By Gary Evans, Medical Writer

The CDC has drafted new pertussis guidance for healthcare workers as part of an ongoing update of its Guideline for Infection Control in Healthcare Personnel. A draft section of pertussis recommendations was discussed at a recent meeting of the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC).

Pertussis — also called whooping cough — has become a recurrent problem, in part due to the fading efficacy of the vaccine over time. Bordetella pertussis can cause hospital outbreaks that expose healthcare workers. The CDC reports that there are from 10,000 to 40,000 cases annually with about 20 deaths.

Antibiotic post-exposure prophylaxis (PEP) typically is given to exposed healthcare workers to prevent transmission to vulnerable patients like infants. HICPAC member Hilary Babcock, MD, MPH, medical director of infection prevention and occupational health at Barnes-Jewish Hospital in St. Louis, outlined the pertussis recommendations at a Feb. 15 meeting.

The CDC draft recommendations for asymptomatic healthcare personnel — regardless of vaccination status — who have unprotected exposure to pertussis are broken down into categories with the following recommendations.

Those likely to interact with persons at increased risk for severe pertussis:

• Administer PEP. If they do not receive PEP, restrict from contact (e.g., furlough, duty restriction/reassignment) with patients and other persons at increased risk for severe pertussis for 21 days after their last exposure.

For similarly exposed workers not likely to interact with patients at high risk for pertussis, the HICPAC recommends:

• Administer PEP or implement daily monitoring for 21 days after the last exposure for development of signs and symptoms of pertussis.

“Work restrictions are not necessary for asymptomatic healthcare personnel who have had unprotected exposure to pertussis and receive post-exposure prophylaxis, regardless of their risk for interaction with persons at increased risk for severe [pertussis] complications,” the HICPAC draft states.

However, employee health professionals should exclude symptomatic healthcare personnel with known or suspected pertussis from work for 21 days from the onset of cough, or until five days after the start of effective antimicrobial therapy.

“The objective of post-exposure prophylaxis is to prevent transmission and disease in others, and we recognize populations at particular risk for serious complications,” Babcock said at HICPAC.

These high-risk patients include:

• infants under 12 months;

• women in their third trimester of pregnancy;

• people with pre-existing health conditions that may be exacerbated by a pertussis infection (e.g., immunocompromised persons and persons with moderate to severe asthma).

Healthcare settings may have patients at high risk for severe pertussis infections in neonatal and pediatric care settings as well as maternity, transplant, and oncology.

“We tried to balance the discussion from the group last time about providing this information, but not be overly prescriptive so that healthcare facilities could identify these areas for themselves,” she said.

When finalized, the draft will note the limitations of the current vaccine, which can wane in immunity without booster shots. The HICPAC guidelines will incorporate the recommendations for pertussis vaccination of healthcare workers by the CDC’s Advisory Committee on Immunization Practices (ACIP).

ACIP currently recommends that healthcare workers be vaccinated and then receive a booster every 10 years thereafter. Pregnant personnel should be immunized against pertussis during each pregnancy. The HICPAC guidelines also include a discussion of exposures, which will include not wearing a face mask when in close, face-to-face contact with an infectious patient.

“Close contact may include, but is not limited to, performing a physical examination, feeding, or bathing a patient; bronchoscopy; intubation; or administration of bronchodilators,” the HICPAC draft guidelines state. “Determination of close contacts may be more inclusive in settings where interaction with persons at risk for severe pertussis is more likely.”

The guidance on exposures was appreciated by Darlene Carey, RN, a liaison representative for the Association of Professionals in Infection Control and Epidemiology.

“I think a lot of infection prevention and occupational health staff members have concerns about that whenever an exposure happens,” she said.