Pertussis (Whooping Cough)

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Pertussis in Arizona

ADHS receives about 200-300 reports of pertussis per year. In 2005 Arizona had a state-wide outbreak of the disease, with 928 cases reported for the year.  The state-wide outbreak was declared over on October 11, 2005; Pima and Coconino Counties remained in outbreak status into 2006.

What is pertussis?

Pertussis is a highly contagious bacterial infection that is vaccine-preventable. Coughing is the primary symptom of pertussis; fever is not present or is minimal throughout the course of illness. The cough of a patient with pertussis may begin as a mild cough and progress to attacks (paroxysms) of coughing, accompanied by gagging and/or vomiting. Some persons with pertussis make a "whoop" sound when they breath in after coughing.

Who can get pertussis?

Pertussis may affect anyone regardless of their age and vaccination status. It is most common in unimmunized or inadequately immunized persons (who typically experience more severe disease) and persons with waning immunity (protection from the vaccine lasts 5-10 years from the last dose).

How is pertussis spread?

Pertussis is spread through close contact with droplets from the mouth and nose of an infected person. Spread can happen when the infected person coughs, sneezes, or talks.

What are the symptoms of pertussis?

The initial symptoms of pertussis are similar to a mild cold and include runny nose and mild cough. The illness then progresses to episodes of severe coughing spasms. These episodes may ultimately last for several months duration and tend to be worse at night. Vomiting may occur after coughing episodes. The person with pertussis may look and feel healthy between coughing episodes. Immunized children, adolescents, and adults may have milder symptoms than unimmunized persons.

How soon after infection do symptoms appear?

Symptoms may appear between 7 - 10 days after exposure to an infected person (range 4-21 days). Rarely, this period may be as long as 42 days.

How long can someone spread pertussis?

A person with pertussis is considered infectious for 21 days after the onset of cough. Treatment with an appropriate antibiotic will shorten the infectious period to 5 days after the initiation of treatment if started early in the course of illness.

Can you catch pertussis more than once?

Immunity acquired from past infection may wane over time. However, some experts believe that immunity acquired from natural pertussis disease is lifelong.

What are the complications associated with pertussis?

Complications of pertussis include pneumonia, seizures, middle ear infection, dehydration, encephalopathy/brain damage, and death.

Infants are at highest risk of complications due to pertussis. Serious complications are less likely in older children, adolescents and adults but may occur.

Is there a vaccine for pertussis?

There are two vaccines for pertussis, one given as part of the childhood immunization schedule (DTaPPDF) and one recently licensed for use in adolescents and adults (TdapPDF). Both of these pertussis vaccines are given in combination with diphtheria and tetanus.

What can be done to prevent the spread of pertussis?

The cornerstone of pertussis prevention is immunization. Before age 7 and preferably at school entry, children should have received 5 doses of DTaP vaccine. Adolescents and adults in need of Td should receive TdaP in its place, and any adults who have close contact with an infant less than one year of age should receive Tdap.

Persons with pertussis should stay home and avoid close contact with others until completion of 5 days of a prescribed course of antibiotic treatment.

Persons with any coughing illness (or other contagious illness) should avoid contact with infants and expectant mothers.

Handwashing may prevent the spread of all infectious diseases, including pertussis.

Caretakers of infants should take measures to limit the spread of contagious diseases, including pertussis, to infants in their care.

References:

  1. CDC's Guidelines for Control of Pertussis Outbreaks
  2. Pertussis Fact Sheet, Seattle/King County
  3. Pertussis Fact Sheet, WA DOH
  4. Pediatric Red Book
  5. Chin's Control of Communicable Diseases

Technical Information

Pertussis Vaccination

The Advisory Committee on Immunization Practices (ACIP) recommends that five doses of DTaPPDF (diphtheria, tetanus, and acellular pertussis) vaccine be given at the following age intervals: two months, four months, six months, 12-19 months, and between four and seven years of age or by school entry. 

Of the two recently licensed Tdap vaccinesPDF, one is licensed for use in 10-18 year olds and the other is licensed for people 11-64 years of age. The ACIP recommends that adolescents 11-18 years of age receive one dose of Tdap in place of a single Td (Tetanus and Diphtheria) booster dose. Adolescents should only be given Tdap if they have completed the five dose childhood DTaP series and have not yet received Td or Tdap. Adults 19-64 years of age should receive a single dose of Tdap to replace their next Td booster dose if they received their most recent Td more than 10 years earlier. The vaccine is also recommended for adults who have close contact with an infant who is less than one year old.

