PERTUSSIS

Wisconsin Division of Public Health Disease Surveillance Manual

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: A cough lasting > 14 days with one of the following: paroxysms of coughing, inspiratory “whoop”, or posttussive vomiting, without other apparent cause (as reported by a health professional).

B. REPORTING CRITERIA: Clinical diagnosis.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Isolation of Bordetella pertussis from clinical specimen (culture), OR
• Positive polymerase chain reaction (PCR) for B. pertussis.

NOTE 1: Although the PCR is a rapid, sensitive test, a representative sample of cultures should also be collected, especially during an outbreak.
NOTE 2: Because direct fluorescent antibody (DFA) testing of nasopharyngeal secretions has been shown in some studies to have low sensitivity and variable sensitivity, it should not be relied on as a criterion for laboratory confirmation. Serologic testing for pertussis is available in some areas but is not standardized and should not be relied on as a criterion for laboratory confirmation.

D. WISCONSIN CASE CLASSIFICATION:

1. Confirmed

• A case of cough illness of any duration with a positive culture of B. Pertussis.
• A case that meets the clinical case definition and is confirmed by PCR
• A case that meets the clinical definition and is epidemiologically linked directly to a case confirmed by either culture or PCR

2. Probable

• A case that meets the clinical case definition, is not laboratory-confirmed, and is not epidemiologically linked to a laboratory-confirmed case.
• A case of acute cough illness for 14 days or more and has a direct epidemiologic link to a confirmed case (applies to cases in areas of increased incidence)

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY I:
Report IMMEDIATELY BY TELEPHONE to the patient's local health officer upon identification of a case or suspected case. Complete and mail an Acute and Communicable Disease Case Report (DPH 4151) to the local health officer, or enter the case into the Wisconsin Epidemiology Disease Surveillance System (WEDSS), within 24 hours. Notify Regional Immunization Program Representative immediately.

B. EPIDEMIOLOGY REPORTS REQUESTED:

1. Acute and Communicable Diseases Case Report (DPH 4151).
2. Pertussis Case Follow-Up (DPH 4236).

C. PREVENTION MEASURES:

• Routinely administer initial DTaP (diphtheria and tetanus toxoids and acellular pertussis) series at 2, 4 and 6 months of age and booster doses at 15-18 months of age and school entry (4-6 years of age). Pertussis vaccine is not recommended after the seventh birthday.
• Routinely administer a booster dose of Tdap vaccine at 11-12 years of age. Tdap vaccine is administered as a one-time booster dose.

D. PUBLIC HEALTH INTERVENTIONS:

• Recommend appropriate antibiotic treatment for individuals with confirmed and probable pertussis. Treatment can be one of the following macrolide antibiotics:
• 5-day course of azithromycin (preferred for infants < 1 month of age)
• 7-day course of clarithromycin
• 14-day course of erythromycin.

Trimethoprim/sulfamethoxazole is an alternative for persons who cannot tolerate macrolides or for whom macrolides are contraindicated.

• Exclude all individuals with confirmed pertussis from work, school or other public contact until at least five days of antibiotic therapy have been completed or until three weeks after onset of paroxysms if appropriate antimicrobial therapy is not taken.
• Household contacts: Assure an appropriate course of macrolide antibiotic (or trimethoprim/sulfamethoxazole) prophylaxis for all household contacts of individuals with confirmed pertussis regardless of immunization status. Immediate treatment of household contacts should take precedence over testing household members to identify additional cases.
• Other close contacts: Recommend the above preventive regimen for all of the case’s close contacts. Close contacts are persons with repeated indoor face-to-face exposure to the case, including those in day care settings and, in certain situations, work and school settings or other places where a person has had face-to-face exposure within 3 feet of a symptomatic patient. Close contacts can also include:
• Persons who have direct contact with respiratory, oral, or nasal secretions from a symptomatic patient (e.g., cough, sneeze, sharing food and eating utensils, mouth-to-mouth resuscitation or performing a medical examination of the mouth, nose and throat).
• Persons who shared the same confined space in close proximity with a symptomatic patient for > 1 hour.
• High risk contacts. Some contacts are at high risk for acquiring severe disease following exposure to pertussis. These contacts include infants aged <1 year, persons with some immunodeficiency conditions, or other underlying medical conditions such as chronic lung disease, respiratory insufficiency or cystic fibrosis, and pregnant females.
• Inform contacts about clinical symptoms of pertussis. Symptomatic contacts should be medically evaluated and, if determined to have pertussis, excluded from work, school, and other public contact until at least five days of antibiotic therapy have been completed.
• Assure that all children six weeks through six years of age (up to the seventh birthday) who are unimmunized or inadequately immunized receive DTaP vaccine.

III. CONTACTS FOR CONSULTATION

A. BCDP / IMMUNIZATION PROGRAM: (608) 266-3031.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / BACTERIOLOGY: (608) 263-3421.

IV. RELATED REFERENCES

1. “Pertussis (Whooping Cough)”, DPH Disease Fact Sheet Series, (Rev. 12/03)
   http://dhfs.wisconsin.gov/communicable/communicable/factsheets/pertussis.htm
2. Heymann DL, ed. PERTUSSIS. Control of Communicable Diseases Manual. 18 th ed. Washington, DC: American Public Health Association, 2004:399-404.
3. Pickering LK, ed. Pertussis. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003:472-485.
4. Food and Drug Administration Approval of an Acellular Pertussis Vaccine for the Initial Four Doses of the Diphtheria, Tetanus, and Pertussis Vaccination Series. MMWR 1996; 45(31):676-677.
5. Pertusssis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children. MMWR 1997; 46(RR-7):1-25
6. Diphtheria, Tetanus and Pertussis: Recommendations for Vaccine Use and Other Preventive Measures: Recommendations of the Immunization Practices Advisory Committee. MMWR 1991;40 (No. RR-10):1-28.
7. Preventing Tetanus, Diphtheria and Pertussis Among Adolescents: Use of Tetanus, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines. MMWR 2006; 55(RR-3):1-43.
8. Preventing Tetanus, Diphtheria and Pertussis Among Adults: Use of Tetanus, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines. MMWR 2006; 55(RR-17):1-37.
9. Recommended Antimicrobial Agents for Treatment and Postexposure Prophylaxis of   Pertussis: 2005 CDC Guidelines.  MMWR 2005;54(No. RR-14):1-16.

V. DISEASE TRENDS

Year	Cases
1999	116
2000	140
2001	196
2002	187
2003	708
2004	4802
2005	1091
2006	188
2007	322