Pertussis Advisory For Health Care Providers

Pertussis Cases in Idaho Rising and Outbreaks Reported; Early Diagnosis and Treatment Critical to Prevent Spread

March 8, 2024

The number of people reported with pertussis in Idaho during the first two months of 2024 has recently increased, including a newborn reported as hospitalized for the infection. Healthcare providers are encouraged to:

• ensure patients are up to date on pertussis vaccination
• consider pertussis in the differential diagnosis of cough illness at any age and of apnea in infants

Delays in diagnosis of pertussis are common, as symptoms can be nonspecific and not include inspiratory whoop, paroxysmal cough, or post-tussive emesis. Pertussis in adults can be misdiagnosed as allergic bronchitis or asthma.

Antimicrobial therapy during the catarrhal stage may ameliorate the disease. Antimicrobial therapy is indicated before test results are received if the clinical history is strongly suggestive of pertussis, the patient is at high risk of severe or complicated disease, or has or will soon have routine contact with someone at high risk of serious disease (e.g., infants, pregnant people, people with serious underlying medical conditions). See https://www.cdc.gov/pertussis/clinical/treatment.html for recommended antimicrobial treatment.

Nasopharyngeal swab for culture and PCR testing ideally should be collected during the first 2 and 3 weeks following cough onset, respectively, but may yield positive results thereafter. See best practices https://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html. Serologic testing is best performed using an assay that measures IgG antibodies against pertussis toxin only and are calibrated to a reference standard. The optimal timing for serologic testing is 2 to 8 weeks after cough onset but may be valuable up to 12 weeks following cough onset.

Vaccination against pertussis prevents against hospital admission and death, but breakthrough disease can occur. The Centers for Disease Control and Prevention (CDC) routinely recommends DTaP at 2, 4, and 6 months, at 15 through 18 months, and at 4 through 6 years. CDC recommends Tdap as a single dose for people 11 through 18 years of age. Any adult 19 years of age or older who has never received a dose of Tdap should get one as soon as feasible. Pregnant people should get a dose of Tdap during each pregnancy, preferably during gestation weeks 27 through 36. For detailed recommendations, including catch up vaccination, see https://www.cdc.gov/vaccines/vpd/vaccines-age.html. Providers are encouraged to use the Reminder/Recall functionality in Idaho’s Immunization Reminder Information System (IRIS) to identify their patients who may be overdue for a pertussis vaccination and contact them about vaccination. Contact the Immunization Program at IIP@dhw.idaho.gov for assistance.

Pertussis is a reportable disease in Idaho and should be reported within one working day of identification. Public health officials will investigate and coordinate with daycare, school, and healthcare facilities to prevent further spread. For additional information or case reporting, contact the Communicable Disease Control at 208-327-8625. To schedule an appointment at CDH, please contact the Family Clinic Services at 208-327-7400.

Resources:

CDC. Pertussis. Specimen collection and diagnostic testing https://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection-diagnosis.html.

CDC. Vaccines and Preventable Diseases. Diphtheria, tetanus, and pertussis vaccination: Information for healthcare professionals. https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/hcp/index.html.

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