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Health Alert: Pertussis Among Infants

Posted: November 20, 2007
To: Health Care Providers
From: Disease Control Unit, Sonoma County Public Health (707-565-4567)

This alert is to advise you of an increase in pertussis among children <12 months old in our community. Although our overall number of pertussis cases this year is low (N=19, to date), seven of these have been in infants, some severe and requiring hospitalization. Infants present a special case for pertussis as symptoms are often non-specific and the illness can be life threatening.

As you know, pertussis is caused by Bordetella pertussis, a bacteria. Pertussis begins with runny nose, sneezing, low grade fever, and mild cough (catarrhal stage). After a week or two, a persistent cough develops which may occur in explosive bursts (paroxysmal coughing) sometime ending in a high-pitched whoop and vomiting (paroxysmal stage). In infants younger than 6 months, older children, and adults, a whoop may be absent. The coughing attacks usually increase during the first two weeks of illness, and then remain the same for two or three more weeks before gradually decreasing. Communicability is highest during the catarrhal stage, but can persist into the first 2 weeks of the paroxysmal stage before gradually decreasing over the subsequent 3 weeks. Communicability is eliminated with 5 days of appropriate antibiotics. Pertussis is sometimes complicated by pneumonia, encephalopathy or other serious sequelae, particularly in infants. Adolescents and adults often serve as reservoirs for infection of infants.

If you have a patient who meets the clinical case definition, or you suspect pertussis, the following is recommended:

1. Complete the Confidential Morbidity Report (CMR) and fax to Sonoma County Public Health, Disease Control, fax 565-4565.
2. If within 2 weeks of symptom onset, obtain a nasopharyngeal specimen for PCR and culture from the posterior nasopharynx and send to the Public Health Lab (565-4711). PCR results are available within 1 -2 days and may be available within hours, depending on timing and workload. PCR results are preliminary and a positive culture is needed to confirm a diagnosis of pertussis. A negative culture does not rule out pertussis since the sensitivity of culture is not high. Culture media can be ordered from the Public Health Lab. PLEASE DO NOT REFRIGERATE SPECIMEN.
3. Treat the patient (if within 3 weeks of cough onset) and members of his/her household according to the table below.
4. Advise symptomatic patients to stay at home for at least the first 5 days of antibiotics.
5. All household contacts of cases should receive chemoprophylaxis according to the table below, whether or not they have symptoms and regardless of their immunization history.
6. All contacts <7 years old who have not received at least 4 doses of DTP/DTaP, or for whom the last dose was over 3 years ago, should receive a DTP/DTaP dose.
7. Tdap (tetanus, diphtheria, acellular pertussis vaccine) is now available and recommended for individuals 11-64 years of age to replace a single dose of Td vaccine when appropriate. Consider vaccinating your adolescent and adult patients. You will need to contact your medical supply representative to order Tdap vaccine. For more information about Tdap vaccine, go to http://www.cdc.gov/vaccines/recs/provisional/default.htm.

For more information regarding pertussis, please go to the Sonoma County Public Health Disease Control website. If you have questions or comments, please contact the Disease Control Unit at 565-4566 (provider line), e-mail phnurse@sonoma-county.org, or fax 565-4565.

Table 4 from MMWR: December 9, 2005 / 54(RR14);1-16

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