Prevention and Control of Communicable Diseases

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Pertussis (also known as whooping cough) can be a serious illness, especially in young, unvaccinated children. Adults and older children with pertussis may be the source of infection for infants and young children. This is a concern because in recent years, more adults, adolescents, and school-aged children have been contracting pertussis.

Cause

Bordetella pertussis bacteria.

Symptoms

Pertussis begins with a runny nose, sneezing, mild cough, and possibly a low-grade fever. After a week or two, a persistent cough develops, which may occur in explosive bursts (paroxysmal coughing), sometimes ending in a high-pitched whoop and vomiting. A whoop may be absent in older children, adults, and infants younger than 6 months. Coughing attacks occur more frequently at night. The coughing attacks usually increase during the first two weeks of illness and then remain the same for two or three more weeks before gradually decreasing. Some people, particularly infants, may develop pneumonia and ear infections. Pertussis can occur in vaccinated children, but the illness is usually milder.

Older children and adults may have a less typical cough; however, it is usually persistent and may lead to vomiting or a whoop. Although the disease may be less severe in adults and older children, they can unknowingly infect infants and preschoolers who are at risk for serious illness.

Spread

When an infected person coughs or sneezes tiny droplets into the air, and another person breathes them in. Also can be spread by touching the secretions from the nose and mouth of an infected person or by touching hands, tissues, or other items soiled with these secretions and then touching one’s eyes, nose, or mouth. A person is at greater risk of infection if they are in close contact with someone with pertussis (within three feet of an individual for at least 10 hours a week).

Incubation

It takes 4 to 21 days, usually 7 to 10 days, from the time a person is exposed until symptoms start.

Contagious Period

Begins at the time of early cold-like symptoms, before a persistent cough and explosive bursts of coughing start. Persons remain contagious until three weeks after cough onset. Those treated with antibiotics are contagious until 5 days of treatment are completed.

Exclusion

Until 5 days after appropriate antibiotic treatment begins. During this time, the person with pertussis should NOT participate in any child care, school, or community activities. If not treated with 5 days of antibiotics, exclusion should be for 21 days after cough onset.

If there is a high index of suspicion that the person has pertussis, exclude until the individual has been evaluated by a medical provider and deemed no longer infectious by the local health department, 5 days of antibiotics are completed or until the laboratory test comes back negative.

Diagnosis

Laboratory tests are performed on material collected by placing a flexible swab through the nostril to the back of the nose and throat or on a blood sample. Some lab tests (pertussis cultures) are less accurate after antibiotics are given or if significant time has passed since the cough onset. Only symptomatic persons should be tested.

Treatment

Antibiotics shorten the time a person with pertussis can give it to others, but may do little to lessen their symptoms. Treatment is most effective if started soon after cough begins. Antibiotics are not recommended for individuals who have had a cough for more than 21 days.

Prevention/Control

• Studies have shown that protection from the pertussis vaccine (DTP/DTaP) decreases from 3 to 5 years after the last vaccination.

  Adolescents ages 11 through 18: Adolescents aged 11 or 12 should receive a single dose of tetanus, diphtheria, and pertussis (Tdap) in place of tetanus and diphtheria (Td). Adolescents aged 13 through 18 should receive a single dose of Tdap if they have not already received one regardless of when Td (tetanus/diphtheria) was last administered.

  Adults Ages 19 through 64: One dose of Tdap vaccine should be administered in place of the next booster of Td, especially if the adult is in close contact with infants less than 12 months of age. Tdap can be given no matter when Td was last received.

  Adults ages 65 and older: Should receive a single dose of Tdap if adult anticipates being in close contact with an infant younger than 12 months of age.

  Pregnant women: One dose of Tdap vaccine is recommended during each pregnancy, preferably at 27 through 36 weeks (third trimester). If Tdap was not administered during pregnancy, Tdap should be administered immediately after delivery.

• People who develop the symptoms of pertussis within 21 days of exposure should stay home and call their healthcare provider.
• Cover your nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues.
• Regular and thorough handwashing is the best way to prevent spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. If soap and water are not available, use an alcohol-based hand sanitizer.
• Clean and sanitize mouthed objects and surfaces at least daily and when soiled. 
• People who are exposed to pertussis and who are not up to date on pertussis vaccinations should contact their healthcare provider or public health clinic to be vaccinated.
• Public health will determine if preventive antibiotics are needed if someone in your child care or school develops pertussis.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or call your local health department.

Your child may have been exposed to:

Pertussis

Pertussis (whooping cough) can be a serious bacterial illness especially in young, unvaccinated children.

If you think your child has Pertussis:

• Tell your child care provider or call the school.
• Need to stay home?
  • Child Care and School:
    Yes, until 5 days after your child starts taking antibiotics.

If staff or children are not treated, they need to stay home until 21 days after cough starts.

Symptoms

Your child may first have a runny nose, sneezing, mild cough, and possibly fever.

After 1 or 2 weeks, your child may cough in explosive bursts. These coughing attacks can end in vomiting and/or in a high-pitched whoop. Coughing attacks occur most often at night. This may last up to three months.

If your child has been infected, it may take 5 to 21 days (usually 7 to 10 days) for symptoms to start.

Spread

• By coughing or sneezing.

• By touching contaminated hands, objects, or surfaces.

Contagious Period

From the time of the first cold-like symptoms until 21 days after coughing begins or after taking 5 days of antibiotics. Antibiotics shorten the time a child with pertussis can give it to others.

Call your Healthcare Provider

If someone in your home has:

• had a cough 7 or more days. Laboratory tests may be done. Antibiotics will reduce the contagious period, but may do little to relieve your child’s cough.
• been exposed to pertussis. Also, if public health has recommended that antibiotics are needed because of an exposure.

Prevention

• Cover nose and mouth when coughing and sneezing. Use a tissue or your sleeve. Dispose of used tissues.
• Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
• All children 2 months of age or older enrolled in child care or school must be vaccinated against pertussis or have an exemption. Consider a pertussis booster vaccine for adolescents and adults (Tdap), especially for those who have close contact with young children. Pregnant women should get a Tdap during each pregnancy, preferably during their third trimester. 
• There is also a pertussis vaccine for adolescents and adults, and it is recommended for persons having close contact with children under one year of age.
• Parents should keep infants away from individuals with cough illness.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or call your local health department.