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Pertussis Notification
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Notifications of pertussis
The 1991 NSW Public Health Act requires doctors, hospitals, laboratories, schools and child care facilities to notify cases of pertussis. The condition is notifiable as the diagnosis is essentially clinical and public health action needs to begin on first clinical suspicion.The recommended notification procedure for pertussis is by telephone to a public health unit on a provisional clinical diagnosis. If you notify by telephone, it is not necessary to fill in a notification form.
The laboratory criteria for diagnosis of pertussis is isolation of Bordetella pertussis from a clinical specimen from the nose or throat or detection of Bordetella-specific IgA in serum in the presence of a clinically compatible illness. School principals and directors of child care facilities are required to notify any child with pertussis attending their school or facility.
The clinical diagnosis criteria for pertussis is a cough illness with one of the following:
- paroxysms of coughing, or
- inspiratory "whoop" without other apparent cause, or
- post-tussive vomiting, or
- linked to a laboratory confirmed case.
The 262 laboratory notifications of pertussis during 1995 were a result of 97 doctors requesting tests. Of these 97 doctors, 12 (12%) had directly notified some of their cases to the PHU. The PHU was not notified by 88% of the doctors ordering tests which subsequently resulted in laboratory notifications.
Towns and centres with the highest number of pertussis cases included Murwillumbah (13%), Casino (10%), Lismore (8%) and Dunoon (5%) with a total of 88 towns and centres having cases. The majority of cases (76%) were under 21 years old and 30% were under 3 years old.
To determine why some medical practitioners on the North Coast do not notify cases of pertussis, we interviewed 21 doctors who treated cases that resulted in laboratory notifications by telephone. Doctors from the Richmond area were excluded on the request of the NRDGP, which was already involved with an immunisation project.
Barriers to Notification
We found that barriers to notifying included lack of knowledge about the notification process (76%) and notifiable conditions, although 43% did know that pertussis and measles were notifiable. There was also a lack of understanding about public health action taken by the PHU by 71% of the doctors surveyed. Doctors frequently commented that they were often unsure of the diagnosis of pertussis until confirmed by a laboratory, and as the laboratories notify the PHU they did not bother. Given that only about 24% of the main notifying laboratory's tests were positive for pertussis, this may indicate that clinical diagnosis is difficult.However, it is difficult for a public health unit to take appropriate and timely action if the first or only notifications of pertussis are made by laboratories up to seven days later than clinical diagnosis. Early notification can help prevent an outbreak, as previously occurred in Casino.
The 21 doctors saw an estimated 227 suspected cases of pertussis in the previous 12 months and of these 9 (4%) were notified to the PHU by three doctors (14%). Difficulties notifying the PHU expressed by respondents included finding notification forms or the PHU telephone number and problems contacting an appropriate person immediately. Suggestions from respondents included: regular reminders and education; allowing the receptionist to notify; and financial incentives.
How the PHU can help
The PHU will be supplying doctors on the North Coast with a sticker that will list notifiable diseases and have the PHU's telephone number, as well as fresh notification forms. Many doctors suggested several feedback mechanisms, including the division newsletters (52%) that could complement the existing information circulated in the North Coast Health Bulletin.The response of the PHU to notifications of pertussis, which is always made in consultation with the patient's doctor, may include contact tracing, immunisation advice, advice on treatment, public awareness campaigns and exclusion of unimmunised children from child care facilities.
Prompt public health action, combined with the introduction of acellular pertussis vaccinations expected next year, should result in a lower incidence of pertussis in the Northern Rivers area.
Suzanne Blogg
Marianne Trent
North Coast Public Health Unit
Acknowledgements
All the doctors who kindly participated in the survey
- Dr John Beard, Director, North Coast Public Health Unit
- Dr Christine Ahern, North Coast Public Health Unit
- Mr Tim Sladden, Epidemiologist, North Coast Public Health Unit
- Mr Geoff Sullivan, Environmental Health Officer, North Coast Public Health Unit
- The Northern Rivers Division of General Practice
- Roberts C, Rubin G, Levy M. Improving Infectious Diseases Control. NSW Public Health Bull 1991; 2:86,92.
- Levy M. Notification of Infectious Diseases under the Public Health Act, 1991. Information Bulletin 1993; 93/21.
- The Public Health Act 1991 (NSW).
- Menzies R. Infectious Diseases Manual. AIDS/Infectious Diseases Branch, NSW Health Department, 1991.
- Merridie Macaitis. You've Got What? Control of Infectious Diseases in Children and Adults. South Australian Health Commission 1992.
- Cough! Cough! Hunter Public Health Unit Bulletin, February 1996.
- Bek M, Lonie C, Levy M. Notifications of infectious diseases by general practitioners in New South Wales - Survey before and after the introduction of the Public Health Act 1991 (NSW). Med J Aust 1994;16: 538,541.
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