Guideline for the Diagnosis and Antimicrobial Management of Whooping Cough (Pertussis) in Adults and Children

• Diagnostics
• Treatment
• Chemoprophylaxis
• Further information

It is a legal requirement for all registered medical practitioners to notify this disease when suspected, prior to confirmation by the laboratory.

• Please telephone the Health Protection Unit on 0113 3860300 and speak to the duty health professional.
• The Consultant in Communicable Disease Control at the HPA should be informed again on laboratory confirmation of pertussis.

Pertussis is a vaccine preventable bacterial infection and should be considered in anyone presenting with history of acute cough lasting 14 days or more without an apparent cause, plus one or more of:

• paroxysms of coughing
• post-tussive vomiting
• inspiratory whoop.
• apnoeas (in infancy)
• known pertussis contacts

In 2017 there were 516 lab confirmed cases in Yorkshire and the Humber. Rates of disease are highest amongst young infants (<3 months), who are too young to be fully immunised and are particularly prone to complications, but rates in adolescents are rising.

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DIAGNOSTICS

For patients with a presumed diagnosis of Pertussis the following diagnostic tests should be taken to confirm diagnosis. PCR and culture are the primary method for confirming infection:

PCR & Culture
Nasopharyngeal swabs, pernasal swabs or nasopharyngneal aspirates are all appropriate specimens for PCR and bacterial culture.
Swab for PCR (the test of choice if only one swab can be tolerated):  Blue, flexible wire shaft swabs without charcoal transport medium.
Swab for culture: Blue, flexible wire shaft swabs in a charcoal transport medium.

Antibody detection
Antibody detection may be helpful in select cases only. Antibodies can be detected in blood or oral fluid after 14 days of symptoms. Practically, these tests are mainly used if PCR/culture is negative but clinical suspicion remains and a laboratory diagnosis is required. The oral fluid testing kit is available via notification of a suspected case to the health protection unit.

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TREATMENT

Medical management of confirmed cases is generally supportive with close monitoring. Younger children are more at risk of complications, particularly those under 3 months, and are likely to require admission. Consider treating prior to receiving test results if the clinical history is compatible with Pertussis or the patient is at risk for severe disease (such as infants).

Antibiotic treatment is recommended if the onset of disease is within the last 21 days.

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CHEMOPROPHYLAXIS

Seek advice from the Consultant in Communicable Disease Control (CCDC) regarding the need for contact chemoprophylaxis. Generally, chemoprophylaxis of contacts is only indicated if the onset of disease in the index case is within the preceding 21 days and if the contact case is either at risk of severe complications or at risk of transmitting it on to other vulnerable individuals.
Doses for chemoprophylaxis are the same as for treatment.

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FURTHER INFORMATION

Source isolation

A hospitalised suspected or confirmed case would need to remain in source isolation until 2 full days of antibiotics have been received. LTHT guideline on infection prevention for cases of pertussis

Exclusion from school / nursery

This should be discussed with the Consultant in Communicable Disease Control (CCDC). Children with suspected, epidemiologically linked or confirmed pertussis should be excluded from schools or nurseries for 48 hours following commencement of recommended antibiotic therapy or for 21 days from onset of symptoms (in those who are not treated with appropriate antibiotics). The CCDC will advise on contacts but generally asymptomatic contacts do not require exclusion.

Advise that all unvaccinated and partially immunised cases up to 10 years of age complete their course of primary pertussis immunisation and booster vaccine once they have recovered from their acute illness. For vaccination in pregnancy, please refer to the full PHE guideline.
Provide parents, guardians and young people with this patient information leaflet.

FOOTNOTES

1 If compliance is a concern, azithromycin can be considered after discussion with microbiology.