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.