Whooping Cough Directorate of Public Health & Health Policy

Directorate of Public Health &

Health Policy Assynt House Beechwood Park Inverness IV2 3BW

Issue: 11 (04) April 2012

Whooping Cough January's Public Health Newsletter highlighted the increasing number of cases of whooping cough across the UK. Since that newsletter Scotland has seen a significant increase in reported cases. During the first 16 weeks of 2012 there have been 166 laboratory confirmed cases in Scotland . The 2011 comparative period was 24.

NHS Highland figures for 2012 currently stands at 140 notifications (not all laboratory confirmed), in comparison to a total 15 notifications in 2011. Increases in levels of whooping cough are generally seen every three to four years, and the last peak noted nationally was in 2008. HPS have advised that the figures so far reported this year exceeds the 2008 figure.

Young infants are most severely affected by this highly contagious infection and are more likely to develop complications, which can require hospital treatment. Adults and older children may have milder symptoms and are less likely to make the characteristic 'whoop'sound. Very young infants also may not make the 'whoop'sound after coughing, but bouts of coughing can be followed by difficulty breathing. Early symptoms of whooping cough are much like an ordinary cold and may include a blocked or runny nose; sneezing; watering eyes; a dry, irritating cough; sore throat; slightly raised temperature and feeling generally unwell. These early symptoms can last for one to two weeks and then progress to bouts of coughing which may be followed by vomiting. A 'whoop'sound may be heard at the end of the bout of coughing, though this is not always present.

The most important control measure in controlling this disease is immunisation and every opportunity should be made to advise completion of immunisation schedule.

Guidelines for the Public Health Management of Cases of Whooping Cough and their Contacts is available in the Policies Library on the intranet, under Clinical/Public Health. Effective treatment must be started within 21 days of symptom onset, it is therefore important to diagnose infection promptly. Likewise if prophylaxis is indicated for contacts, this must be initiated within the same time period. There is no evidence of benefit after 21 days. The updated guidelines contain information about appropriate antibiotic therapy, and clarithromycin is now considered the

first choice in most individuals. description of vulnerable contacts, as prophylaxis would only be initiated if

a vulnerable contact is identified. NB if one contact requires prophylaxis then all close contacts should be treated. further immunisation advice for cases and contacts

The occurrence of a case provides an opportunity to ensure that the case and other family members are appropriately immunised, even if the 21 day period has elapsed for treatment administration.

Microbiological confirmation of whooping cough can be undertaken by submission of a perinasal swab. Please contact your local laboratory prior to submission.

In primary care clinically suspected cases of whooping cough should be notified via the SCI Gateway. It is not necessary to wait for laboratory confirmation before notifying. Clinicians who do not have access to SCI can notify using the form at:

Tattoo craze causing growing health fears.

The Chartered Institute for Environmental Health has in the past raised concerns that the increasing popularity of tattooing poses a threat to public health.

Concern is now being raised regarding the increasing reports of home based `tattoo parties' at which potentially unlicensed operators are facilitating provision of tattoos without due diligence to good infection control practice and therefore exposing individuals to infections including blood borne viruses (BBV's).

Recent media coverage has alluded to children as young as nine years old receiving tattoos at such a party and NHS Forth Valley have issued warnings relating to underage teenagers receiving tattoos at tattoo parties

Arrangements for tattoo parties tend to be word of mouth and are very rarely advertised in a public forum so it is difficult to ascertain where or how frequently they are occurring.

Licensing of skin piercing and tattooing was introduced by the Civic Government (Scotland) Act 1982 (Licensing of Skin Piercing and Tattooing) Order 2006 - accessible at ssi/2006/604/contents/made. Health Protection Scotland (HPS) and the Royal Environmental Health Institute of Scotland (REHIS) issued an implementation guide on these regulations in 2009 (available at ).

Local Authorities through their Environmental Health Departments carry out inspections of licensed tattoo parlours to ensure that the requirements for holding a licence are maintained. Requirements for holding a license include the use of sterile single use needles and sterile single use pigment pots and appropriate decontamination equipment for other instruments used in the tattooing process. These strict requirements are part of infection control processes to negate the risk of transmitting infections such as hepatitis B, hepatitis C and HIV.

Health care workers should be alert to concerns over what may be a growing trend particularly amongst young people. Enquiries should be made as to where an individual obtained their tattoo. Where a tattoo party is identified as the source discussions regarding the risks and testing for BBV's should be advised.

The Health care worker should also contact their local Environmental Health Department with any information they may have. Tattooing of individuals under 18years is an offence under the Tattooing of Minors Act (1969) and should be reported to the police.

The Health Protection Team are:

Dr Ken Oates - Consultant in Public Health Medicine

Abhayadevi Tissington (Nurse Consultant Health Protection) Lorraine McKee (Health Protection Nurse Specialist)

Eric Wiseman (TB Liaison Nurse)

Peter MacPhee (Emergency Planning Officer)

Tara Mackintosh (Administrative Assistant) Karen Main & Alex Medcalf (Secretaries - Health Protection & Emergency Planning)

01463 704886 / tara.mackintosh1@

Comments, feedback and suggestions all welcome.

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