Infectious Diseases

Pertussis Information for Clinicians

What is pertussis?
How is pertussis spread?
When should I suspect pertussis?
How do I test for pertussis?
How is pertussis treated?
When can I recommend that a patient with pertussis be allowed to return to school/daycare?
Who should wear a mask in the waiting room?
What precautions do I need?
Who should receive post‐exposure prophylaxis (PEP)?
What should I do if I’ve been exposed to pertussis at work?
What if I recently took PEP and I am re‐exposed to another patient with pertussis?
What should I do if my patient’s test comes back positive for parapertussis?

What is pertussis?

Pertussis is an afebrile respiratory illness caused by the bacterium, Bordetella pertussis. It is highly contagious and occurs in ALL age groups. Although the vaccine is effective, immunity is incomplete and wanes over time. Therefore, anyone can contract pertussis infection. Persons who have been previously immunized are more likely to have milder symptoms although they are still highly contagious. In a vaccinated child or adult, pertussis can mimic other cough-related illnesses.

How is pertussis spread?

Pertussis is spread by respiratory droplets generated through coughing, sneezing and even talking. Persons with pertussis usually spread the disease while in close contact with others, who then breathe in the bacteria. Many infants who contract pertussis are infected by older siblings, parents or caregivers who may not be aware they have the disease. An infected person is most contagious early in the course of illness. If untreated, an infected person can spread pertussis for up to three weeks after symptoms begin. The attack rate (percent of those exposed who actually get the disease) among unimmunized household contacts is 90 percent. Antibiotic treatment limits contagiousness to five days after treatment is started. After pertussis exposure, patients do not become contagious until symptoms develop.

When should I suspect pertussis?

During this high transmission period, pertussis should be suspected in any patient with a cough illness with no or mild fever, particularly if cough has persisted for more than one week.

Additional key signs and symptoms include:

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How do I test for pertussis?

Pertussis testing instructions

How is pertussis treated?

All confirmed pertussis cases should be treated with antibiotics to limit disease spread, even if the patient has had symptoms for several weeks. Treatment options include azithromycin x 5 days; erythromycin x 14 days; or clarithromycin x 7 days. Alternative treatment for allergic patients includes trimethoprim‐sulfamethoxazole x 14 days. Once the cough is established, treatment will not impact the course of disease, but is used to limit disease spread. Parents may request retesting and retreatment if the child remains symptomatic. Retesting and retreatment is not indicated if the child has completed the appropriate course of initial therapy, regardless of ongoing symptoms. Please note that patients may be symptomatic for six‐10 weeks.

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When can I recommend that a patient with pertussis be allowed to return to school/daycare?

Who should wear a mask in the waiting room?

Any patient with an afebrile respiratory illness and prolonged cough greater than one week should wear a mask in the waiting room.

What precautions do I need?

Pertussis is spread by respiratory droplets only. Wearing a surgical mask within 3 feet of the patient provides protection from the spread of pertussis. If a patient is wearing a surgical mask, then it is not necessary for caregivers to also wear masks. Often times, close household contacts are the source of the child’s infection; therefore, providers should also wear masks when within 3 feet of symptomatic parents or siblings.

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Who should receive post-exposure prophylaxis (PEP)?

What should I do if I have been exposed to pertussis at work?

Please contact Infection Prevention and Control with the name of the patient, date of exposure(s) and any names of other healthcare workers that you know were exposed. Infection Prevention and Control will forward your information to Occupational Health, who will provide you with prophylaxis if you have been exposed to a confirmed case of pertussis.

What if I recently took PEP and I am re-exposed to another patient with pertussis?

With PEP, we are relying on drug levels to prevent establishment of infection. Since azithromycin remains in the system at therapeutic levels for 10 days following initiation of treatment:

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What should I do if my patient’s test comes back positive for parapertussis?

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Reviewed by: Julia Shaklee, MD, MSCE, Associate Hospital Epidemiologist and Medical Director
Date: August 15, 2012

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