Pertussis and Health Care Workers
Epidemiology
- Pertussis is endemic and can be severe in nonimmunized infants.
- Transmitted from patients to close contacts by aerosolized respiratory droplets.
- Highly communicable during the catarrhal stage (inflammation of the nose and throat) and the first three weeks after cough onset.
Laboratory Diagnosis/Testing
- Isolation of Bordetella pertussis by culture is the standard test. Success in isolating the organism declines with antibiotic therapy, delay in specimen collection beyond the first 3 weeks of illness, and immunity.
- Polymerase chain reaction (PCR) testing of specimens is rapid but is not yet nationally validated or standardized; once validated, PCR could be used in addition to culture.
- Standardized and validated enzyme-linked immunosorbent assay for antipertussis-toxin IgG is under development.
Clinical Findings
- Incubation period: 7-10 days (range: 4-12 days).
- Catarrhal stage: 1-2 weeks. Coryza, low-grade fever, mild cough.
- Paroxysmal stage: 1-6 weeks. Paroxysmal cough, post-tussive vomiting, and inspiratory whoop.
- Convalescent stage: >3 weeks. Cough lessens and disappears.
Treatment/Prophylaxis
- Macrolides (erythromycin, azithromycin, or clarithromycin) are preferred.
- Trimethoprim-sulfamethoxazole is an alternate antibiotic for use in people with allergy or intolerance to macrolides.
Prevention
- Vaccination of children is available as a 5-dose series administered at ages 2, 4, and 6 months, 15-18 months, and 4-6 years.
- HCWs or patients with pertussis-like illness (i.e., highly suspected for pertussis) should be tested and treated.
- HCWs with pertussis should be excluded from work for 5 days from the start of antibiotic use; if no antibiotic is taken, HCWs should be excluded from work for 21 days from onset of symptoms.
- HCWs should keep coughing patients >3 feet away from others and implement droplet precautions, including wearing of procedural or surgical masks.
- Isolation precautions are recommended for confirmed and suspected pertussis cases.
Source: Centers for Disease Control and Prevention. Outbreaks of pertussis associated with hospitals Kentucky, Pennsylvania, and Oregon, 2003. MMWR 2005; 54:67-71.
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