Pertussis is also known as whooping cough. It is an infection affecting the respiratory system. The respiratory tract includes the parts of the body that help you breathe.
What causes the Pertussis infection?
Pertussis is caused by the bacteria, Bordetella pertussis.
How is it transmitted?
Pertussis is spread when the pertussis bacteria is sneezed or coughed into the air and a close contact breathes it in. Most babies and unvaccinated children get pertussis from infected teenagers and adults.
Is it contagious?
Yes. Pertussis is extremely contagious. People who have the infection will be very contagious for about 21 days after the onset of symptoms. If you or your child is suspected of having pertussis, seek medical care promptly to get started on antibiotics. Close contacts should also be treated with antibiotics as a precaution.
What are some signs/symptoms?
Pertussis is a serious disease that should not be taken lightly. It can make you very sick, and in rare cases may even lead to death, especially in babies. The incubation period is commonly 7-10 days. This means that signs and symptoms may take a week to begin. There are three stages of pertussis infection. Here is a list of signs and symptoms that a person with pertussis may experience:
The First Stage (Catarrhal Stage) can last about 1-2 weeks. Presentation includes:
• Slow onset of runny nose
• Sneezing
• Mild fever
• Occasional cough that becomes more severe
The Second Stage (Paroxysmal Stage) can last 1-6 weeks, but may continue up to 10 weeks.Signs and symptoms include:
• Bursts of numerous, rapid coughs that may or may not sound like a high-pitched "whoop"
• Take a listen to what pertussis (whooping cough) sounds like: http://health.utah.gov/epi/diseases/pertussis/pertussis_sounds.htm
• Vomiting
• Exhaustion
The Third Stage (Convalescent or Recovery Stage)
• Fewer bursts of coughing that gradually disappears in 2-3 weeks
What are some treatment options?
Most young infants will need to be hospitalized if they are suspected of having pertussis. All patients will receive antibiotics (azithromycin, erythromycin, sulfamethoxazole/trimethoprim) that may decrease duration of symptoms and limit the spread of pertussis. Additionally, appropriate rest and fluids are recommended. Since many of the signs and symptoms of pertussis are similar to other diseases like the common cold, it is very easy for the disease to be overlooked. It’s always important to remember that prevention is the best option. All persons in close contact with the patient with pertussis should also receive antibiotics to prevent disease. When in doubt, be sure to call the doctor to check it out.
What are options for prevention?
Immunization is the best option available for prevention. Depending on age, several vaccines are available for use based on the person's age. See Table 1. DTaP (combination of diphtheria, tetanus, and acellular pertussis toxoids) and Tdap (tetanus, diphtheria, and acellular pertussis toxoids). DTaP is given as a routine childhood vaccination, while Tdap is given as a booster shot for adolescents and adults. In cases of outbreaks, these vaccines may be suggested for older or younger persons. By giving Tdap, the patient gets a full dose of tetanus, and a smaller dose of diphtheria and pertussis than that given to younger children to help protect your body from getting pertussis or diphtheria.
Table 1: Available Pertussis Vaccines
DTaP
for children 6 weeks through 6 years of age
Tdap
for adolescents and adults
Boostrix®
minimum age 10 years
Adacel®
minimum age is 11 year
Why is it important for adults to get a booster shot for pertussis?
Vaccinations have always played a major role in the prevention of many infections diseases, including pertussis. This has led to a dramatic decrease in the number of annual cases of pertussis reported. In recent years, however, there has been a rise in the amount of pertussis outbreaks in daycare, school, and hospital settings - making vaccinations a must. Between January - August 2010, over 3,000 cases have been reported in California alone. See Table 2. This is a huge increase from the 434 cases reported during the same time period in 2009. Other states, including Michigan, have reported similar trends.
Table 2: Impact of Pertussis Vaccination
Time Period
Incidence of Pertussis
Pre-Vaccination Era
200, 000 cases/year
Post-Vaccination Era
1, 010 cases/year
2005
25, 000 cases/year
Additionally, according to the Centers for Disease Control (CDC), the number of pertussis cases involving adolescents and adults has jumped from 24% to a staggering 56%. This jump points toward the overwhelming need for vaccination among adults and adolescents. See Figure 1. In 2005, the Tdap vaccine (Tetanus, Diphtheria, and Acellular Pertussis Vaccine) was introduced to help in the fight against pertussis. Unlike the previous pertussis vaccines, the Tdap vaccine is approved for use in those greater than 7 years of age – allowing for vaccination among adults and adolescents. Talk to your doctor or pharmacist today about Tdap to help protect you and your family from pertussis.
Figure 1: Data from the CDC
Table 3: CDC Recommendations for Tdap
Age
Recommendations
*Children (7-10 years)
Those not fully vaccinated against pertussis and have no contraindication to pertussis vaccine should receive a single dose of Tdap.
Children who have never been vaccinated against tetanus, diphtheria, or pertussis or who have unknown vaccination status should receive a series of three vaccinations containing tetanus and diphtheria toxoids. The first 3 doses should be Tdap.
A fully vaccinated child has had 5 doses of DTaP or 4 doses of DTaP if the fourth dose was given on or after the 4th birthday.
Adolescents (11-18 years)
Adolescents who received DTaP as kids and need a booster dose of Td (For those individuals, one booster dose of Td should be substituted with one dose of Tdap.) Adolescents should receive Tdap at the 11-12 year-old well-child visit.
Adolescents who received their booster dose of Td should still get vaccinated with Tdap. In most cases, it is suggested to wait five years from his/her last Td to get a dose of Tdap, but can be administered regardless of interval since the last tetanus- or diphtheria-toxoid containing vaccine.*
Adolescents who did not complete the DTaP series should finish the series with Tdap and Td.
Adults (19-64 years)
New mothers who have never been administered Tdap should get a dose of Tdap soon after giving birth. It is not contraindicated in pregnancy, and in areas where pertussis is known to be prevalent, it may be recommended during pregnancy. It is important to remember that although there has been a rise in pertussis cases among adolescents and adults, the CDC reports that 38 out of 39 pertussis-related deaths in 2005 occurred in infants. Vaccinating new mothers and direct caregivers of infants will help reduce the risk of passing on the infection.
Any adult less than 65 years of age who cares for an infant under 12 months of age should get vaccinated with Tdap
Health care employees less than 65 years of age involved in direct patient care
Any adult who has never received Tdap and requires a booster of Td. Remember that booster doses with Td are required every 10 years. These individuals can substitute one Td booster with one dose of Tdap.
For adult patients requiring Tdap, a minimum separation of 2 years between Td and Tdap is suggested, but not required.
Other Ages
Although not currently approved by the Food and Drug Administration (FDA), during times of outbreaks (such as the case in California in 2010), local Departments of Health may suggest administering a pertussis-containing vaccine to older or younger aged patients than stated on the vaccine label.
Brown K. The Centers for Disease Control. www.cdc.gov/pertussis. Updated August 10, 2009. Accessed August 20, 2010.
Immunization Action Coalition. http://www.vaccineinformation.org/pertuss/qandadis.asp. Updated February 2009. Accessed August 20, 2010.
The Centers for Disease Control. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5104a1.htm#fig1. Updated February 2002. Accessed August 20, 2010.
Appendix A: Summary of Recommendations for Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a2.htm
MMWR. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices, 2010. January 14, 2011/60(01);13-15.
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