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Whooping Cough (Pertussis) Disease

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Deaths associated with pertussis are rare, but not non-existent. Do you know this disease? Whooping cough is a contagious respiratory tract infection. Ten days after patients become infected, they begin to show symptoms such as nasal congestion, fever or a characteristic cough (which sounds like "whoop"). In order for you to answer all the frequently asked questions about this disease, we bring you this watercolor-style template. Its illustrations reflect the different phases of this clinical picture, as well as the advantages of using vaccines to prevent its transmission. Adapt the presentation to your content and modify it to your liking!

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Pertussis Clinical Presentation

• Author: Joseph J Bocka, MD; Chief Editor: Russell W Steele, MD  more...
• Sections Pertussis
• Practice Essentials
• Etiology and Pathophysiology
• Epidemiology
• Patient Education
• Physical Examination
• Approach Considerations
• PCR Assay and ELISA
• Pharmacologic Therapy
• Immunization
• Medication Summary
• Antibiotics, Other
• Vaccines, Inactivated, Bacterial
• Questions & Answers

Typically, the incubation period of pertussis ranges from 3-12 days. Pertussis is a 6-week disease divided into catarrhal, paroxysmal, and convalescent stages, each lasting from 1-2 weeks.

Older children, adolescents, and adults may not exhibit distinct stages. Symptoms in these patients include uninterrupted coughing, feelings of suffocation or strangulation, and headaches. Vaccinated adults usually develop only prolonged bronchitis without a whoop, whereas unvaccinated adults are more likely to have whooping and posttussive emesis.

Stage 1 - Catarrhal phase

The initial (catarrhal) phase is indistinguishable from common upper respiratory infections. It includes nasal congestion, rhinorrhea, and sneezing, variably accompanied by low-grade fever, tearing, and conjunctival suffusion. Pertussis is most infectious when patients are in the catarrhal phase, but pertussis may remain communicable for 3 or more weeks after the onset of cough.

Stage 2 - Paroxysmal phase

Patients in the second (paroxysmal) phase present with paroxysms of intense coughing lasting up to several minutes. In older infants and toddlers, the paroxysms of coughing occasionally are followed by a loud whoop as inspired air goes through a still partially closed airway. Infants younger than 6 months do not have the characteristic whoop but may have apneic episodes and are at risk for exhaustion. Posttussive vomiting and turning red with coughing are common in affected children.

Stage 3 - Convalescent phase

Patients in the third (convalescent) stage have a chronic cough, which may last for weeks.

In patients with uncomplicated pertussis, physical examination findings contribute little to the diagnosis. In all patients with pertussis, fever is typically absent. Most patients do not have signs of lower respiratory tract disease. Conjunctival hemorrhages and facial petechiae are common and result from intense coughing. Dehydration  also is common on presentation. Hypoxia should be considered and assessed.

The classic inspiratory gasp or whoop develops primarily in children aged 6 months to 5 years. It usually is absent in patients younger than 6 months and in most older vaccinated children and adults. However, it often can be observed in unvaccinated adults, as can posttussive emesis.

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Walsh PF, Kimmel L, Feola M, Tran T, Lim C, De Salvia L, et al. Prevalence of Bordetella pertussis and Bordetella parapertussis in infants presenting to the emergency department with bronchiolitis. J Emerg Med . 2011 Mar. 40(3):256-61. [QxMD MEDLINE Link] .

Bisgard KM, Pascual FB, Ehresmann KR, Miller CA, Cianfrini C, Jennings CE, et al. Infant pertussis: who was the source?. Pediatr Infect Dis J . 2004 Nov. 23(11):985-9. [QxMD MEDLINE Link] .

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Notes from the field : use of tetanus, diphtheria, and pertussis vaccine (Tdap) in an Emergency Department - Arizona, 2009-2010. MMWR Morb Mortal Wkly Rep . 2012 Jan 27. 61(3):55-6. [QxMD MEDLINE Link] .

