Clinical Notes : Respiratory
5. Pertussis / whooping cough

Incidence
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Increasing rates in spite of vaccination
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Immunity wanes over time and increasing numbers of adolescents and adults are being affected
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1:5 school age children with a persistent cough for 2 weeks have evidence of pertussis infection
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Un-vaccinated infants are the most vulnerable with the highest complications and mortality in this group
Presentation
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Incubation period usually 7-10 days (range 5-21),
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Highly contagious especially in catarrhal and first 3 weeks of cough
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Initial catarrhal stage (7-10 days) followed by a cough +/- paroxysms (lasting for 2-6 weeks and in some cases months)
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4 out 6 children coughed >400 times in 24 hours
Whooping Cough

Diagnosis
Clinical diagnosis can be made on the basis of symptoms
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Acute cough for ≥14 days without apparent cause plus >1
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Paroxysms of coughing
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Post-tussive vomiting
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Inspiratory whoop
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Check immunisation status
Infectivity
From 1 week after exposure, to 3 weeks after onset of symptoms
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For 7 days if antibiotics given
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stay away from school 7 days if abiotics given
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
Management
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Exclusion from school/place of work for 5 after starting antibiotics
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Antibiotics
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Start as soon as possible after onset of illness
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The main benefit is to eradicate the bacteria and prevent transmission
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If symptoms have lasted for >3 weeks, there is little benefit in giving antibiotics
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Use clarithromycin for 7 days, or azithromycin for 3 days
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2nd choice, use erythromycin for 7 days. Also 1st choice in pregnancy.
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macrolide allerguy : use trimethoprim/sulphamethoxazole for 7 days (not in pregnacy)
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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
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)
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