Doctor possibly exposed 200 to whooping cough

By Warren King
Seattle Times medical reporter

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No cases stemming from exposures to the doctor inside or outside the hospital had been diagnosed as of yesterday, Swedish and public-health officials said.

Swedish officials said 107 emergency-room patients and 90 employees were potentially exposed to the physician, who worked intermittently at the First Hill Campus of the hospital from July 1 through July 18, and was diagnosed with the disease Saturday.

The number of patients potentially exposed could increase, depending on the length of time doctors determine the ER physician was contagious, hospital officials said.

Whooping cough symptoms Appear an average of six to 21 days after exposure. They start with a cough and runny nose, followed by severe coughing that can last more than a month. The person has little or no fever. Vomiting may occur after severe coughing. A "whoop" sound may occur when breathing in. Teenagers and adults typically have milder symptoms.Source: Public Health — Seattle & King County

All but 11 of the 107 patients and all of the employees had been notified by late yesterday to come to the hospital for an evaluation and antibiotics. A special clinic for the contacts was set up at noon Monday and was scheduled to run continuously until 11 last night, followed by 16-hour clinics for the next several days.

Public Health — Seattle & King County officials are investigating possible contacts outside the hospital. That includes some patients and staff members at the offices of Seattle OB/GYN Group, according to Dr. Susan Harvey, an obstetrician at the clinic. She said no one at the clinic has developed symptoms, but recent patients are being notified about possible exposure to the Swedish physician who was treated at the clinic.

Whooping cough, or pertussis, is often not recognized in adults, who have much milder illness than children. It is particularly dangerous to infants, who can develop pneumonia as a complication of the disease and die from insufficient oxygen.

Hospital officials said one of the contacts of the infected physician was an infant, but the child has shown no symptoms.

Helpful information Swedish Medical Center has set up a whooping cough hotline: 206-215-2621. Information also is available at Public Health — Seattle & King County: 206-296-4949, tape 3, or at www.metrokc.gov/health/prevcont/pertussis.htm

"Based on our previous experience, we don't expect a lot of positive tests. But we're casting a broad net to be sure we protect everybody that needs to be protected," said Dr. Martin Siegel, medical director for epidemiology at Swedish. Two of 140 people exposed to an infected Swedish employee in 2002 contracted the disease.

Siegel said there could be additional contacts to be notified if any of the people exposed at the hospital tested positive for the disease.

The emergency-room physician was hospitalized over the weekend and is now recovering, Siegel said.

The new case is part of an upswing in whooping cough in King County during the past few years. The number of cases increased from 39 in 2001, to 155 in 2002, to 282 in 2003, and 122 cases so far this year. Similar increases have been seen statewide. No one knows the reason for the increase, though the disease typically seems to surge in numbers every three to five years. There haven't been any deaths in King County in recent years, but the state averages one death per year.

Especially worrisome is the record 43 cases in infants last year, said Dr. Jeff Duchin, director communicable disease control for Public Health. That may be due to many adults not recognizing they have the disease and then exposing infants, he said.

"People should just stay away from infants if they have a prolonged coughing illness, lasting two weeks or longer," said Duchin.

Immunization rates in Washington state also are lower than the national average.

Doctors recommend children receive four vaccinations during the first 18 months of life and another at age 4 to 6. But the immunization wears off by the teen years.

A vaccine booster for teenagers and adults, already available in Canada, is being studied by the Food and Drug Administration for use in the U.S.

Warren King: 206-464-2247 or wking@seattletimes.com

Copyright © 2004 The Seattle Times Company

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