Characteristics

  • Infectious Agent: Bordetella pertussis (a fastidious, gram-negative, pleomorphic bacillus)
  • Mode of Transmission: Person-to-person via aerosolized droplets produced from a cough or sneeze, or by direct contact with secretions from the respiratory tracts of infectious individuals.
  • Communicability:  Infectious for five days after the start of appropriate antibiotics.  If untreated, infectious for three weeks from the start of cold-like symptoms.
  • Incubation Period:  7-10 days, but can range 6-21 days.
  • Clinical Features
    • Prodromal Stage:
      • Onset of cold-like symptoms (coryza, sneezing, mild fever, occasional cough) that lasts 1-2 weeks with cough gradually becoming more severe.
    • Paroxysmal Stage:
      • Characterized by patient having bursts (paroxysms) of numerous, rapid coughs, sometimes followed by high-pitched "whoop," cyanosis, apnea, post-tussive vomiting/gagging, and/or sticky mucus production.  Usually lasts 1-6 weeks, but may last up to 10 weeks.
        • Infants (<6 months): cough, choking, cyanosis, paroxysms.  May not have "whoop."
        • Adults/teens/immunized children: Milder illness, hacking cough, occasional paroxysms, and usually with sticky mucus production.  Sometimes post-tussive vomiting and gagging.  May not have "whoop."  Mimics bronchitis.
    • Convalescent Stage:
      • Gradual recovery, with cough becoming less frequent and less paroxysmal.  Generally cough disappears after 2-4 weeks, but some will have temporary recurrence of cough paroxysms with respiratory infections for next several months.

Arizona Administrative Code: R9-6-356

  1. Case control measures
    1. An administrator of a school or child care establishment, either personally or through a representative, shall:
      1. Exclude a pertussis case from the school or child care establishment for 21 days after the date of onset of cough or for five days after the date of initiation of antibiotic treatment for pertussis; and
      2. Exclude a pertussis suspect case from the school or child care establishment until evaluated and determined to be noninfectious by a physician, physician assistant, or registered nurse practitioner.
    2. An administrator of a health care institution, either personally or through a representative, shall:
      1. Exclude a pertussis case from working at the health care institution for 21 days after the date of onset of cough or for five days after the date of initiation of antibiotic treatment for pertussis; and
      2. Exclude a pertussis suspect case from working at the health care institution until evaluated and determined to be noninfectious by a physician, physician assistant, or registered nurse practitioner.
    3. A health care provider shall use droplet precautions for a pertussis case for five days after the date of initiation of antibiotic treatment for pertussis.
    4. A local health agency shall conduct an epidemiologic investigation of each reported pertussis case or suspect case. For each pertussis case, a local health agency shall complete and submit to the Department within 10 working days after completing an epidemiologic investigation:
      1. A Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, "Pertussis Surveillance Worksheet" (November 1999), which is incorporated by reference, on file with the Department, and available from the Centers for Disease Control and Prevention, Division of Bacterial and Mycotic Diseases, 1600 Clifton Rd., NE, Mail-stop C-09, Atlanta, GA 30333, including no future editions or amendments; or
      2. An electronic equivalent of the Pertussis Surveillance WorksheetPDF provided by the Department.
  2. Contact control measures:
    1. When a pertussis case has been at a school or child care establishment, the administrator of the school or child care establishment, either personally or through a representative, shall:
      1. Consult with a local health agency to determine who shall be excluded and how long each individual shall be excluded from the school or child care establishment, and
      2. Comply with the local health agency's recommendations for exclusion.
    2. A local health agency shall identify close contacts of a pertussis case and, if indicated, shall provide or arrange for each close contact to receive antibiotic prophylaxis.

Lab Tests

Lab Criteria for Diagnosis

  • Isolation of Bordetella pertussis from a clinical specimen
  • Positive PCR for B. pertussis
  • A positive serology test result or a direct fluorescent antibody test of nasopharyngeal secretions does not make a case confirmed for reporting purposes.

Lab Tests

Additional Information