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Centers for Disease Control and Prevention. Pertussis (Whooping Cough): Outbreaks. Available at https://www.cdc.gov/pertussis/outbreaks.html . Accessed: Aug 9, 2012.

Centers for Disease Control and Prevention. Pertussis (Whooping Cough): Surveillance and Reporting. Available at https://www.cdc.gov/pertussis/surv-reporting.html . Accessed: Aug 10, 2012.

Christensen J. California declares whooping cough epidemic. CNN.com. Available at https://www.cnn.com/2014/06/13/health/whooping-cough-california/ . Accessed: June 17, 2014.

Atwell JE, Van Otterloo J, Zipprich J, Winter K, Harriman K, Salmon DA. Nonmedical vaccine exemptions and pertussis in California, 2010. Pediatrics . 2013 Oct. 132(4):624-30. [QxMD MEDLINE Link] .

CDC. Pertussis Outbreak Trends. CDC.gov. Available at https://www.cdc.gov/pertussis/outbreaks/trends.html . Accessed: June 17, 2014.

Barclay L. Pertussis Cases Near 10,000 in California This Year. Medscape Medical News. Available at https://www.medscape.com/viewarticle/835898 . Accessed: December 5, 2014.

Winter K, Glaser C, Watt J, et al. Pertussis Epidemic — California, 2014. Morb Mortal Wkly Rep . 2014. 63:1129-1132. [Full Text] .

Bettiol S, Thompson MJ, Roberts NW, Perera R, Heneghan CJ, Harnden A. Symptomatic treatment of the cough in whooping cough. Cochrane Database Syst Rev . 2010 Jan 20. CD003257. [QxMD MEDLINE Link] .

Nitsch-Osuch A, Kuchar E, Modrzejewska G, Pirogowicz I, Zycinska K, Wardyn K. Epidemiology of Pertussis in an Urban Region of Poland: Time for a Booster for Adolescents and Adults. Adv Exp Med Biol . 2013. 755:203-212. [QxMD MEDLINE Link] .

Centers for Disease Control and Prevention. Pertussis--United States, 2001-2003 MMWR Morb Mortal Wkly Rep. Dec 23, 2005;54(50):1283-6. Available at https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a3.htm . Accessed: Aug 9, 2012.

Mattoo S, Cherry JD. Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies. Clin Microbiol Rev . 2005 Apr. 18(2):326-82. [QxMD MEDLINE Link] . [Full Text] .

Bisgard K. Background. Guidelines for the Control of Pertussis Outbreaks . 2000;1-1-1-11: [Full Text] .

Vitek CR, Pascual FB, Baughman AL, Murphy TV. Increase in deaths from pertussis among young infants in the United States in the 1990s. Pediatr Infect Dis J . 2003 Jul. 22(7):628-34. [QxMD MEDLINE Link] .

Guinto-Ocampo H, Bennett JE, Attia MW. Predicting pertussis in infants. Pediatr Emerg Care . 2008 Jan. 24(1):16-20. [QxMD MEDLINE Link] .

Waknine Y. Infant Pertussis: Early White Blood Cell Counts Crucial. Available at https://www.medscape.com/viewarticle/777732 . Accessed: January 23, 2013.

Murray E, Nieves D, Bradley J, et al. Characteristics of Severe Bordetella pertussis Infection Among Infants Older than 90 Days of Age Admitted to Pediatric Intensive Care Units – Southern California, September 2009–June 2011. J Ped Infect Dis . 2013.

Edwards K, Decker MD. Pertussis vaccine. In: Plotkin SA, Orenstein WA. Vaccines. 4th ed. Philadelphia, PA: Saunders; 2004:471-528.

de Greeff SC, Mooi FR, Westerhof A, Verbakel JM, Peeters MF, Heuvelman CJ, et al. Pertussis disease burden in the household: how to protect young infants. Clin Infect Dis . 2010 May 15. 50(10):1339-45. [QxMD MEDLINE Link] .

