When Susan Sukstorf read an urgent note reporting a case of whooping cough at her sons middle school, she tossed it aside with little worry./pp span class=”italic”Oh, some kid didnt get their vaccination. That really stinks for them/span, she remembers thinking./ppDays later the Olathe mom was calling the car pool parents, her 14-year-old sons best friends and the staff at Frontier Trail Middle School to warn them. A laboratory test completed only because she casually told her sons doctor that he had bunked with the ill student at a school trip confirmed he had whooping cough./ppNever in anybodys wildest dreams were we expecting that he had whooping cough, she said, noting that the boy was fully vaccinated./ppThe teenager is one of 111 people more than 21 this week alone who have reported the diagnosis to the public health department in Johnson County. /ppThe health department issued a warning last week about the outbreak, urging residents to get the vaccine and be mindful of symptoms to help lessen the spread. Residents in regular contact with infants can receive the shot for free at the health department./ppSukstorf considers her son lucky. He received antibiotics early and avoided the so-called 100-day cough that is so violent in some people that it has been known to cause vomiting and fractured ribs in adults./ppThe Johnson County Department of Health and Environment and the state of Kansas are working to fully investigate all 111 cases, which were reported from laboratories, doctors, schools and elsewhere since January. Whooping cough could be disproven in some cases./ppIn 2011 the department received 11 suspected, probable and laboratory confirmed cases, said Nancy Tausz, disease containment division director with the health department./ppThe cases initially were reported mainly in southern Johnson County, but whooping cough has since become more widespread, Tausz said./ppThis is a problem that Johnson County is sharing with Americans all across the country, said William Schaffner, an infectious disease specialist and professor and chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine. /ppOutbreaks are bound to happen as more parents become skeptical of vaccines and because the vaccines effectiveness tends to wane over time, he said. Many adults dont realize they need a booster shot, he said./ppCases might not be as severe in neighboring counties like Jackson or Wyandotte right now, but tighten your seatbelts, he said, it will happen within the next couple of years. /ppThe Kansas City Health Department has noticed an uptick in cases. The city has 22 reported cases compared to about four at this time last year. But the number is skewed, health officials said, because several cases were clustered in a few families./ppIts a different story in Johnson County./ppWeve seen cases in all ages, she said./ppBut the majority of illnesses have affected young people in the fifth through eighth grades, Tausz said./ppBy seventh grade, students in Kansas are required to have a whooping cough booster. But the shots are not 100 percent effective, she and other health experts acknowledged./ppIts why doctors urge large-scale vaccinations to create a herd effect that protects the majority. The federal Centers for Disease Control and Prevention reports that those who receive the vaccine tend to develop less severe symptoms./ppThe disease gets its name from the whooping sound present in some, but not all cases. The whoop sound comes as patients struggle to take deep breaths between fits of exhaustive coughing./ppThe most vulnerable are infants, toddlers and the elderly. About half of infants with pertussis are hospitalized, according to the CDC. Of those hospitalized, one in five develop pneumonia and one in 100 will die./ppTeenagers and adults usually experience less serious problems. However the disease can still be grueling in adults./ppCharles Hunt, state epidemiologist for the Kansas health department, said the disease is transmitted when patients cough and send droplets of bacteria into the air. One hour of close contact could be enough to spread the illness.Whooping cough is not as infectious as measles or chicken pox, he said. But many carriers spread the disease for days, even weeks, before they know there is a problem./ppThe respiratory illness can start as a cough that simply wont go away. By the time most patients go to the doctor, theyve passed it on to several others. /ppThe disease got little attention until 2010 when California reported 9,143 cases including 10 infant deaths. It was the biggest outbreak reported there since 1947, according to CDC reports./ppIn recent weeks the spotlight has turned to the state of Washington where 1,484 cases were reported to the CDC as of last week, compared to 134 in the same time period last year./ppWashington is now trying for Olympic gold, Schaffner said./ppThe problem is complicated in Washington, he said, because a substantial proportion of parents are skeptical of vaccines and have chosen to forgo or delay vaccines altogether. The state allows parents to opt their school-aged children out of vaccination laws if they have a personal objection to vaccines./ppKansas lawmakers considered a similar measure earlier this year that would have allowed parents to opt out as a conscientious objector. Some parents argued that they should have the freedom to choose whats best for their child. However the bill failed to gain any momentum in Topeka./ppDuring testimony in Topeka, Deborah Clements, president of the Kansas Academy of Family Physicians, said immunizations have eradicated 13 diseases. Every birth generation, immunizations prevent 40,000 deaths and save $33 billion in health costs./pp”I dont want to go back to a time when I have to spend my days taking care of babies that die because they werent immunized,” Clements said./ppThe outbreak comes as area health departments have become more aggressive about marketing booster shots to adults. The booster became available in 2005, said Hunt. It is coupled with the tetanus booster and has been widely promoted to new parents. Many area maternity wards encourage mothers to be vaccinated and then subsequently coax grandparents, and daycare providers to be treated as well to provide a cocoon effect for the infant./ppHunt said the practice has been effective because infant caregivers are receptive to the idea./ppBut health experts said its up to adults to inform themselves and up to primary care doctors to see that others receive boosters. And thats unlikely to happen if adults dont see their doctor regularly./ppMany adults dont have whats called a medical home. They dont show up except when they feel sick and then they go to the emergency room, said Schaffner, who spent several days at a conference this week discussing how to improve adult immunizations. /ppBack in Johnson County, Tausz is hopeful that summer vacation at area schools will help curb the outbreak./ppHopefully with the ending of school, well see a dramatic decrease of the cases, she said. /ppThe disease has an especially big impact on daycares and schools./ppOnce a student tests positive for whooping cough, it triggers an immediate response from school officials./ppState law requires that the ill child stay home for five days to complete antibiotic therapy or for three weeks if they decline treatment./ppThe state doesnt consider casual encounters like passing in the school hallway to be a problem. But it does consider classmates of the sick child to be at risk./ppThose sharing a classroom with the child must provide proof of vaccination within 24 hours or complete the five-day course of antibiotics. Those with a religious or medical exemption to Kansas law must stay home for 21 days after the onset of the last reported illness in the facility./ppThe same rules apply to daycare facilities and homes./ppThe Olathe School District has received 17 reports of whooping cough cases this year compared to one last year. The first cases were reported shortly after spring break and have progressed since then, said Cindy Galemore, Olathe School District director of health services./ppShe and school nurses have vigilantly sent notes home to the parents of classmates each time a case has been reported. They also alert parents of children with weakened immune systems./ppThis is an illness that a healthy child or adult will likely recover from, but our infants are particularly at risk or those that are immunosuppressed or more frail or more weakened, Galemore said./ppAt Frontier Trail Middle School, where Sukstorfs son and two other children have tested positive for it, the school has tried not to panic parents./ppWe inform, we dont alarm, said school nurse Catherine Bennett./ppIts good to be mindful, shes told parents. But she reminds them that most people wont develop whooping cough./ppSukstorf has also let parents know that her sons case was mild, but enough to convince her family to take the antibiotics as a precaution./ppFor now area schools are doing their best to update parents./ppBennett has urged some common-sense approaches./pp Being vaccinated is the first step, good hand washing and then live life.