Mariam, a school nurse, was examining 5-year-old Sam, who was sent to her office an hour after school began. He complained of a bad cough and felt extremely tired. After talking to Sam for a few minutes, the boy erupted into a coughing fit with loud wheezing sounds between coughs. Although Mariam had never seen a case of whooping cough in a school setting, she suspected this disease immediately. To obtain more information, she called Sam’s parents. When the boy’s parents arrived, Mariam asked about recent changes in Sam’s health. Sam’s mother said she noticed he had a runny nose and felt warmer than usual a week or so earlier, but thought it was just a lingering cold. Two nights before, Sam had broken into a coughing fit and then vomited, but he ap-peared to be fine the next morning, except for the cough. Mariam told the parents that based on Sam’s signs and symptoms, she suspected he had whooping cough (pertussis), a bacterial infection caused by Bordetella pertussis in the lungs. She also added that the disease is highly contagious, prolonged, se-vere, and preventable by a vaccine. The parents were unconvinced. They believed that Sam was suffering from a bad cold or perhaps the flu that had been cir-culating. They were not aware of anyone with whooping-cough symptoms who had been in contact with their son. Mariam urged them to seek a doctor to make a final diagnosis of the boy’s condition. They assured Mariam that they would, and left with Sam. After the parents left, Mariam looked through Sam’s medical records. Not surprisingly, he did not have any vaccinations due to a medical exemption. Mariam walked straight to the princi-pal’s office to discuss Sam’s condition and what steps should be taken by the school to warn parents, if he was indeed diagnosed with whooping cough.

Required:
a. Should Mariam be concerned for the other children who are in class with Sam? Why or why not?
b. Was Mariam being overly worried by telling the principal she suspected Sam had whooping cough?
c. If you were Sam’s pediatrician, what type of diagnostic tool would you most likely use in the clinic to quickly identify whether or not he has whooping cough?
d. If Sam does indeed have whooping cough, should the entire school body get vaccinated, or would another treatment be preferable?
e. Could the parents be correct in their suspicion that the boy most likely caught the disease at school?
f. If another child was exposed to Sam and did not have the pertussis vaccination for whooping cough, should the child be vaccinated immediately?