[Guideline] American Academy of Pediatric Committee on Infectious Diseases. Prevention of pertussis among adolescents: recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Pediatrics . 2006 Mar. 117(3):965-78. [QxMD MEDLINE Link] .

Centers for Disease Control and Prevention; American Academy of Pediatrics Committee on Infectious Diseases. Additional recommendations for use of tetanus toxoid, reduced-content diphtheria toxoid, and acellular pertussis vaccine (Tdap). Pediatrics . 2011 Oct. 128(4):809-12. [QxMD MEDLINE Link] .

Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged MMWR Morb Mortal Wkly Rep</i>. 2011 Oct 21. 60(41):1424-6. [QxMD MEDLINE Link] .

McNamara LA, Skoff T, Faulkner A, Miller L, Kudish K, Kenyon C, et al. Reduced Severity of Pertussis in Persons With Age-Appropriate Pertussis Vaccination-United States, 2010-2012. Clin Infect Dis . 2017 Sep 1. 65 (5):811-818. [QxMD MEDLINE Link] .

Harding A. Pertussis Vaccine Appears Safe in Pregnancy for Mom, Baby. Medscape Medical News. Available at https://www.medscape.com/viewarticle/834849 . Accessed: November 14, 2014.

Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Klein NP, Cheetham TC, Naleway A, et al. Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes. JAMA . 2014 Nov 12. 312(18):1897-904. [QxMD MEDLINE Link] .

Skoff TH, Blain AE, Watt J, Scherzinger K, McMahon M, Zansky SM, et al. Impact of the US Maternal Tetanus, Diphtheria, and Acellular Pertussis Vaccination Program on Preventing Pertussis in Infants Clin Infect Dis</i>. 2017 Sep 28. [QxMD MEDLINE Link] .

Kent A, Ladhani SN, Andrews NJ, et al. Pertussis Antibody Concentrations in Infants Born Prematurely to Mothers Vaccinated in Pregnancy. Pediatrics . Online: June 2016:

Pregnant Women and Tdap Vaccination, Internet Panel Survey, United States, April 2016. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/tdap-report-2016.html . September 19, 2016; Accessed: October 20, 2017.

Recommended childhood and adolescent immunization schedule--United States, 2014. Pediatrics . 2014 Feb. 133(2):357-63. [QxMD MEDLINE Link] .

American Academy of Pediatrics. Pickering LK, ed. Red Book: 2012 Report of the Committee on Infectious Diseases . 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.

Zhang L, Prietsch SO, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. Cochrane Database Syst Rev . 2011 Jan 19. CD001478. [QxMD MEDLINE Link] .

Glanz JM, McClure DL, Magid DJ, Daley MF, France EK, Salmon DA, et al. Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children. Pediatrics . 2009 Jun. 123(6):1446-51. [QxMD MEDLINE Link] .

Centers for Disease Control and Prevention. Immunization Schedules. Available at https://www.cdc.gov/vaccines/schedules/index.html . Accessed: Aug 9, 2012.

Brown T. Pertussis vaccines: whole-cell more durable than acellular. Medscape Medical News . May 22, 2013. [Full Text] .

Klein NP, Bartlett J, Fireman B, Rowhani-Rahbar A, Baxter R. Comparative Effectiveness of Acellular Versus Whole-Cell Pertussis Vaccines in Teenagers. Pediatrics . 2013 May 20. [QxMD MEDLINE Link] .

New S, Winter K, Boyte R, Harriman K, Gutman A, Christiansen A, et al. Barriers to Receipt of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine Among Mothers of Infants Aged MMWR Morb Mortal Wkly Rep</i>. 2018 Sep 28. 67 (38):1068-1071. [QxMD MEDLINE Link] .

Pitisuttithum P, Chokephaibulkit K, Sirivichayakul C, et al. Antibody persistence after vaccination of adolescents with monovalent and combined acellular pertussis vaccines containing genetically inactivated pertussis toxin: a phase 2/3 randomised, controlled, non-inferiority trial. Lancet Infect Dis . 2018 Sep 25. [QxMD MEDLINE Link] .

Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women--Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep . 2013 Feb 22. 62 (7):131-5. [QxMD MEDLINE Link] . [Full Text] .

• A photomicrograph of the bacterium Bordetella pertussis, using Gram stain technique.

Contributor Information and Disclosures

Joseph J Bocka, MD Attending Emergency Physician, OhioHealth MedCentral Health System; Emergency Medical Service Medical Director, Multiple EMS Service; Ohio EMS RPAB Region Chair Joseph J Bocka, MD is a member of the following medical societies: American Academy of Emergency Medicine , Phi Beta Kappa , American College of Emergency Physicians , American Medical Association , National Association of EMS Physicians Disclosure: Nothing to disclose.

Bryon K McNeil, MD Medical Director, Bioterrorism and Emergency Preparedness, Clinical Assistant Professor, Departments of Internal Medicine and Emergency Medicine, Via Christ Regional Medical Center Bryon K McNeil, MD is a member of the following medical societies: American Academy of Emergency Medicine , Pennsylvania Medical Society Disclosure: Nothing to disclose.

Stephen C Aronoff, MD Waldo E Nelson Chair and Professor, Department of Pediatrics, Temple University School of Medicine Stephen C Aronoff, MD is a member of the following medical societies: Pediatric Infectious Diseases Society , Society for Pediatric Research Disclosure: Nothing to disclose.

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics , American Association of Immunologists , American Pediatric Society , American Society for Microbiology , Infectious Diseases Society of America , Louisiana State Medical Society , Pediatric Infectious Diseases Society , Society for Pediatric Research , Southern Medical Association Disclosure: Nothing to disclose.

Hazel Guinto-Ocampo, MD Consulting Staff, Assistant Professor of Pediatrics, Department of Pediatrics, Division of Emergency Medicine, Nemours Children's Clinic, AI duPont Hospital for Children

Hazel Guinto-Ocampo, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Mark R Schleiss, MD American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society , Infectious Diseases Society of America , Pediatric Infectious Diseases Society , and Society for Pediatric Research

Garry Wilkes MBBS, FACEM, Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

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Pertussis, also known as whooping cough, is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. In 2018, there were more than 151 000 cases of pertussis globally.

Pertussis spreads easily from person to person mainly through droplets produced by coughing or sneezing. The disease is most dangerous in infants, and is a significant cause of disease and death in this age group.

The first symptoms generally appear 7 to 10 days after infection. They include a mild fever, runny nose and cough, which in typical cases gradually develops into a hacking cough followed by whooping (hence the common name of whooping cough). Pneumonia is a relatively common complication, and seizures and brain disease occur rarely.

The best way to prevent pertussis is through immunization. The three-dose primary series diphtheria-tetanus-pertussis (DTP3) (- containing) vaccines decrease the risk of severe pertussis in infancy. In 2018, 86% of the global target population had received the recommended three doses of DTP-containing vaccine during infancy.

WHO recommends the first dose be administered as early as 6 weeks of age; with subsequent doses given 4-8 weeks apart, at age 10-14 weeks and 14-18 weeks. A booster dose is recommended, preferably during the second year of life. Based on local epidemiology, further booster doses may be warranted later in life.

Vaccination of pregnant women is effective in preventing disease in infants too young to be vaccinated. National programmes may consider vaccination of pregnant women with pertussis-containing vaccine as a strategy additional to routine primary infant pertussis vaccination in countries or settings with high or increasing infant morbidity/mortality from pertussis.

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At a glance

Pertussis from the Infection Control in Healthcare Personnel: Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients (2024) guideline.

