CDC offers guidelines for pertussis
September 1, 1999 3 minutes read
CDC offers guidelines for pertussis
The following are excerpts from the Centers for Disease Control and Prevention’s 1998 Guide lines for Infection Control in Health Care Personnel that relate to pertussis.1
Pertussis prophylaxis: Erythromycin, 500 mg qid PO, or one tablet bid PO, for 14 days after exposure. Indications: Personnel with direct contact with respiratory secretions or large aerosol droplets from respiratory tract of infected persons.
Work restrictions (active pertussis): Exclude from duty. Duration: From beginning of catarrhal stage through third week after onset of paroxysms or until five days after start of effective antimicrobial therapy.
Work restrictions (postexposure asymptom atic personnel): No restriction, prophylaxis recommended.
Work restrictions (postexposure symptomatic personnel): Exclude from duty. Duration: Until five days after start of effective antimicrobial therapy.
Prevention of Nosocomial Transmission of Pertussis:
• Do not administer whole-cell pertussis vaccine to personnel.
• NO RECOMMENDATION for routine administration of an acellular pertussis vaccine to health care personnel. UNRESOLVED ISSUE.
• Immediately offer antimicrobial prophylaxis against pertussis to personnel who have had unprotected (i.e., without the use of proper precautions), intensive (i.e., close, face-to-face) contact with a patient who has a clinical syndrome highly suggestive of pertussis and whose cultures are pending; discontinue prophylaxis if results of cultures or other tests are negative for pertussis and the clinical course is suggestive of an alternative diagnosis.
• Exclude personnel in whom symptoms develop (e.g., cough for greater than or equal to seven days, particularly if accompanied by paroxysms of coughing, inspiratory whoop, or post-tussive vomiting) after known exposure to pertussis from patient care areas until five days after the start of appropriate therapy.
Nosocomial transmission of Bordetela pertus-sis has involved both patients and personnel; nonimmunized children are at greatest risk. Sero logic studies of health care personnel indicate that personnel may be exposed to and infected with pertussis much more frequently than indicated by the occurrence of recognized clinical illness. In one such study, the level of pertussis agglutination antibodies was found to correlate with the degree of patient contact; the prevalence of such antibody was highest in pediatric house staff (82%) and ward nurses (71%) and lowest in nurses with administrative responsibilities (35%).
Pertussis is highly contagious; secondary attack rates exceed 80% in susceptible household contacts. B. pertussis transmission occurs by contact with respiratory secretions or large aerosol droplets from the respiratory tracts of infected persons. The incubation period is usually seven to 10 days. The period of communicability starts at the onset of the catarrhal stage and extends into the paroxysmal stage up to three weeks after onset of symptoms. Prevention of secondary transmission of pertussis is especially difficult during the early stages of the disease because pertussis is highly communicable in the catarrhal stage, when the symptoms are nonspecific and the diagnosis is uncertain.
During nosocomial pertussis outbreaks, the risk of acquiring infection among patients or personnel is often difficult to quantify because exposure is not easily determined. Furthermore, clinical symptoms in adults are less severe than in children and may not be recognized as pertussis. Pertussis should be considered for any person seeking treatment with an acute cough lasting at least seven days, particularly if accompanied by paroxysms of coughing, inspiratory whoop, or posttussive vomiting.
Prevention of transmission of B. Pertussis in health care settings involves (a) early diagnosis and treatment of patients with clinical infection, (b) implementation of droplet precautions for infectious patients, (c) exclusion of infectious personnel from work, and (d) administration of postexposure prophylaxis to persons exposed to infectious patients. Patients with suspected or confirmed pertussis who are admitted to the hospital need to be placed on droplet precautions until they have clinical improvement and have received antimicrobial therapy for at least five days.
Postexposure prophylaxis is indicated for personnel exposed to pertussis; a 14-day course of either erythromycin (500 mg orally four times daily) or trimethoprim-sulfamethoxazole (one tablet twice daily) has been used for this purpose. The efficacy of such prophylaxis has not been well-documented, but studies suggest that it may minimize transmission. There are not data on the efficacy of newer macrolides (clarithromycin or azithromycin) for prophylaxis in persons exposed to pertussis.
Restriction from duty is indicated for personnel with pertussis from the beginning of the catarrhal stage through the third week after onset of paroxysms, or until five days after the start of effective antimicrobial therapy. Exposed personnel do not need to be excluded from duty.
Reference
1. Bolyard EA, Tablan OC, Williams WW, et al. Guideline for Infection Control in Health Care Personnel, 1998. Atlanta; Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.
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