Pertussis in Wisconsin: Key Points and Resources for Infection Preventionists
This message is being sent to infection preventionists.
Pertussis, also known as whooping cough, is a highly contagious respiratory infection that is currently increasing across the nation, including in Wisconsin. On September 25, 2024, the Wisconsin Department of Health Services (DHS) released DHS Health Alert #61: Pertussis Cases in Wisconsin, encouraging clinicians to be alert for signs and symptoms of pertussis and obtain a nasopharyngeal (NP) swab for PCR testing prior to antimicrobial treatment.
The following are key points and resources for infection prevention and control in health care settings. Please share widely, including with clinicians and health care personnel responsible for infection prevention and control within your networks.
Background
Pertussis infection is caused by the bacteria Bordetella pertussis. Transmission occurs person-to-person through respiratory droplets. Symptoms usually develop within 5 to 10 days after exposure, but sometimes not for as long as 21 days.
There are three stages of clinical pertussis. Clinical presentation, complications, and risk of death can differ based on age and vaccination status. Previously vaccinated adolescents and adults may become infected with pertussis but may have milder disease than infants and young children. Suspected and confirmed cases of pertussis must immediately be reported to the local health department in which the patient resides.
Infection prevention and control
Being prepared to care for a patient with pertussis helps reduce risk of transmission to other patients and health care personnel.
In preparation of a suspected or confirmed pertussis case
- Ensure health care personnel are up to date on pertussis vaccines.
- Assess supply of personal protective equipment (PPE) and alcohol-based hand rub available to staff.
- Review facility policy and procedures regarding intake of a pertussis case. Educate health care personnel on the process.
When caring for a suspected or confirmed pertussis case
- Immediately mask the patient and place the patient in an exam room. Do not allow the patient to remain in the waiting room.
- Adhere to standard and droplet precautions. All health care personnel entering the patient room should be wearing a mask.
- Limit transport of the patient to essential care needs. The patient should remain masked during transport. If a patient is being transported to another health care facility or moved within a facility, personnel should be notified ahead of time about suspected pertussis infection.
- Follow health care cleaning and disinfection procedures to adequately clean the health care environment following a pertussis patient.
- Make note of the health care personnel and other patients who were in the same area during the time the suspect pertussis patient was in the facility for public health follow-up.
- In an inpatient setting, patients with suspect or confirmed pertussis should be placed on standard and droplet precautions until five days of the full course of antibiotic therapy have been completed.
Reporting
Health care providers must immediately report by telephone the suspected or confirmed case to the local or Tribal health department (LTHD) in which the patient resides. Within 24 hours, health care providers should also report the case online through the Wisconsin Electronic Disease Surveillance System (WEDSS) or by fax using an Acute and Communicable Disease Case Report.
Testing
PCR testing is the preferred method. Obtain a nasopharyngeal (NP) swab as soon as pertussis is suspected, preferably within 21 days of cough onset and prior to the initiation of antibiotic therapy. Many clinical labs and the Wisconsin State Laboratory of Hygiene perform this testing.
Treatment and prophylaxis
Recommended antimicrobial treatment and post-exposure for pertussis should be initiated upon suspicion of disease for the patient and household contacts. The recommended antibiotic is azithromycin; clarithromycin, erythromycin and TMP-SMX may be used. See the DHS guidance for clinicians or the American Academy of Pediatrics Redbook for more specifics.
Additional resources
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