Recommendations

• For asymptomatic healthcare personnel, regardless of vaccination status, who have an exposure to pertussis and are likely to interact with persons at increased risk for severe pertussis:
• Administer postexposure prophylaxis.
• If not receiving postexposure prophylaxis, restrict from contact (e.g., furlough, duty restriction, or reassignment) with patients and other persons at increased risk for severe pertussis for 21 days after the last exposure.
• For asymptomatic healthcare personnel, regardless of vaccination status, who have an exposure to pertussis and are not likely to interact with persons at increased risk for severe pertussis:
• Administer postexposure prophylaxis, OR
• Implement daily monitoring for 21 days after the last exposure for development of signs and symptoms of pertussis.
• For asymptomatic healthcare personnel, regardless of vaccination status, who have an exposure to pertussis and who have preexisting health conditions that may be exacerbated by a pertussis infection:
• Exclude symptomatic healthcare personnel with known or suspected pertussis from work for 21 days from the onset of cough, or until 5 days after the start of effective antimicrobial therapy.
• Work restrictions are not necessary for asymptomatic healthcare personnel who have an exposure to pertussis and receive postexposure prophylaxis, regardless of their risk for interaction with persons at increased risk for severe pertussis.

Healthcare-associated transmission of Bordetella pertussis ( B. pertussis ) has involved both patients and healthcare personnel (HCP); nonimmunized infants and children are at greatest risk for severe morbidity and mortality 1 2 3 4 5 6 7 8 9 10 11 12 . Serologic studies of HCP suggest that they may be infected with pertussis much more frequently than indicated by attack rates of clinical disease 13 14 .

Prevention of transmission of B. pertussis in healthcare settings involves:

• vaccinating HCP against pertussis in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations 13,15 ;
• in addition to using Standard Precautions, placing patients with known or suspected pertussis in Droplet Precautions 16 ;
• rapidly diagnosing and treating patients with clinical infection;
• appropriately administering postexposure prophylaxis (PEP) to persons exposed to pertussis; and
• excluding potentially infectious HCP from work. 5,13

Guidelines for pertussis vaccination of HCP are maintained by ACIP in Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the ACIP (https://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm). 13 17 18 In addition, information and recommendations addressing the potential need for revaccination of HCP with Tdap are available from the CDC webpage Evaluating Revaccination of Healthcare Personnel with Tdap: Factors to Consider (https://www.cdc.gov/vaccines/vpd/pertussis/tdap-revac-hcp.html). 17

Occupational Exposures

During pertussis outbreaks in healthcare settings, the risk for HCP contracting pertussis is often difficult to quantify because exposure is not well-defined 13 . Transmission of B. pertussis occurs through deposition of respiratory, oral, or nasal secretions from an infected source person on the mucous membranes of a susceptible host. Unprotected (e.g., not wearing a facemask), close, face-to-face contact with an infectious source person or contact with their secretions may be considered an exposure to pertussis. Close contact may include, but is not limited to, performing a physical examination on, feeding, or bathing a patient; bronchoscopy; intubation; or administration of bronchodilators. Determination of close contact may be more inclusive in settings where interaction with persons at increased risk for severe pertussis is more likely.

Clinical Features

Pertussis is highly contagious; secondary attack rates exceed 80% in susceptible household contacts 19 20 . The incubation period is usually 5 to 10 days, but symptoms may develop up to 3 weeks after exposure 21 . The clinical course of pertussis infection has 3 stages: catarrhal, paroxysmal, and convalescent.

• Stage One, the catarrhal stage (the first 1-2 weeks of infection), is characterized by symptoms such as runny nose, low-grade fever, and mild coughing. Infected persons are highly contagious in this stage, when symptoms are similar to other upper respiratory infections.
• Stage Two, the paroxysmal stage (the next 1-6 weeks; may last up to 10 weeks), is characterized by fits of rapid coughing. Rapid coughing can be followed by the typical "whoop" sound. Vomiting may occur after coughing fits (i.e., post-tussive vomiting).
• Stage Three, the convalescent stage (lasting approximately 2-3 weeks), is characterized by gradual recovery, with improving cough and fewer fits of coughing.

Populations at increased risk for serious complications and death from severe pertussis include:

• Infants aged under 12 months
• Women in their third trimester of pregnancy
• Persons with pre-existing health conditions that may be exacerbated by a pertussis infection (e.g., immunocompromised persons, persons with moderate to severe asthma) 22 .

