Pertussis, the whooping cough bacteria -- CDC photo

The number of cases of whooping cough in Washington state increased by more than 50 percent between 2010 and 2011, the State Department of Health reported Wednesday.

Last year there were 912 cases in the state — the highest in six years — up from 608 cases reported in 2010.

In recent years, adolescents and adults have accounted for an increasing proportion of cases, health officials said.

“The number of reported cases is just the tip of the iceberg,” State Health Officer and pediatrician Dr. Maxine Hayes said. “Many young people and adults who get pertussis may not know they have it and don’t seek medical attention.

Whooping cough, also known as pertussis, is a highly contagious respiratory illness spread by coughing and sneezing.

Initially, an infection may seem like a cold, but patients then go on to develop a severe, persistent–often wracking–cough that can last for weeks.

The coughing fits can be prolonged and are often followed by a long inhalation that causes the “whooping” sound that gives the disease its name.

The bouts of coughing can leave victims breathless and unable to eat, drink or sleep. Complications of the infection include pneumonia, seizures and death.

Whooping cough can affect people of all ages — but is most serious in infants, especially those too young to get vaccinated or who aren’t fully protected.

Adolescents and adults often get a much milder case of whooping cough, but they can still spread it, the Department of Health warned.

There is a vaccine that can prevent infection, but it is not effective in newborns or infants. Health officials therefore recommend that anyone who has contact with newborns and infants be vaccinated or, if they have been vaccinated, to make sure their vaccination is up-to-date.

Who should get the vaccine?

The U.S. Advisory Committee on Immunization Practices has issued new pertussis vaccination recommendations:

• Pregnant women to get pertussis vaccine (Tdap) later in pregnancy (after 20 weeks’ gestation). Women who get Tdap vaccine before or during pregnancy pass on extra protection against pertussis to their babies.

• Anyone who takes care of or has close contact with babies to get pertussis vaccine, ideally at least two weeks before beginning close contact with the infant. This includes siblings of infants who should be up-to-date on DTaP and other recommended immunizations.

• Tdap vaccine is available for adolescents and adults through age 64. But adults 65 and older who expect to have close contact with babies younger than 12 months should get a dose of Tdap to help protect the baby from pertussis.

• Health care workers of all ages who have contact with infants should get vaccinated too.

Protection wears off so you may need a booster

Most people get a series of pertussis vaccines when they’re kids, but protection wears off over time. The Department of Health recommends people substitute a Tdap vaccine for one routine tetanus (Td) booster, which is needed every 10 years; people should get it sooner if they’re in close contact with young kids or live in an area where there are pertussis cases. There’s no minimum time period between getting Td and Tdap vaccines. Only one Tdap vaccine is recommended in a person’s lifetime.

Vaccines available for free for kids under 19

All recommended vaccines are offered to all kids under 19 at no cost through health care provider offices participating in the state’s Childhood Vaccine Program.

Health care providers may charge an office visit fee and a fee to give the vaccine, called an administration fee.

People who cannot afford the administration fee can ask their regular health care provider to waive the cost.

Adults should talk to their insurance carriers about coverage for pertussis vaccine.

To learn more:

• Visit the PKIDS Online pertussis information page.

• Contact your local health agency  or the Department of Health’s Office of Immunization and Child Profile at 360-236-3595.

By Jenny Gold
This story was produced in collaboration with 

On a Monday night in December, Lauretta Martin, 47, visited the sleep lab at the National Rehabilitation Hospital in Washington, D.C. for the second time.

On her first visit, Martin, a heavyset woman whose husband reports she is a loud snorer, was diagnosed with sleep apnea. This time, she was being fitted for a CPAP machine, which helps keep a snorer’s airway open throughout the night.

The sleep lab has six testing rooms, each of which looks just like a room at a Holiday Inn, with striped wallpaper, a floral bedspread, framed prints of the seaside and free wifi.

“They have a brochure that says it’s just like being in a hotel room, and it is,” says Martin, sitting on the edge of her bed wearing a pair of soft grey pajamas and watching a football game on her flat-screen TV.

Aside from the two-dozen colorful electrodes taped to her body to monitor her every motion and the scuba-style mask on her face to enhance her breathing, she looked ready for a cozy night of slumber.

In the tech room a few doors down, a professional sleep technician observed her over a video monitor, testing the electrodes and preparing to listen in to the sounds of her sleep.

Snoring was once considered a simple annoyance for bed partners, but there is a growing awareness in the medical community that the grunts and snorts of noisy sleepers can also be a sign of sleep apnea, a condition shown to increase the risk of numerous serious illnesses, including heart disease, stroke and dementia.

Testing can be a lucrative business, and labs have popped up in free-standing clinics and hospitals across the country. Over the past decade, the number of accredited sleep labs that test for the disorder has quadrupled, according to the American Academy of Sleep Medicine (AASM).

Sleep apnea occurs when the muscles in the back of the throat relax, causing an airway obstruction that can stop a person’s breathing for several seconds or even minutes.  It causes restless sleep and sometimes dangerously-low blood oxygen levels.

