Pertussis

Pertussis is primarily spread by breathing in droplets from the nose or throat of infected individuals. Pertussis can even be spread by an individual who has only a mild form of pertussis or by an individual who is asymptomatic.  Frequently, older siblings and parents who may be harboring the bacteria bring the disease home and infect an infant in the household.

Diagnosing whooping cough in its early stages can be difficult because the signs and symptoms resemble those of other common respiratory illnesses, such as a cold, the flu or bronchitis.

Sometimes, doctors can diagnose whooping cough simply by asking about symptoms and listening to the cough. Medical tests may be needed to confirm the diagnosis. Such tests may include:

• A nose or throat culture and test: Your doctor takes a swab or suction sample from the area where the nose and throat meet (nasopharynx). The sample is then checked for evidence of the presence of whooping cough bacteria.
• Blood tests: A blood sample may be drawn and sent to a lab to check your white blood cell count, because white blood cells help the body fight infections, such as whooping cough. A high white blood cell count typically indicates the presence of infection or inflammation. This is a general test and not specific for whooping cough.

Supportive care following hospital admission is especially important for very young infants or older children with severe disease.

Antibiotic therapy (e.g., macrolides) is the treatment of choice for pertussis. However, to be effective, treatment must begin early in the course of disease, preferably within two weeks of onset. Antibiotic treatment can eradicate the bacteria from the nose and throat and limits the risk of it being passed on to others.

The best way to prevent pertussis is through immunization. The three-dose primary series diphtheria-tetanus-pertussis (DTP3) – containing vaccines decrease the risk of severe pertussis in infancy. In 2018, 86% of the global target population had received the recommended three doses of DTP-containing vaccine during infancy.

WHO recommends the first dose be administered as early as six weeks of age; with subsequent doses given 4-8 weeks apart, at age 10-14 weeks and 14-18 weeks. Three booster doses are also recommended at 12-23 months, 4-7 years, and 9-15 years of age, with a minimum interval of four years between each dose.

Vaccination of pregnant women is effective in preventing disease in infants too young to be vaccinated. National programmes may consider vaccination of pregnant women with pertussis-containing vaccine as a strategy additional to routine primary infant pertussis vaccination in countries or settings with high or increasing infant morbidity/mortality from pertussis.

Tdap vaccination of health care facility personnel, especially those in the maternity ward and caregivers of infants under 1 year of age, is recommended.