Symptomatic persons who receive effective antimicrobial therapy for pertussis are no longer contagious after 5 days of appropriate treatment 13 23 .

The period of communicability starts at the onset of the catarrhal stage and extends into the paroxysmal stage, up to 3 weeks after the onset of paroxysms 21 . Prevention of secondary transmission of pertussis is especially difficult during the early stages of the disease because pertussis is highly communicable in the catarrhal stage, when symptoms are nonspecific and the diagnosis is uncertain. Furthermore, clinical symptoms in adults and adolescents may be less severe than in children and young infants and may not be recognized as pertussis 21 .

Testing and Diagnosis

Diagnosis of pertussis is typically made based upon compatible clinical history and diagnostic laboratory testing. Although culture is considered the "gold standard" for establishing a diagnosis of pertussis, polymerase chain reaction (PCR) provides sensitive results more rapidly 24 25 . More detailed information regarding testing persons for pertussis is available on the CDC Pertussis (Whooping Cough) Diagnostic Testing website (https://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection-diagnosis.html). 26

Other Bordetella species (e.g., B. parapertussis , B. holmesii ) may be detected and can occur alone or simultaneously with B. pertussis infection 27 28 29 30 31 . Although the clinical presentation for B. parapertussis is similar to that of B. pertussis , B. parapertussis usually causes less severe disease, which may be related to its lack of production of pertussis toxin 27 28 32 33 . One report from 1971 estimated that 3-4% of patients with parapertussis develop clinical disease, compared to 75% with pertussis 33 . The severity of parapertussis illness among special populations, such as infants and immunocompromised persons, is unclear, with few hospitalizations and related deaths reported 34 35 36 37 38 39 . Data on the effectiveness of antibiotics for the treatment or chemoprophylaxis of B. parapertussis are also limited. Some states have parapertussis postexposure and illness management guidance, and some institutions choose to apply pertussis strategies for parapertussis 25 40 .

Postexposure Prophylaxis

Vaccinated HCP may still be susceptible to pertussis due to waning immunity, lack of response to the vaccine, immunosuppression, or other factors. Because vaccinated HCP may still be at risk for pertussis infection, vaccination does not preclude the need for PEP, when indicated 13 17 18 . Data on the efficacy of, and need for, PEP in Tetanus, Diphtheria, Pertussis (Tdap)-vaccinated HCP are inconclusive, but studies suggest that it may minimize transmission 5 13 41 42 43 . The preferred agents for postexposure prophylaxis are azithromycin, erythromycin, and clarithromycin 44 . Trimethoprim-sulfamethoxazole (TMP-SMZ) may also be used as an alternative agent. Detailed information regarding dosage and administration of PEP is available in the Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, 2005 CDC Guidelines (https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm). 44

Information and recommendations on the potential need for booster doses of vaccine during outbreaks or periods of increased risk for healthcare-associated transmission of pertussis can be found on the CDC Pertussis (Whooping Cough) website (https://www.cdc.gov/pertussis/outbreaks.html). 45

Abbreviations

• ACIP = Advisory Committee on Immunization Practices
• B. pertussis = Bordetella pertussis
• CDC = Centers for Disease Control and Prevention
• HCP = Healthcare Personnel
• PCR = Polymerase Chain Reaction
• PEP = Postexposure Prophylaxis
• PPE = Personal Protective Equipment
• Tdap = Tetanus, Diphtheria, Pertussis
• TMP-SMZ = Trimethoprim-sulfamethoxazole
• Bassinet L, Matrat M, Njamkepo E, Aberrane S, Housset B, Guiso N. Nosocomial pertussis outbreak among adult patients and healthcare workers. Infect Control Hospital Epidemiol. 2004;25(11):995-997.
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• Shefer A, Dales L, Nelson M, Werner B, Baron R, Jackson R. Use and safety of acellular pertussis vaccine among adult hospital staff during an outbreak of pertussis. J Infect Dis. 1995;171(4):1053-1056.
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