TERRE HAUTE — While Indiana is reporting its largest outbreak of pertussis cases since 1959, most Wabash Valley counties are reporting fewer than five cases each so far this year. Clay County has had five reported cases of the illness, commonly known as whooping cough, according to an Indiana Department of Health chart that lists counties with five or more cases. Twenty-eight out of 92 counties report five or more, including Henry County with 76; Hamilton, 50; Marion, 48; St. Joseph, 31; Hendricks, 23; and Porter, 22. other Wabash Valley counties, including Vigo, are not on the chart because they’ve had four or fewer cases.  But having fewer than five cases of pertussis in a county does not necessarily mean that the county has a low rate of the illness, said Jennifer Dunlap, ISDH spokeswoman.  “the ISDH only releases counties with five or more cases to ensure confidentiality,” she said. so far this year, there have been more than 500 reported cases of pertussis in Indiana, state officials say, including two infant deaths. Pertussis is a contagious illness caused by bacteria. It may cause severe coughing fits that can interfere with breathing. although pertussis is often milder in older children and adults, undiagnosed individuals can transmit the disease to infants and young children. Pertussis can lead to pneumonia and seizures — sometimes death. Most of these serious problems occur in infants who are younger than a year old. “I find this outbreak particularly concerning because pertussis can be prevented with a vaccine,” State Health Commissioner Dr. Gregory Larkin stated in a news release. “the key to the success of the pertussis vaccine is for everyone to be vaccinated,” he said. “when an infant is hospitalized or dies from pertussis, it is because someone in the child’s environment of family, friends, community members and health care providers were themselves not vaccinated and therefore exposed a susceptible child to infection. “only when families, communities and health care providers are fully vaccinated will we have a ‘cocoon of safety’ around those most vulnerable for severe illness, particularly those too young or too ill to get vaccinated,” he stated. It is important that children — and adults — are up-to-date on all immunizations, including pertussis, he said. And teens and adults need to have booster shots because the childhood vaccine’s strength dissipates. In Clay County, pertussis cases have occurred in a few families where children have not been immunized, said Kim Hyatt, public health nurse with the Clay County Health Department. she urged families to “vaccinate your children.” Clay County families whose children need the vaccination can call the department for an appointment at (812) 448-9019 the numbers of actual cases statewide may be higher than what is reported, said Joni Foulkes, administrator with the Vigo County Health Department. Physicians may not recognize pertussis and instead treat it as a respiratory infection, croup or other disease. “the numbers [of pertussis cases] are probably higher than what is turned in,” Foulkes said. the Vigo County Health Department, which now has only two nurses on staff, is booked through the end of the year with appointments for vaccinations, Foulkes said.  But the health department “is always actively using surveillance for any type of disease,” she said. For children who need the vaccine or a booster and are uninsured, under-insured or on Medicaid, Union Hospital offers two programs that can assist. People need to call for an appointment, said Lorrie Heber, Union Hospital spokeswoman. one program is Healthcheck, which can be contacted at (812) 238-7711; the other is the Family Medicine Center at (812) 238-7631. the programs participate in the federal Vaccines for Children program and can offer the vaccinations for free, although there is an $8 administration charge. Insurance and Medicaid would be billed for the $8, while the uninsured would have to pay the $8 fee, Heber said. People should always contact their family physician first, Heber said. “many family physicians participate in the program as well.” this school year, the state has new vaccination requirements for students in grades 6-12 that includes: • one dose of Tdap (tetanus, diphtheria and pertussis) given on or after the 10th birthday • two doses of chicken pox vaccine (those who have a history of chicken pox are not required to take it, although there must be written verification by the parent or physician) • And one dose of meningococcal vaccine. Another option is Indiana State University’s Sycamore Nursing Center, which will offer a free immunization clinic for students in grades 6-12 at 4 p.m. Monday. there is a $5 cash-only administrative fee, and families must bring the child’s immunization record. the clinic will be able to vaccinate another 125 students, said Leslie Krockenberger of the Sycamore Nursing Center. the clinic will take -place in the Landsbaum Center south of Union Hospital. Ray Azar, Vigo County School Corp. director of student services, said many students in grades 6-12 still have not received, or provided documentation of, the newly mandated vaccines. He’s concerned some people “may not be taking the matter seriously.” It is the law, he said. If a pertussis outbreak occurred in the community, or school district, students not immunized would likely have to be excluded from school for their own protection, he said. the school district has been in discussion with the Vigo County Health Department about a possible joint effort to make the required vaccinations more available to students, but it is “very complex trying to work it out, especially in view of budget constraints,” he said. the district doesn’t have the ability to get the vaccine itself; that must come through the health department, Azar said. Sue Loughlin can be reached at (812) 231-4235 or . About pertussis the symptoms of pertussis (whooping cough) occur in three stages: • 1. During the first stage, symptoms are similar to a cold: slight fever, sneezing, runny nose, dry cough, loss of appetite, and irritability. • 2. During the second stage (about one to two weeks later), the cough becomes more intense. there may be short, intense coughing spells followed by a long gasp for air (this is when the “whoop” is heard). the coughing fits may be followed by vomiting, nose bleeds, or bluish color to the face. • 3. During the third stage, the cough is less intense and less frequent, and appetite begins to increase. Eventually the cough stops, although this may take several months. Pertussis can lead to pneumonia, seizures and sometimes death. Most of these serious problems occur in infants who are younger than a year old. In addition to vaccination, there are additional steps people can take to prevent the spread of pertussis, as well as other respiratory diseases, like influenza: • Clean — properly wash your hands frequently. • Cover — cover your coughs and sneezes. • Contain — contain your germs by staying home (or keep children at home from school) if sick.