Date Sent: 01/25/2017 08:35 AM EST
Sender: Michigan Health Alert Network
Subject: Pertussis (whooping cough) advisory
January 24, 2017
Reported levels of pertussis activity have increased in Michigan since late fall 2016. The increase has been seen particularly in children age 4 or younger who have not completed their fifth dose of DTaP and who are in childcare settings. Please share the following information with clinicians and other appropriate health care providers.
Medical and public health providers should help to ensure proper diagnosis, treatment, prevention, and control. Clinicians should have heightened awareness to consider pertussis in symptomatic children or childcare providers who may have been exposed to pertussis. Children who are partially vaccinated against pertussis are significantly less likely to present with a whoop or other classic presenting signs, yet can still infect others and should, therefore, be tested and treated. Recommended diagnostic tests are culture or PCR of nasopharyngeal (NP) aspirate or swab (polyester tip). Serology and DFA tests are NOT recommended. Cases should be reported to local public health departments, investigated, and classified according to the national surveillance case definition.
Antimicrobial agents administered during the catarrhal stage may ameliorate the disease. Clinicians should begin antimicrobial therapy prior to test results if the clinical history is strongly suggestive of pertussis, the patient is at high risk of severe or complicated disease, (e.g., an infant), or the patient has been a close contact to a confirmed case of pertussis. Children and child care providers who are symptomatic or who have confirmed pertussis should be excluded from childcare pending physician evaluation, testing and completion of the recommended course of antimicrobial therapy. A 5-day course of azithromycin is the appropriate first-line choice for treatment and for post-exposure prophylaxis (PEP); other choices include 7 days clarithromycin or 14 days erythromycin; an alternative is 14 days of TMP-SMZ. Antimicrobial agents used for infants younger than 6 months require special consideration and monitoring. (See AAP Red Book p 610-611).
Close contacts who are unimmunized or under-immunized should have pertussis immunization initiated or continue vaccination according to the recommended pertussis vaccine schedule as soon as possible; this includes off-label use of Tdap in children 7 through 10 years of age who did not complete the DTaP series. Additionally, PEP is recommended for all household contacts of a case, and other close contacts such as other children in childcare, regardless of immunization status. Close contacts include face-to-face exposure within 3 feet of a symptomatic person; direct contact with respiratory, nasal, or oral secretions; or sharing the same confined space in close proximity to an infected person for one hour or more. Contacts should receive antibiotic prophylaxis within 3 weeks of exposure using the same antibiotic options and dosing as for case treatment. The primary objective of PEP should be to prevent death and serious complications from pertussis in individuals at increased risk of severe disease.
Infants are at highest risk of severe disease and death; older siblings and adults often are the source. Infants and children should receive pertussis vaccine series (DTaP) as per the U.S. recommended childhood immunization schedule. All doses should be given as close to the recommended ages as possible. A pertussis vaccine booster dose (Tdap) is recommended for adolescents and adults, and is especially important for those in contact with infants. Current recommendations call for a single lifetime Tdap booster dose with the following exception: a dose of Tdap is recommended for pregnant females in each pregnancy between weeks 27 and 36. Comprehensive pertussis information is available at www.cdc.gov/pertussis