Pertussis

Maintain High Index of Suspicion 1. Classic findings include inspiratory whoop and staccato cough. 2. Infants often do not have the “whoop.” This video from the Mayo Clinic is a great example of a classic infant presentation. 3. Pertussis is predominantly a clinical diagnosis: if you are very suspicious (especially in babies), treat empirically while awaiting test results. 4. Highest index of suspicion for pertussis in patients from cluster villages.

Protect Yourself 1. Consider using droplet precautions for all respiratory patients. 2. Check your Tdap status on Immuware. Reach out to Employee Health if you are behind.

Prevention 1. Update DTaP and Tdap for anyone eligible. Here are the CDC vaccine schedules, including catch-up. 2. 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) (This is subject to change. Here is the strategy we are starting with. Stay tuned as things evolve.) 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