Pertussis

Pediatric Home Service

Infection Control Committee

December 9, 2010

Mode of Transmission

•

Bacteria is found in fluids from the mouth and nose.

•

Bacteria can be spread by coughing, sneezing, or having it on your hands and rubbing your eyes, nose, or mouth.

•

Greatest risk comes from being within three feet of someone with pertussis for at least 10 hours per week (close contact).

Pertussis in Minnesota•

Pertussis is endemic in Minnesota

•

Occurs year round, peaking in the later part of the year

•

Annual incidence peaks every 3-5

years•

Adults and adolescents are half of all cases nationally

•

Waning immunity leads to a substantial number of older children and adults

MN Pertussis Statistics

0200400600800

1,0001,2001,4001,600

2005 2006 2007 2008 2009 2010(thru 10-21-10)

Clinical Features•

Common incubation period of 7-10

days with a

range of 4-21

days•

Severe rapid, violent cough

•

Bursts of coughing resulting in shortness of breath

•

After a coughing spell, the person breathes in deeply and the breathing pattern often makes a whooping sound followed by the next coughing spell

Treatment

•

Can be treated with antibiotics•

Antibiotic treatment may not cure

the

symptoms•

Will reduce the spread of disease to others

•

Antibiotics lessen the symptoms if given in the early stage of the illness

Fatal Cases

•

Pertussis in infants is often severe•

Infants are more likely than older children and adults to develop complications–

Most common complication is bacterial pneumonia

–

Rare complications include seizures, inflammation of the brain, and death

Pertussis Vaccination

•

Two types of pertussis vaccination–

DTaP for infants and children

–

Tdap for adolescents and adults

Vaccination

•

Infants and children– 5 doses of the DTaP at:

•

2, 4, 6 months•

15-18 months

•

4-6 years–

All doses are needed for maximum protection

•

Immunity is not permanent

Vaccination (cont’d)•

Adolescents–

Tdap vaccine at age 11 or 12

•

Adults 19-64 years of age–

One-time Tdap in place of the Td booster every 10 years

•

Pregnant women–

Tdap before pregnancy; otherwise, it is recommended that Tdap be given in the postpartum period before leaving the hospital or birth center

•

Hospitals and acute ambulatory facilities should provide Tdap

for healthcare workers

–

An interval as short as 2 years from the last Td may be used

Implications for Healthcare Workers

•

Priority for vaccination should be given to those caring for infants younger than 12 months of age

MN Department of Health

•

Recommendations for preventing pertussis spread to healthcare workers–

Immunization

–

Surgical masks when in contact with any coughing patient

–

Wash hands after contact

Additional Precautions•

At PHS, employees may be performing close contact procedures (suctioning with possible coughing resulting)

•

The MN Department of Health recommends the use of eye and face protection, in addition to masks when performing procedures, such as close suctioning for all patients, not just those with pertussis

•

What to Do After an Exposure to a Patient with Pertussis?–

If you were wearing a mask during the exposure, antibiotic prophylaxis is not recommended

–

If you were not

wearing a mask and had close face-face contact, preventive antibiotics would be recommended

What to Do After an Exposure to a Patient with Pertussis?

•

If you were wearing a mask during the exposure, antibiotic prophylaxis is not recommended

•

If you were not

wearing a mask and had close face-face contact, preventive antibiotics would be recommended

References•

Center for Disease Control and Prevention. (2010, August). Pertussis: Clinical features. Retrieved from www.cdc.gov/pertussis/clinical/features.html

•

Center for Disease Control and Prevention. (2010, August). Pertussis: Outbreaks-questions and answers. Retrieved from www.cdc.gov/pertussis/outbreaks-faqs.html

•

Minnesota Department of Health. (2010, August). Pertussis: school and activities exclusion recommendations. Retrieved from www.health.state.mn.us/immunize

•

Minnesota Department of Health. (2010, August). Pertussis: Fact sheet for EMS, public safety and first responders. Retrieved from www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/ps

/pertussis.pdf