The disorder can be diagnosed by monitoring a snorer’s sleep patterns, either in an overnight visit to a sleep lab or at home using a portable testing device. It is then often treated with a CPAP machine, which helps keep a snorer’s airway open during sleep.

Sleep apnea has likely gotten more common as the population has grown older and more obese, two major risk factors for apnea, and the National Institutes of Health estimates that more than 12 million Americans suffer from the disorder.  Many are never diagnosed.

“I think the medical community is sort of dropping the ball” on apnea, explains Dr. David Gross, medical director of the sleep lab at the National Rehabilitation Hospital. “It’s just sad when you walk through the hospital and you see these patients with heart failure—the person might be 35 years old, he’s 350 lbs — but no one’s thinking that he has sleep apnea, which he statistically does.”

Dr. David Gross, director of the sleep lab at the National Rehabilitation Hospital in Washington, D.C., analyzes a sleep test (Photo by Jenny Gold/KHN)

He says more than three-quarters of the patients who come to the lab are diagnosed with apnea.

But the testing isn’t cheap: each night at a hospital sleep lab can cost $1,900 and is usually mostly covered by a patient’s health insurance. Some patients, including Martin, end up spending two nights at the lab – one to test for apnea, and the second to try the CPAP machine.

Dr. Fred Holt, an expert on fraud and abuse and the medical director of Blue Cross Blue Shield in North Carolina, says some patients aren’t having basic exams done first and are therefore being prescribed expensive tests they don’t need. Not everyone who snores has a chronic disorder, he notes.

In other cases, Holt says the labs prescribe CPAP machines right away without first suggesting other strategies like losing weight of sleeping on your side, which can also reduce apnea.

“We are spending more and more money on sleep testing and treatment, and like anything else in health care, there are unscrupulous people out there who are more than happy to do testing and treatment that might be of questionable value,” says Holt. “This might be because of naiveté on the part of the physician, or unfortunately, it could be done for the sake of improving the cash flow of one’s business.”

It’s no secret that the sleep business can be lucrative for physicians. A website for Aviisha, a sleep testing company, has a section for physicians showing a picture of a doctor with a stack of money in his lab coat pocket.  And in February, the AASM is offering a seminar on the “business of sleep medicine for physicians” at a golf resort in Arizona.

Dr. Nancy Collop, president of the AASM, says that while many sleep centers offer comprehensive care for sleep disorders, others are largely focused on overnight sleep testing.

“A lot of people have gotten into the sleep business specifically to do that procedure,” she explains. The goal of the AASM’s accreditation process, she says, is to make sure sleep labs are offering more because “many patients may not even need a sleep study.”

Helen Darling, president of the National Business Group on Health, which represents large employers offering health insurance to their workers, says the tests are driving up the cost of premiums.

“This is a good example of something where we have technology, we have financial incentives to use more of it then we have historically done, you have enough problems including a growing obesity epidemic, and you sort of put together the so-called perfect storm for driving up overuse and health care cost,” Darling says.

She says doctors should focus instead on common-sense approaches to sleep apnea, like losing weight, before turning to expensive testing and medical devices.

Another option are home sleep tests, which costs less than a fifth of the cost of a lab test, and are considered effective for most patients. Medicare began paying for home sleep tests in 2008, but the tests have had only modest growth.

“I believe lab tests, as opposed to the home tests, are being wildly overprescribed,” says Mike Backus, senior vice president of American Imaging Management, a subsidiary of Wellpoint.

Right now, he says, 99 percent of the sleep tests given to Wellpoint patients are done in the lab, but “it should be 70 percent at home and 30 percent in the lab.”

Backus adds that the majority of patients who are diagnosed with apnea and then given CPAP machines stop using them within the first year.

Some insurers, including Wellpoint, are changing the way they pay for sleep testing to curb the costs. Many now require a special pre-authorization. They also ask the doctor whether a patient qualifies for a home sleep test instead of one at the lab.

Those changes are now widespread among Massachusetts insurers and are having an effect on the sleep industry in the state.

Dr. Lawrence Epstein, the chief medical officer of Sleep Healthcenters in Massachusetts, says the labs have already experienced a 20 percent drop in the number of patients coming in for testing.

While the past decade was focused on industry growth, he says it’s “now going to be about consolidation and provision of better quality, more efficient care.”

Sleep Healthcenters has shut down three of its 15 sleep labs, and more closures may be on the way. Epstein says the company is focusing more on “sleep wellness,” including treating and managing sleep disorders, and less on testing.

The key, he explains, is to become more efficient without decreasing access to care for patients who need it.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Photo: Sanja Gjenero

The  Puget Sound Clean Air Agency has issued a Stage 1 burn ban for King, Kitsap, Pierce and Snohomish counties, as a high-pressure system brings cold temperatures and calm winds to the region and creates conditions that can trap smoke from wood fires and other air pollutants.

Under the ban the use of fireplaces and uncertified wood stoves is prohibited until further notice.

Air quality is expected to worsen at least through Friday, especially in communities where residential wood burning is common, Clean Air Agency forecasters said.

Air pollution can trigger asthma attacks, cause difficulty breathing, and make lung and heart problems worse.

