Whooping Cough / Pertussis

Information taken from Guidelines for the Public Health Management of Pertussis in England

Pertussis (whooping cough) is an acute bacterial infection caused by Bordetella pertussis, and can affect people of all ages. While adolescents and adults tend to have a prolonged cough illness but without other major symptoms, young unimmunised infants are the most vulnerable group with the highest rates of complications and death. Transmission of the organism occurs as a result of close direct contact with an infected person. It is highly contagious, with up to 90% of household contacts developing the disease. The incubation period of pertussis is on average between 7-10 days (range 5-21 days).

The usual clinical presentation is an initial catarrhal stage with a cough that becomes paroxysmal. Paroxysms of cough usually increase in frequency and severity as the illness progresses and persist for 2-6 weeks. These paroxysms may end in vomiting, cyanosis and/or a characteristic inspiratory whoop. Patients with pertussis are most infectious in the initial catarrhal stage and during the first 3 weeks after the onset of cough. Symptoms slowly improve in the convalescent phase, which generally lasts 2-6 weeks but can persist for months. Adults generally have a non-productive cough illness without fever. Serious complications include pneumonia, seizures and encephalitis.

Symptoms of Whooping Cough

You should suspect pertussis infection and report it to the Health Protection Team if someone presents with an acute cough lasting for 14 days or more without an apparent cause plus one or more of the following:

• paroxysms of coughing
• post-tussive vomiting
• inspiratory whoop
• undiagnosed apnoeic attacks in young infants

Or

• someone with signs and symptoms consistent with pertussis who has been in contact with a confirmed case in the previous 21 days

Or

• someone who is known to be part of any ongoing outbreak investigation in a specific group of people. For example, children attending the same school or nursery where pertussis is known to be been circulating

 

Assessment of people with symptoms of Pertussis at SevernSide

Many people with suspected whooping cough will have a mild illness and do not necessarily require a face to face assessment.  Please assess each patient on a case by case basis and discuss with the Clinical Coordinator if needed.

 

Seeing patients with suspected Pertussis at a Treatment Centre

If a patient with suspected pertussis requires assessment at a treatment centre, please ensure the infection prevention control measures are followed as specified in the infectious disease PPE and cleaning policy. This contains details on what PPE is required for suspected whooping cough cases, alongside the cleaning process required post patient review.

Pertussis is a Notifiable Disease

Pertussis remains a notifiable disease.  Suspected cases should be notified to the local health protection team (HPT). This should be done by telephone as soon as is practicable and in writing within 3 days.  Contact details and further information can be found on the toolkit.  Please take advise from the HPT with regards to testing.

 

Groups at Increased Risk of Severe or Complicated Pertussis

• Young, unimmunised infants (particularly those prematurely born, under three months of age, or born to unimmunised mothers) (36) are at greatest risk of severe complications, hospitalisation and death following pertussis infection. Partially immunised infants are not fully protected, although disease severity may be reduced. Further detail about the definition of vulnerable infants can be found in the Public Health England Pertussis guidance.
• Serious complications such as pneumonia, syncope and rib fracture can occur in older individuals but here is little evidence to suggest that any specific clinical groups are at increased risk of pertussis or its complications (38–40)
• Pregnant women are not considered at increased risk of severe disease compared with non-pregnant women
• Current evidence suggests that immunocompromised individuals are not at higher risk of complications from pertussis (42)

 

Treatment of Suspected Cases

Antibiotic therapy is effective in eliminating pertussis, however it does not alter the subsequent clinical course of the illness.  Please take advice from the health protection team on the most appropriate antibiotic choice.  A table with antibiotic option based on age can also be found on page 25 (Appendix 5) of the Public Health England Pertussis Guidance.

Ideally antibiotics should be administered as soon as possible after onset of illness in order to eradicate the organism and limit ongoing transmission. The effect of treatment on reducing symptoms, however, is limited or lacking especially when given late during the disease.  Antibiotics are not recommended or thought to be beneficial after three weeks of symptoms.

 

Contact Management

Please seek advice from Health Protection team re contact management.  Further information can also be found in the Public Health England Pertussis Guidance.

The use of chemoprophylaxis in the UK has been limited to households with vulnerable contacts where the risk of severe complications and/or ongoing transmission is high.  Please discuss this with the Health Protection Team.

 

Exclusion

• Children with suspected, epidemiologically linked or confirmed pertussis should be excluded from schools or nurseries for 48 hours following commencement of recommended antibiotic therapy or for 21 days from onset of symptoms (in those who are not treated with appropriate antibiotics) (125).
• Cases (suspected, epidemiologically linked or confirmed) amongst staff working in nursery and school setting should also be excluded for 48 hours following commencement of recommended antibiotic therapy (or for 21 days from onset of symptoms if not treated) if they report active uncontrollable coughing.
• For other cases, consideration should be given to reallocate their work for 48 hours from commencement of appropriate antibiotic therapy to reduce the risk of ongoing transmission if they report active coughing where potential exposure cannot be minimised by adherence to good respiratory hygiene.
• If the case is a healthcare worker, or patient in a healthcare setting, see PHE Guidelines for management of pertussis incidents in healthcare settings (69) for further details. For cases working in other settings, contact with ‘vulnerable’ individuals (as defined in section 1.6) should be avoided for 48 hours from commencing appropriate/recommended antibiotic therapy or for 21 days from onset of symptoms (in those who are not treated).

Links

National Infection Prevention and Control Manual for England