Pertussis, also known as whooping cough, is caused by the bacterium Bordetella pertussis and is considered a highly communicable disease. Pertussis is known for its uncontrollable, violent coughing which often makes it hard to take in a breath.
The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After one to two weeks, severe coughing can begin. But, unlike the common cold, pertussis can become a series of coughing attacks that continues for weeks. When someone with pertussis is able take in a deep breath a “whooping” sound emerges. This may be followed by post-tussive vomiting.
- Weight loss (33%)
- Loss of bladder control (28%)
- Passing out (6%)
- Rib fractures from severe coughing (4%)
Early symptoms can last for one to two weeks and usually include
- Runny nose
- Low-grade fever (generally minimal throughout the course of the disease)
- Mild, occasional cough
Antibiotics serve only to shorten the amount of time someone is contagious. Recovery from pertussis can happen slowly. The cough becomes less severe and less common. However, coughing attacks can return along with other respiratory infections.
Outbreaks of pertussis can be difficult to identify and manage. To respond appropriately (e.g., provide appropriate antibiotic prophylaxis), it is important to confirm that B. pertussis is circulating in the outbreak setting and to determine whether other pathogens are contributing to the outbreak. Polymerase chain reaction (PCR) tests vary in specificity, so obtaining culture confirmation of pertussis for at least one suspicious case is recommended any time there is suspicion of a pertussis outbreak.
Institutional outbreaks of pertussis are common. Outbreaks at middle and high schools can occur as protection from childhood vaccines fades. In school outbreaks, prophylaxis is recommended for close classroom and team contacts–and the pertussis booster vaccine (Tdap), depending on age. Pertussis outbreaks in hospitals and other clinical settings can put infants and other patients at risk.
- From January to October 5, 2010, more than 5,200 cases of pertussis (including nine infant deaths) were reported throughout California. This is the greatest number of cases reported in 60 years (6,613 cases were reported in 1950) and the highest incidence in 51 years (a rate of 16.1 cases/100,000 was reported in 1959). Previously, the peak was in 2005, when 3,182 cases were reported. Visit the California Department of Public Health Web site for the most recent information.
- In Michigan, an increase in pertussis was first observed in the second half of 2008; it continued throughout 2009 and has continued to date throughout 2010. This is on top of a long-term rising trend in the reported number of pertussis cases since about 1990. As of August 15, 610 cases were reported for this year. In 2009 (for the complete year), 902 cases were reported. In 200, 315 were cases reported. Visit the Michigan Department of Community Health Web site for the most recent information
Pertussis vaccines are very effective in protecting you from disease, but no vaccine is 100 percent effective. If pertussis is circulating in the community, there is a chance that a fully vaccinated person, of any age, can contract this disease. If you have been vaccinated, the infection is usually less severe. The Centers for Disease Control and Prevention (CDC) recommend that all healthcare workers under age 65 who have direct patient care get a one-time booster of Tdap (tetanus/diphtheria/pertussis). (www.cdc.gov/vaccines) Your department should offer and pay for this vaccine.
Cortese MM, Bisgard KM. Pertussis. In: Wallace RB, Kohatsu N, Kast JM, ed. Maxcy-Rosenau-Last Public Health & Preventive Medicine, Fifteenth Edition. The McGraw-Hill Companies, Inc.; 2008:111-14.
MMWR June 9, 2010; 59(26):817
Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines (ACIP, 2006). Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for Use of Tdap Among Health-Care Personnel. MMWR Recomm Rep. 2006;55:1-33. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a1.htm Accessed June 28, 2010 /.
KATHERINE H. WEST, BSN, MSEd, CIC, has been working in the field of infection control since 1975 and actively working with Fire/EMS since 1978. She lectures nationally and internationally and has authored books, video tapes, and articles on infection control-related issues. She has served as a consultant to the Centers for Disease Control and Prevention and the National Institute of Occupational Safety & Health; she is an education specialist for the National Institutes of Health and authored theInfectious Disease Handbook for Emergency Care Personnel, now in its third edition. She is also a consultant to the U.S. Public Health Service, Federal Occupational Health, and was voted a “Hero in Infection Control & Prevention” for 2006 for her work in the field of infection control & EMS by the Association for Professionals in Infection Control & Epidemiology (APIC). Visit her Web site at www.ic-ec.com.