County of Marin Health and Human Services

Pertussis Update

coughing infantThe California Department of Public Health (CDPH) reported approximately 10,000 cases of pertussis throughout California in 2014--the highest number in recent memory. CDPH has stated that pertussis has become endemic in California and high numbers of pertussis cases are expected to persist.

Marin County Public Health recommends:

  1. Vaccinate all susceptible individuals against pertussis according to the ACIP schedule and implement cocooning strategy around infants. The pertussis vaccine can prevent the disease or attenuate the severity of the disease.
  2. Think pertussis. Enquire if other household members are or have been recently sick with a respiratory illness, particularly characterized by paroxysmal coughing and post-tussive emesis.
  3. Test for pertussis. People who have been vaccinated for pertussis often present with mild symptoms. Have a high index of suspicion and a low threshold for testing and evaluating individuals for pertussis.
  4. Treat pertussis cases with a course of appropriate antimicrobial therapy.

Chemoprophylaxis is recommended for high risk close contacts of pertussis cases.

  • Infants
  • Pregnant women in their third trimester
  • Household contacts, particularly if there is an infant or a third trimester pregnant woman in the household.
  • Close contacts of high risk individuals (infants and pregnant women)
  • Individuals who visit a sensitive setting or work in sensitive occupations, e.g., day care or health care

Isolate known or suspected pertussis cases and symptomatic close contacts until three full days of antibiotics have been completed and until the cough is manageable; or until the lab test result is received and is negative for pertussis.

Pertussis is especially severe in infants and very young children and can present as an acute cough illness of any duration. Typically, it starts with cold-like symptoms (coryza, sneezing, occasional cough). Fever is absent or minimal. This stage lasts 1-2 weeks with the cough gradually becoming more severe. Spasms of severe coughing are followed by a sudden deep inspiration, often resulting in a characteristic "whooping" sound especially in infants and very young children. Post-tussive vomiting is common in all ages. Illness may be milder in previously vaccinated people. Classic pertussis is 6-10 weeks in duration, but cough may last longer in some people.

Pertussis is highly contagious. Transmission typically occurs when a susceptible person inhales aerosolized droplets from the respiratory tract of an infected person.

Period of communicability: Persons one year of age and older are considered infectious from the onset of cold-like symptoms until completion of three days of treatment or until 21 days after cough onset if no or partial treatment is given. Infants < 1 year are considered infectious for six weeks without treatment.

While questions regarding acellular vaccine efficacy are being addressed, vaccination remains the only avenue to reducing bacterial burden in the community and still offers individual protection and moderation of disease severity.

The Public Health investigation will consist of attempting to contact the case to ascertain if there are high risk individuals inside or outside of the household who need chemoprophylaxis. High risk household contacts will be referred to their usual source of care for chemoprophylaxis.

For more information about pertussis: http://www.cdph.ca.gov/programs/immunize/Documents/PertussisLaboratoryTe...

http://www.cdph.ca.gov/healthinfo/discond/documents/cdph_pertussis_quick...

To report pertussis cases, please call:

Marin County Communicable Disease Prevention and Control at phone: 415-473-7805 or 415-473-4163, or fax: 415-473-6002 Monday through Friday 8:30 a.m. through 5:00 p.m. On weekends, holidays, and after 5:00 p.m. Monday through Friday, call 415-499-9464 and ask to speak with the Health Officer on call.

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