Managing Pertussis: Think, Test, Treat & Stop Transmission

Fact sheet for health professionals on when to think of pertussis, how to test for pertussis, how to treat and report suspected and confirmed cases, and stop transmission.

Download PDF version formatted for print:
Managing Pertussis: Think, Test, Treat & Stop Transmission (PDF: 53KB/1 page)

On this page:
Think of pertussis
Test for pertussis
Interpreting Test Results
Treat and report suspected and confirmed cases
Stop Transmission

THINK of pertussis in anyone with the following symptoms, regardless of vaccination history:

  • A cough in a person who has been notified of a close exposure to pertussis,
  • A paroxysmal cough of any duration, with whooping, post-tussive vomiting/gagging or apnea, or
  • A persistent cough of unknown etiology, lasting more than seven days.

TEST for pertussis:

Collect a specimen using a nasopharyngeal (NP) swab, wash or aspirate for PCR or culture. Collect serum for IgG.

  • Do not test if symptoms are not present. It is unlikely that B. pertussis can be recovered through testing if the patient is not experiencing symptoms.
Interpreting Test Results
Test Timing of specimen collection Test result interpretation
PCR
(results within 24-96 hours)
Best if collected within first 2-3 weeks of cough. PCR will detect non-viable organisms present, even in persons who have been treated with antimicrobials; however, false negatives can occur and are more common later in the illness.

(+) Positive: Confirms B. pertussis if clinical and/or exposure history support the diagnosis of pertussis.

(-) Negative: Does not rule out B. pertussis infection.

Culture
(results can take up to 10 days)
Best if collected within first 2-3 weeks of cough. Recovering the organism is unlikely beyond 3 weeks of cough or in patients who have received antimicrobials. False negatives are common even early in the illness.

(+) Positive: Confirms B. pertussis infection.

(-) Negative: Does not rule out B. pertussis infection.

IgG Serology (results can take up to a week) In general, specimens are best collected at 2-3 weeks or later after onset of cough. Collected earlier in cough illness can lead to false negatives.

(+)┬áPositive: Likely pertussis, although should be interpreted in combination with recent pertussis vaccine history (can give a false positive) and in combination with each lab’s specific panel.

(-) Negative: Likely negative for pertussis.

TREAT and report suspected and confirmed cases.

  • Use Erythromycin, Azithromycin, Clarithromycin, or Trimethoprim-Sulfamethoxazole for treatment.
    If 21 days have already elapsed since cough onset, treatment is not recommended, as it will not improve outcome.
  • Prescribe antimicrobial prophylaxis (same regimen as treatment) to persons who are close contacts of pertussis cases.
    • Special emphasis for prophylaxis should be placed on:
      • household members,
      • infants less than 12 months of age,
      • pregnant women (especially in third trimester),
      • persons with a pre-existing condition that may be exacerbated by a pertussis infection,
      • persons in contact with those at high risk of severe pertussis.
  • Antimicrobial prophylaxis is recommended if exposure to an infectious case occurred within the previous 21 days (the maximum incubation period for pertussis).
  • Asymptomatic contacts receiving prophylaxis should not be excluded from their usual activities.
  • Symptomatic contacts should be evaluated for pertussis.
  • Refer to Pertussis Treatment and Prophylaxis for recommendations on pertussis treatment and on prophylaxis of case contacts.
  • Call your local health department if you have questions.

STOP TRANSMISSION

  • Inform patients with suspected pertussis to stay at home and avoid close contact with others until they have:
    • Completed the fifth day of an appropriate antibiotic

OR

  • Had cough symptoms for at least three weeks. (Cases are potentially infectious for the first three weeks of cough.)

Updated Friday, November 22, 2013 at 10:55AM