Pertussis (whooping cough)
What is Pertussis (whooping cough)?
Pertussis, also known as whooping cough, is a contagious bacterial infection caused by Bordetella pertussis. Pertussis can be severe in infants and young children, resulting in hospitalizations, pneumonia, neurologic problems, and death. The cough from pertussis may last as long as three months. Pertussis is usually not as severe in adults and individuals who are fully immunized.
Signs and symptoms
- Begins with cold-like symptoms, including mild cough and low-grade or no fever
- Cough becomes more severe, causing coughing spells or fits
- Coughing spells may be followed by vomiting, difficulty catching breath, face turning blue, and/or high-pitched whoop
- Appears well between coughing spells
Incubation period
Ranges from 5-21 days; usually 7-10 days
Contagious period and spread
- A person is most contagious in the early stages of the disease and will remain contagious for 21 days after coughing begins, or until five days of appropriate antibiotic treatment has been completed.
- Bacteria that cause pertussis are spread by direct contact with respiratory droplets of a person with infection. Respiratory droplets that form when a child talks, coughs, or sneezes do not stay in the air, but they may travel up to three feet and can infect others when they land on or are rubbed into eyes, noses, or mouths.
Public health reporting requirements
- Report confirmed and suspected pertussis to the facility director, school nurse, or child care health consultant.
- Report the infection to the state or local public health agency by phone within one working day of a suspected or confirmed diagnosis.
- Contact state or local public health agencies for assistance if the school or child care facility plans to notify parents/guardians about a case of pertussis in the facility.
Control of spread
- Monitor all children and staff members for respiratory signs or symptoms, and recommend treatment if cough develops within 21 days of exposure to pertussis.
- An antibiotic to prevent infection is frequently recommended for child care/preschool classroom contacts and rarely recommended for school classroom contacts.
- Pertussis vaccination after exposure will not prevent infection. However, it may provide protection against future exposure. Review pertussis immunization records and recommend DTaP or Tdap vaccines for under-immunized students/children and staff.
Vaccination
Routine child/adolescent recommendations:
- Children should receive five doses of diphtheria, tetanus, pertussis (DTaP at 2, 4, and 6 months, at 12-15 months, and at 4-6 years of age. Some children may only received four doses if the fourth dose is given on or after the 4th birthday and the dose is administered six months after the previous dose.
- Children 10 years and older and and adults should receive a single ‘adolescent’ dose of Tdap. Tdap can be given as early as 7 years of age to complete an incomplete series of DTaP.
Colorado school-required vaccines:
- Child care/preschool: Infants and children are required to have DTaP vaccine starting at 2 months of age. When children are on schedule, five doses are required to start kindergarten.
- School (K-12): Five doses are required for kindergarten entry. (Dose 5 is not required if dose 4 was administered on or after the 4th birthday and at least 6 months after dose 3). Tdap is required for students aged 10 years and older prior to sixth-grage entry.
- A complete school-required vaccine exemption provided to the child/adolescent’s school may be accepted in place of documentation of an age-appropriate DTaP vaccination series.
Routine adult/other recommendations:
- Pertussis (tetanus, diphtheria, pertussis [Tdap]) vaccine is recommended for all adults who did not receive a primary vaccination series for tetanus, diphtheria, or pertussis.
- Tdap vaccine is recommended for all pregnant persons during weeks 27-36 of each pregnancy.
Treatment
Pertussis is treated with antibiotics. Early treatment of pertussis is very important. The earlier a person, especially an infant, starts treatment the better. If a patient starts treatment for pertussis early in the course of illness, during the first one to two weeks before coughing paroxysms occur, symptoms may be lessened.
Exclusion
- Pertussis is a highly contagious illness for which routine exclusion of infected children is warranted. Exclude infected children/students and close contacts (including siblings, caregivers, and teaching staff) who are coughing until they receive appropriate evaluation and treatment with antibiotics.
- Readmit after five days of appropriate antibiotic treatment or until 21 days after the onset of cough (whichever is first), or if cleared by a health care provider, and when the child is able to participate and the staff members determine they can care for the child without compromising their ability to care for the other children in the group.
Role of teachers, caregivers, and family
- Encourage routine vaccination. Review and ensure all children have received the pertussis-containing vaccine according to current immunization recommendations.
- Report the infection to the local or state health department. If the health professional who makes the diagnosis does not inform the local health department that the infected child is a participant in a child care program or school, this could delay controlling the spread.
- Report the infection to the staff member designated by the child care program or school for decision-making and action related to the care of ill children. That person, in turn, alerts possibly exposed family and staff members and parents of unimmunized children to watch for symptoms and notifies the health consultant.