Pertussis
From Guide to YKHC Medical Practices
Maintain High Index of Suspicion
- Classic findings include inspiratory whoop and staccato cough.
- Infants often do not have the “whoop.” This video from the Mayo Clinic is a great example of a classic infant presentation.
- Pertussis is predominantly a clinical diagnosis: if you are very suspicious (especially in babies), treat empirically while awaiting test results.
- Highest index of suspicion for pertussis in patients from cluster villages.
Protect Yourself
- Consider using droplet precautions for all respiratory patients.
- Check your Tdap status on Immuware. Reach out to Employee Health if you are behind.
Prevention
- Update DTaP and Tdap for anyone eligible. Here are the CDC vaccine schedules, including catch-up.
- Remember that pregnant patients are due for Tdap after 28 weeks. This gives protection to the baby.
Testing
(as of 9/24/2024, but should change in 2025 when we have validated respiratory PCR)
There are two tests orderable in RAVEN:
- ANMC Respiratory Panel: Expensive but faster. Use only for infants <6 months.
- B pertussis and B parapertussis LC: Goes to LabCorps, much cheaper, but takes longer to result (2-7 days). Use for patients >6 months.
Who to test:
- Babies <6 months with suspicious symptoms: Test with ANMC respiratory panel.
- Older patients with suspicious symptoms: Test with LapCorps test.
- Any patient with a possible exposure AND any symptoms: Test with LabCorps test. Do not test completely asymptomatic people.
- Any household contact of a known case may be treated without a test.
- Exposed healthcare providers may be treated without a test.
Treatment
(per the CDC)
- Patients <12 months within 6 weeks of cough onset. If high level of suspicion for patients at high risk, treat empirically while awaiting test result.
- Patients >12 months within 3 weeks of cough onset. If high level of suspicion for patients at high risk, treat empirically while awaiting test result.
- Pregnant patients (especially if near term) within 6 weeks of cough onset.
- Any household contact of a known case may be treated without a test.
- Exposed healthcare providers may be treated without a test.
Hospitalization
- Infants <4 months:
- Check CBC with diff.
- Low threshold to hospitalize these infants until they have begun to show some improvement.
- Risk factors for significant morbidity (including “rapid, unpredictable deterioration”): apnea, cyanosis, and WBC >30K. If any of these are present, consider transfer to a facility with a PICU. (Note: We are using prolonged cyanosis as a criterium rather than brief, self-limited perioral cyanosis with coughing.)
- Older patients: Consider hospitalization and/or empiric treatment for patients with history of prematurity, chronic lung disease, neuromuscular disorders, etc. Feel free to consult Peds Wards on Duty with any questions.
Here is a CDC page on post-exposure PPX for more information