Air pollution is especially harmful to people with lung and heart problems, people with diabetes, children, and older adults (over age 65), the agency warned.

The Washington State Department of Health recommends that people who are sensitive to air pollution limit time spent outdoors, especially when exercising.

Photo by Sanja Gjenero

During a Stage 1 burn ban:

• No burning is allowed in fireplaces or uncertified wood stoves. Residents should rely instead on their home’s other, cleaner source of heat (such as their furnace or electric baseboard heaters) for a few days until air quality improves, the public health risk diminishes and the ban is cancelled.The only exception is if a wood stove is a home’s only adequate source of heat.

• No outdoor fires are allowed. This includes recreational fires such as bonfires, campfires and the use of fire pits and chimineas.

• Burn ban violations are subject to a $1,000 penalty.

It is OK to use natural gas, propane, pellet and EPA certified wood stoves or inserts during a Stage 1 burn ban.

(Note: The Seattle Parks Department prohibits beach fires at Alki and Golden Gardens during air quality burn bans.)

How to tell if a wood stove is certified, and OK to use during a Stage 1 burn ban?

Age matters – if the stove is over 20 years old, it is likely uncertified and prohibited for use during a burn ban.  Uncertified wood stoves are no longer legal to sell or purchase in the State of Washington due to the significant pollution they generate.  A certified stove will have an EPA label on the back.

For more information:

• Updated air pollution data and forecasts

• Frequently asked questions about burn bans

The report, America’s Health Rankings, is published jointly by United Health Foundation, American Public Health Association and Partnership for Prevention.

Top-ranked states:

1. Vermont
2. New Hampshire
3. Connecticut
4. Hawaii
5. Massachusetts

Bottom-ranked states:

Washington State Trends:

Among the trends that drove down Washington State’s rankings this year were rises in the rates of obesity, diabetes, and smoking and a decline in high school graduation rates.

The annual study, America’s Health Rankings, assesses a state’s health using not only standard measures of health, such as infant mortality rates, but also by such measures as smoking, obesity, and high school graduation rates — all of which provide indications of a population’s overall health status.

High school graduation rates are considered in the ranking because, in general, graduates tend to go on to have fewer health problems later in life.

Among the trends in Washingtion the report found troubling were:

• A marked increase in obesity rates among the state’s residents over the past decade from 18.8 percent to 26.2 percent, meaning that 1.6 million of Washington state’s adults are now obese.

• A steady increase in the the rate of diabetes, which rose from 6.3 percent five years to 7.3 percent in 2011, meaning that 391,000 adults in the state now have the disease.

• And a decline in the number of students graduating from high school in four years to the lowest rate in seven years, 71.9 percent, placing the state 38th in the nation for high school graduation.

Other challenges facing the state identified by the report were a low immunization rate among children, 88.6 percent. That rate makes the state 39th in the nation.

National progress stagnates

The report found that the nation made no progress in improving its overall health this year with modest improvements being offset by a number of troubling trends.

Among improvements were declines in smoking, cardiovascular deaths and preventable hospitalizations:

• Smoking cessation: 17.3 percent of the population smoked in 2011, down from 17.9 percent in 2010 – a 3.4 percent decline since 2010; a 25.4 percent decline since 2001.

• Cardiovascular deaths: 270.4 deaths per 100,000 in 2011, down from 278.2 deaths per 100,000 in 2010 – a 2.8 percent decline since 2010; a 22.2 percent decline since 2001.

• Preventable hospitalizations: 68.2 preventable hospitalizations per 1,000 Medicare enrollees in 2011, down from 70.6 preventable hospitalizations in 2010 – a 3.4 percent decline since 2010; a 17.3 percent decline since 2001.

In the previous five years, the 7 percent of retailers were caught selling tobacco to underage teens. This year the number caught jumped to 15 percent of the time.

Overall, there were 70 sales (from 63 establishments) to minors across Seattle over 468 retailer inspections this year, Public Health – Seattle King County officials said.

King County saw a similar jump in illegal sales to minors, from an average of six percent between 2006 and 2010 to 12 percent in 2011, officials said.

The Law

In Washington State, selling tobacco to a minor is prohibited by law and results in a fine for retailers of $100 for the first offense, the officials said. The fine for a clerk is $50.

Repeat offenders within a two year window are fined up to $1,500 and may have their license to sell tobacco products suspended.

Retailer compliance checks are conducted throughout the year by Public Health and the Washington State Liquor Control Board, as well as the U.S. Food and Drug Administration (FDA) due to new federal laws around tobacco and cigarettes.

Fast Facts About Teen Smoking:

• 90 percent of current smokers became addicted before they were 19 years old.

• About a third of all kids who become regular smokers before adulthood will eventually die from smoking.

• Tobacco use is the leading cause of death in King County, leading to 1,990 deaths per year and $343 million in medical care costs, lost productivity and other expenses.

Public health officials encourage anyone who witnesses a merchant or other adults providing tobacco to a minor is encouraged to call Public Health’s Tobacco Prevention Program at 206-296-7613 to file a confidential complaint or text the information to 206-745-2548.

To learn more:

• Visit Public Health – Seattle & King County’s web site at www.kingcounty.gov/health/tobacco