COMMENTARY

Pertussis and Cocooning Strategies: The Latest From ACIP

Sandra Adamson Fryhofer, MD

Disclosures

March 08, 2012

In This Article
Sandra Adamson Fryhofer, MD
Clinical Associate Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia; Past President, American College of Physicians

This issue of Staying Well focuses on pertussis, a public health threat that is common in adolescents and adults but is deadly for babies. Some experts call pertussis "the most poorly controlled vaccine-preventable disease in the developed world."[1]

Pertussis (Whooping Cough) Defined

Pertussis is on the Centers for Disease Control and Prevention's (CDC's) 2012 list of Nationally Notifiable Diseases and Conditions and has been a reportable disease since 1922.[2,3] The pathologic agent is Bordetella pertussis, a gram-negative coccobacillus that, like others, produces toxins that damage the respiratory tract and cause systemic lymphocytosis.

Pertussis infection is extremely contagious. Person-to-person transmission occurs through spread of respiratory droplets from coughing or sneezing. The average incubation period is 7-10 days. The infection can range from asymptomatic to producing mild to severe symptoms.[2,4]

Cough is the predominant feature, hence the common name "whooping cough." The classic pertussis infection has 3 stages (although it does not always present "classically"):

  1. Catarrhal stage (1-2 weeks): Symptoms in the catarrhal phase mimic those of the common cold -- sneezing, tearing, and watery nasal discharge, and cough. But the cough persists, and it occurs day and night.

  2. Paroxysmal stage (4-6 weeks): Cough during the paroxysmal stage is intense, often with an inspiratory whoop, and coughing spasms that can cause rib fractures and may require hospitalization.

  3. Convalescent (2 to 6 weeks). Symptoms gradually resolve during the convalescent phase but can occur for as long as 6 months, sometimes even longer.[2,4]

The basics of the CDC clinical case definition include a cough illness lasting at least 2 weeks with at least 1 of these symptoms: paroxysms of coughing, inspiratory whoop, or posttussive vomiting.[5]

Laboratory tests can be used to confirm the diagnosis. The CDC recommends that nasopharyngeal swab or aspirate be obtained if pertussis is suspected. Detailed instructions on the precise procedure for obtaining a nasopharyngeal sample are available on the CDC's Website.[5,6]

Polymerase chain reaction is the fastest way to diagnose pertussis; it should ideally be done during the first few weeks of symptoms. A culture has better specificity, but it takes at least 1 week to get results.[4,7]

First-line antibiotic regimens for treating pertussis include a choice of macrolide antibiotics:

  • 5 days of azithromycin;

  • 7 days of clarithromycin; or

  • 14 days of erythromycin.

Alternatively, a 14-day course of trimethoprim/sulfamethoxazole can be used.[4,8]

Early treatment (before coughing fits begin) is best and can help stop spread to others.[8] The best way to prevent pertussis, however, is vaccination.

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