To date this year, there have been over 1000 cases of pertussis reported in the state of California. This is approximately 3.4 cases/100,000 which is a five-fold increase from that observed in 2009 (California Pertussis Summary Report, 6/30/2010). The population mostly affected by this disease are infants less than six months of age. The disease is spread through respiratory droplets from an infected person through coughing and the people most likely to transmit the illness to young children are adults (parents or grandparents). The most common serious complications associated with pertussis in young children include bacterial pneumonia, followed by seizures, and encephalopathy. Also, nutritional disturbance can lead to weight loss and dehydration. More than half of infants less than 6 months of age require hospitalization.
When is the illness most contagious?
Pertussis seems to be most contagious in its early stages which is usually before the coughing spell begins. Persons can transmit the disease for up to three weeks after the cough onset. However, with the appropriate course of antibiotics, the spread period can decrease to five days after the start of antibiotics. (1)
What is the Treatment?
Currently, there are four antibiotics that are recommended to treat pertussis. These include Azithromycin (5 day course), Clarithromycin (7 day course), Erythromycin (14 day course), and Trimethoprim/Sulfamethoxasole (TMP/SMX) also a 14 day course. (2)
How is it diagnosed/confirmed?
Symptoms of pertussis vary depending on what stage of the illness you are in. The three stages are the catarrhal stage, the paroxysmal stage, and the convalescent stage. Symptoms during the first stage (catarrhal) can last between 7 and 14 days. These include runny nose, nasal congestion, sneezing, cough, and low-grade fever. The next stage is the paroxysmal stage in which the patient experiences the sudden bouts of cough. Finally, the last stage is the convalescent stage and the patient can develop a chronic cough during this time.
The illness can be confirmed by PCR (Polymerase Chain Reaction). This is the test of choice.
Prevention
The best way to prevent Pertussis is through routine immunization. Children should be immunized at 2, 4, 6 and 15-18 months. A booster shot is recommended at 4-6 years of age. The pertussis vaccine is given in a combination with Diptheria and Tetanus (DTaP). In 2005, a vaccine for adolescents and adults was licensed. This vaccine is known as Tdap and is given as a one time booster in children 11-12 years old and adults who have not previously received the vaccine.
Pregnancy
Can pregnant women be immunized against pertussis? Yes. The pertussis vaccine is not a live vaccine and therefore is not contraindicated in pregnancy. However, women should only receive this vaccine while pregnant if they have been exposed or are at high risk of contracting the disease. Otherwise, they should wait until after delivery. The vaccine has not been shown to cause any congenital abnormalities in the fetus.
Breastfeeding
Is it safe to receive the vaccine while breastfeeding? Yes. Breastfeeding mothers can receive the vaccine. However, if they are going to receive treatment for pertussis within the first few months of the infants life, then it is recommended that they try not to use trimethoprim/sulfamethoxasole or erythromycin as these have been shown to cause hyperbilirubinemia and pyloric stenosis, respectively, in the infant.
For information regarding where to obtain your vaccination today, contact your local health department .
For further information regarding pertussis during pregnancy and/or breastfeeding, call us at (806) 352-2519
References:
1. Pertussis--United States, 2001-2003. MMWR Morb Mortal Wkly Rep. Dec 23 2005;54(50):1283-1286.
2. Altunaiji S, Kukuruzovic R, Curtis N, Massie J. Antibiotics for whooping cough (pertussis). Cochrane Database Syst Rev. 2007(3):CD004404.
