Health Alerts > 8/17/09 Pertussis
As of August 7th, 127, cases of pertussis have been reported in Indiana in 2009, compared to 28 cases as of the same week in 2008. Indiana ended 2008 with 271 cases and it is expected that the number will increase in 2009. In addition, there has been significant activity in camps this summer as well (in addition to H1N1). Therefore, it is important to include pertussis in the differential diagnosis when an individual presents with a persistent cough.
Symptoms
Initial Catarrhal Phase:
Cold-like symptoms for first week – this is when the disease is most contagious
Second Paroxysmal Phase: worsening cough, which may be associated with characteristic whoop, petechiae, or cyanosis. . Infants younger than 6months of age may not have the strength to have a whoop, but they do have paroxysms of coughing. Fever is usually minimal during the whole infection.
Recovery Phase: can last up to 6 weeks
Diagnosis/Laboratory Testing
Appropriate confirmatory testing for pertussis includes culture and/or polymerase chain reaction (PCR). The preferred specimen for testing is a nasopharyngeal swab or aspirate (check with your lab to determine which is acceptable).
Direct Fluorescent Antibody (DFA) testing is insensitive and non-specific and should not be used for confirmation of pertussis. While serologic tests are available to test for the presence of pertussis antibodies, no standardized test is available, and they should not be used for confirmation of pertussis.
Treatment
An antibiotic effective against pertussis (such as azithromycin, erythromycin or trimethoprim-sulfamethoxazole) should be administered to all close contacts, especially household contacts, of persons with pertussis, regardless of age and vaccination status. Note that antibiotics will shorten the infectious period of pertussis, but will not shorten the duration of symptoms unless provided very early.
Vaccination
All close contacts younger than 7 years of age who have not completed the four-dose primary series should complete the series with the minimal intervals. (Minimum age for first dose is 6 weeks; minimum intervals from dose 1 to 2 and from dose 2 to 3 are 4 weeks; minimum interval from dose 3 to 4 is 6 months.) Close contacts who are 4–6 years of age and who have not yet received the second booster dose (usually the fifth dose of DTaP) should be vaccinated.
Remember also the following changes will be required for the 2010-2011 school year:
a. One meningococcal vaccine (MCV4) will be required for all students entering 6th - 12th grades.
b. One Tdap (tetanus, diphtheria, and pertussis) booster will be required after 10 years of age for all students entering 6th -12th grades.
In addition, according to the vaccine manufacturer, if a child has recently received a Td vaccination, unless they are associated with a local outbreak, they should wait approximately two years to receive the Tdap vaccine.
Vaccines: BOOSTRIX is approved for use in individuals 10 through 64 years of age. Adacel approved for use in persons 11 through 64 years of age.
Containment (especially important with school resuming)
Suspect cases should be excluded from work, school, or other public gatherings through 5 days of treatment with an appropriate antibiotic. If a suspect case is not treated, the case should be excluded through 21 days after cough onset.
Symptomatic close contacts should be excluded from work, school, or other public gatherings through 5 days of treatment with an appropriate antibiotic.
Symptomatic contacts who are not treated should be excluded through 21 days after cough onset.
Asymptomatic close contacts should be placed on antibiotics, but they may immediately return to work or school. One exception: inadequately immunized household contacts under the age of 7 should be excluded through 5 days of
antibiotic prophylaxis per the Indiana Communicable Disease Reporting Rule (410 IAC 1-2.3).
Thanks, any questions call Deb McMahan, MD
