Managing Pertussis: Think, Test, Treat & Stop Transmission

Pertussis activity remains high in Kitsap County and Washington state, especially among school-aged children.

ACTIONS REQUESTED:

A cough of any duration 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.

Based on the guidance in the table, 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.

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. Consider clinical presentation.
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. Consider clinical presentation.

Healthcare providers and laboratories report cases to Kitsap Public Health District within 24 hours.
Use Azithromycin, Erythromycin, 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 household contacts or high-risk contacts of the pertussis case.
- High-risk contacts include infants less than 1 year of age, pregnant persons, other immunocompromised people, and those who have contact with high-risk people.
- Asymptomatic contacts receiving prophylaxis should not be excluded from their usual activities.
- Symptomatic contacts should be evaluated for pertussis.
Please see the table below from the Washington State Department of Health for recommended antimicrobial treatment and post-exposure prophylaxis for pertussis, by age group.
Call the Kitsap Public Health District at 360-728-2235 if you have questions.

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 3 weeks. (Cases are potentially infectious for the first 3 weeks of cough.)

Call: 360-728-2235 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient’s name, date of birth and disease.