Clinical Notes : Respiratory

5. Pertussis / whooping cough

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

 

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

 
 

Whooping Cough

Whooping cough -
00:00 / 00:00
 

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

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

 

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

  • 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

 
 
 

Pertussis (Whooping cough)

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

August 2017

Access

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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