Clinical Notes : Respiratory

5. Pertussis / whooping cough

Incidence

Presentation

Diagnosis

Notifiable Disease

Management

- References -

- CPD Quiz -

Incidence

• Increasing rates in spite of vaccination

• Immunity wanes over time and increasing numbers of adolescents and adults are being affected

• 1:5 school age children with a persistent cough for 2 weeks have evidence of pertussis infection

• Un-vaccinated infants are the most vulnerable with the highest complications and mortality in this group

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Presentation

• Incubation period usually 7-10 days (range 5-21),

• Highly contagious especially in catarrhal and first 3 weeks of cough

• Initial catarrhal stage (7-10 days) followed by a cough +/- paroxysms (lasting for 2-6 weeks and in some cases months)

• 4 out 6 children coughed >400 times in 24 hours

Diagnosis

Clinical diagnosis can be made on the basis of symptoms

• Acute cough for ≥14 days without apparent cause plus >1

  • Paroxysms of coughing

  • Post-tussive vomiting

  • Inspiratory whoop

• Check immunisation status

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Infectivity

From 1 week after exposure, to 3 weeks after onset of symptoms

• For 7 days if antibiotics given

• stay away from school 7 days if abiotics given

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Prophylactic antibiotics

Recommended for all close contacts  over 10 yrs of age who have not received a pertussis vaccination in the past 5 years.

Up to 90% household contacts may become infected

Whooping Cough : Child

Whooping Cough : Adult

Notifiable disease

Testing will be performed by the Public Health body, and notification should be made on clinical features alone

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Management

• Exclusion from school/place of work for 5 after starting antibiotics

• Antibiotics

  • Start as soon as possible after onset of illness

  • The main benefit is to eradicate the bacteria and prevent transmission

  • If symptoms have lasted for >3 weeks, there is little benefit in giving antibiotics

    • Use  clarithromycin for 7 days, or azithromycin for 3 days

    • 2nd choice, use erythromycin for 7 days. Also 1st choice in pregnancy.

    • macrolide allerguy : use trimethoprim/sulphamethoxazole for 7 days (not in pregnacy)

  • Prophylaxis for vulnerable contacts is recommended when the onset of illness was in the preceding 21 days. This should be managed with assistance from the public health team

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Pertussis (Whooping cough)

CDC, National Center for Immunization and Respiratory Diseases (NCIRD)

August 2017

​Access

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Pertussis

BMJ Best Practice

September 2019​

The following are available in Ireland :

Erythromycin (Erythrocin, Primacine suspension, Erythroped)

Clarithromycin (Clarithromycin, Clonocid, Clorom, Klacid, Klaram, Klariger) 

Azithromycin (Azythromycin, Azromaz, Zithromax)

Trimethoprim/Sulphamethoxazole (Septrin)

CPD Quiz and Certificate

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