Lightning Learning: Whooping Cough

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STOP!

THIS IS A NOTIFIABLE DISEASE

In England (UK) there were 2,947 laboratory confirmed cases of Pertussis reported to Public Health England in 2018, with peak cases occurring from July to September.

Incidence remains highest in infants under 3 months who are most at risk of severe disease but are too young to be fully immunised.

Causative bacteria: Bordetella Pertussis

Alternative name: Pertussis, 100 day cough

Method of distribution: aerosol droplets

Incubation period: 7 days

Infectious period: 3 weeks after onset of cough

Arrange admission if the person…

• Is 6 months of age (or younger) and acutely unwell

• Has significant breathing difficulties (e.g. apnoea, severe paroxysms, or cyanosis)

• Has significant complication (e.g. seizures or pneumonia)

  • NOTE: inform the hospital of the need for appropriate isolation before the person is admitted.

LOOK

Three phases of symptoms:

1. Catarrhal phase (one week productive cough)

2. Paroxysmal phase (cough, cough induced vomits & audible whoop)

3. Convalescent phase

Investigations:

Cultures: Nasopharyngeal, pernasal or nasopharyngeal aspirates sent for cultures. Negative cultures do not exclude disease.

Serology: Anti-pertussis IgG antibodies if in doubt about diagnosis to be taken 2 weeks after cough onset. Suitable for older children who have not had immunisations within a year.

PCR for pertussis: Nasopharyngeal or throat swabs to confirm infection in people of all ages with symptoms of less than a 3 week duration.

LEARN

Treatment:

• Advise rest, adequate fluid intake, paracetamol and ibuprofen for symptomatic relief.
• Prescribe antibiotics, macrolides such as Clarithromycin within 21 days of cough onset – this will not affect severity or duration but will reduce transmission.
• Consider prophylactic antibiotics in vulnerable close contacts (e.g. newborn infants born to symptomatic mothers, unimmunised children).
• Advise that children and healthcare workers who have suspected or confirmed whooping cough should stay off nursery, school, or work until 48 hours of appropriate treatment has been completed, or 21 days after onset of symptoms if not treated.

References:

• Whooping cough (NICE)
• Notifiable diseases and causative organisms: how to report (GOV.UK)
• Laboratory confirmed cases of Pertussis (England): annual report for 2018 (Public Health England)