.

•
•

•

•

DO NOT DELAY REPORTING
while awaiting laboratory confirmation.
Whenever possible, collect
nasopharyngeal specimens from
suspect cases. Please contact
MCDPH to obtain media and
access to free testing from the
ADHS laboratory.
Immediately treat all cases and
suspect cases, and prophylax all
household contacts with oral
erythromycin for a full 14 days.
This is required to eradicate carriage and prevent bacteriologic
relapse and antibiotic resistance.
Age-appropriately immunize all
children under seven years of age
against pertussis with DTaP vaccine.

If you have questions or need further assistance, contact the MCDPH
office of Community Health Nursing
at 602.506.6767.
July/August 2004