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.

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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 7 days.

TEST for pertussis:

Collect a specimen using a nasopharyngeal (NP) swab applicator with a flexible wire

  • Insert the swab gently into the nare and proceed gently to the posterior wall of the pharynx.
    • Don't direct the swab upward; allow the swab to move along the floor of the nasal cavity.
    • Don't force the swab past obstruction.
    • Turn the swab a quarter of a turn and hold in place until a paroxysmal cough is elicited, or ask patient to cough. (This ensures an adequate specimen and reduces the possibility of false negative results.)
  • 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)		 Collect specimens as early as possible. 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)		 Collect specimens as early as possible. 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.

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 5th day of an appropriate antibiotic

OR

  • Had cough symptoms for at least 3 weeks. (Cases are potentially infectious for the first 3 weeks of cough.)

Updated Tuesday, 25-Sep-2012 12:15:05 CDT