COMMENTARY

Considerations for Antimicrobial Prophylaxis After Exposure to Pertussis

Lara Misegades, PhD, MS

Disclosures

January 21, 2014

Editorial Collaboration

Medscape &

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Hi. I'm Dr. Lara Misegades, an epidemiologist at CDC. Thanks for tuning in to this CDC Expert Video Commentary. Today I would like to share some guidelines to help you determine when to use antimicrobial prophylaxis after someone is exposed to pertussis.

The United States has seen a dramatic increase in the number of reported pertussis cases since the 1980s. Pertussis is naturally cyclic, with peaks in disease every 3-5 years. The last peak was in 2012 when the United States set a nearly 60-year record high with more than 48,000 reported cases.

With the ongoing resurgence in the disease, CDC supports providing postexposure antimicrobial prophylaxis (PEP) to:

All household contacts of a pertussis case;

People who are at high risk for severe illness; and

People who will have close contact with a person at high risk for severe illness.

Let's look at each of these in more detail to understand when PEP is called for and who fits into each category. CDC supports administering PEP to all household contacts of a pertussis case because secondary attack rates have been shown to be high within families, even when household contacts are current with immunizations. In household settings, PEP should be administered within 21 days of cough onset in the index patient to prevent illness in close contacts.

CDC also supports administering PEP to those at high risk for severe illness. People who are at high risk for severe illness include infants less than 12 months of age and people with certain pre-existing health conditions that may be worsened by a pertussis infection, such as immunocompromised patients and patients being treated for moderate to severe asthma.

Among infants less than 12 months of age who get pertussis, about half are hospitalized, and most pertussis deaths each year occur in infants who are less than 3 months old. CDC supports providing PEP to women in their third trimester of pregnancy, because they may be a source of pertussis to their newborn.

Lastly, CDC supports providing PEP to anyone who will have close contact with the groups that I just mentioned -- infants, pregnant women, and people with certain pre-existing health conditions. This includes all contacts in settings such as neonatal intensive care units, childcare settings, and maternity wards.

For individuals at high risk for severe illness or for their close contacts, PEP should be administered within 21 days of the last exposure to the pertussis case patient.

In some situations, CDC supports a broader use of PEP, primarily in closed settings when the number of identified cases is small and no community-wide outbreak is ongoing. However, if transmission continues in these settings, multiple rounds of antibiotics are not recommended. Rather than repeating a course of antibiotics, contacts should be monitored for signs and symptoms of pertussis for 21 days.

Although these recommendations are the result of close discussions with health departments about their experience with chemoprophylaxis, some health departments may have slightly broader or more restrictive PEP recommendations. It's important to contact your local health department when you diagnose pertussis in a patient to ensure that you are following the current guidance in your state. For more information about pertussis, including vaccine recommendations across the lifespan and for pregnant women, visit www.cdc.gov/pertussis. Thanks for tuning in to this CDC Expert Video Commentary on Medscape.

Web Resources

Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis: 2005 CDC Guidelines

CDC Clinical Information about Pertussis

CDC Commentary — Protect Patients from Deadly Pertussis: Updated Vaccine Guidelines

CDC Commentary — Pertussis: Recognition and Treatment

CDC Commentary — Pertussis Diagnosis: Avoid the Pitfalls of PCR

Pertussis Testing Video: Collecting a Nasopharyngeal Swab Clinical Specimen

Pertussis Testing Video: Collecting a Nasopharyngeal Aspirate Clinical Specimen

Lara Misegades, PhD, MS, is an epidemiologist with the Meningitis and Vaccine Preventable Diseases Branch (MVPDB) within the National Center for Immunization and Respiratory Diseases where she works on pertussis and other vaccine-preventable diseases. She first joined CDC as an Epidemic Intelligence Service Officer assigned to MVPDB. She received her PhD in epidemiology from the University of California at Berkeley while working at the Center for Infectious Disease and Emergency Readiness, and her master's degree from the Harvard School of Public Health. Prior to joining CDC, she worked on emerging infectious disease policy issues at the Association of State and Territorial Health Officials in Washington, DC.

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