Pertussis (Whooping cough)

Pertussis Vaccination

The Advisory Committee on Immunization Practices (ACIP) recommends that five doses of DTaP [PDF 43K] (diphtheria, tetanus, and acellular pertussis) vaccine be given at the following age intervals: two months, four months, six months, 12-19 months, and between four and seven years of age or by school entry. 

Of the two recently licensed Tdap vaccines [PDF 59K], one is licensed for use in 10-18 year olds and the other is licensed for people 11-64 years of age. The ACIP recommends that adolescents 11-18 years of age receive one dose of Tdap in place of a single Td (Tetanus and Diphtheria) booster dose. Adolescents should only be given Tdap if they have completed the five dose childhood DTaP series and have not yet received Td or Tdap. Adults 19-64 years of age should receive a single dose of Tdap to replace their next Td booster dose if they received their most recent Td more than 10 years earlier. The vaccine is also recommended for adults who have close contact with an infant who is less than one year old.

Reporting Requirements

• Health Care Providers, Health Care Institutions, and Correctional Facilities
• Clinical Laboratories
• Schools, Child Care Establishments, and Shelters

Characteristics

• Infectious Agent: Bordetella pertussis (a fastidious, gram-negative, pleomorphic bacillus)
• Mode of Transmission: Person-to-person via aerosolized droplets produced from a cough or sneeze, or by direct contact with secretions from the respiratory tracts of infectious individuals.
• Communicability:  Infectious for five days after the start of appropriate antibiotics.  If untreated, infectious for three weeks from the start of cold-like symptoms.
• Incubation Period:  7-10 days, but can range 6-21 days.
• Clinical Features
• Prodromal Stage:
• Onset of cold-like symptoms (coryza, sneezing, mild fever, occasional cough) that lasts 1-2 weeks with cough gradually becoming more severe.
• Paroxysmal Stage:
• Characterized by patient having bursts (paroxysms) of numerous, rapid coughs, sometimes followed by high-pitched "whoop," cyanosis, apnea, post-tussive vomiting/gagging, and/or sticky mucus production.  Usually lasts 1-6 weeks, but may last up to 10 weeks.
• Infants (<6 months): cough, choking, cyanosis, paroxysms.  May not have "whoop."
• Adults/teens/immunized children: Milder illness, hacking cough, occasional paroxysms, and usually with sticky mucus production.  Sometimes post-tussive vomiting and gagging.  May not have "whoop."  Mimics bronchitis.
• Convalescent Stage:
• Gradual recovery, with cough becoming less frequent and less paroxysmal.  Generally cough disappears after 2-4 weeks, but some will have temporary recurrence of cough paroxysms with respiratory infections for next several months.

Arizona Administrative Code: R9-6-351

1. Case control measures
   1. An administrator of a school or child care establishment, either personally or through a representative, shall:
      1. Exclude a pertussis case from the school or child care establishment for 21 days after the date of onset of cough or for five days after the date of initiation of antibiotic treatment for pertussis; and
      2. Exclude a pertussis suspect case from the school or child care establishment until evaluated and determined to be noninfectious by a physician, physician assistant, or registered nurse practitioner.
   2. An administrator of a health care institution, either personally or through a representative, shall:
      1. Exclude a pertussis case from working at the health care institution for 21 days after the date of onset of cough or for five days after the date of initiation of antibiotic treatment for pertussis; and
      2. Exclude a pertussis suspect case from working at the health care institution until evaluated and determined to be noninfectious by a physician, physician assistant, or registered nurse practitioner.
   3. A health care provider shall use droplet precautions for a pertussis case for five days after the date of initiation of antibiotic treatment for pertussis.
   4. A local health agency shall conduct an epidemiologic investigation of each reported pertussis case or suspect case. For each pertussis case, a local health agency shall complete and submit to the Department within 10 working days after completing an epidemiologic investigation:
      1. A Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, "Pertussis Surveillance Worksheet" (November 1999), which is incorporated by reference, on file with the Department, and available from the Centers for Disease Control and Prevention, Division of Bacterial and Mycotic Diseases, 1600 Clifton Rd., NE, Mail-stop C-09, Atlanta, GA 30333, including no future editions or amendments; or
      2. An electronic equivalent of the "Pertussis Surveillance Worksheet" [PDF 45K] provided by the Department.
2. Contact control measures:
   1. When a pertussis case has been at a school or child care establishment, the administrator of the school or child care establishment, either personally or through a representative, shall:
      1. Consult with a local health agency to determine who shall be excluded and how long each individual shall be excluded from the school or child care establishment, and
      2. Comply with the local health agency's recommendations for exclusion.
   2. A local health agency shall identify close contacts of a pertussis case and, if indicated, shall provide or arrange for each close contact to receive antibiotic prophylaxis.

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