Pertussis: background information on prevention and management
Information for healthcare professionals on pertussis (whooping cough).
Whooping cough is a notifiable disease in England and Wales. A diagnosis may be made on clinical grounds without the need for laboratory confirmation. Notifications provide timely data relating to trends over time and by age.
Isolation of the B. pertussis organism through culture will confirm diagnoses. But culture lacks sensitivity and since 2001, the enhanced diagnostic methods based on PCR and serological testing, have been made available by PHE. These methods have increased case ascertainment, particularly the use of serology in adults. In 2013 Oral Fluid testing was made available for all children aged 5-16 years who had not had pertussis confirmed by other laboratory methods.
Classic (severe) pertussis, as defined by the World Health Organization (WHO), consists of at least 21 days of cough illness with paroxysms, associated whoops or post-tussis vomiting, and culture confirmation. In young infants, the typical ‘whoop’ may never develop and coughing spasms can be followed by difficulty in breathing (apnoea). Severe complications and deaths occur mostly in infants under 6 months of age. Serious illness is less common in older children and adults, however, they have the potential to transmit infection to vulnerable babies.
Respiratory and vaccine preventable bacteria reference unit (RVPBRU) provides national reference facilities for Bordetella pertussis and other bordetella.
Prevention and treatment
Acellular pertussis vaccine is given in the primary course with diphtheria, tetanus, polio and Hib, as DTaP/IPV/Hib, given at aged 2, 3, and 4 months of age. A further booster dose with acellular pertussis, given as dTaP-IPV, is given with the preschool boosters 3 years after the completion of the primary course and before school entry. For more information see:
Infant vaccination before 2 months of age
Infants may receive their first dose of primary immunisations from 6 weeks of age in exceptional circumstances, for example, pre-travel but it is not routinely recommended to offer infants vaccine before 2 months of age. It is however important that infants complete their primary schedule on time.
Children and adults can catch pertussis even if they were vaccinated in the past. This is because both natural and vaccine immunity wane over time.
Pertussis immunisation for pregnant women has been in place as a temporary outbreak response measure that will continue to at least 2019.
Pertussis commonly lasts 6 to 8 weeks even when treated with antibiotics, with severity of symptoms related to age. The most severe infections are usually in infants. Over 90% of laboratory confirmed cases in infants are hospitalised. Morbidity and mortality is greatest in those aged less than 6 months of age.
For suspected, epidemiologically linked or confirmed cases, recommended antibiotic regimens should be administered as soon as possible after onset of illness in order to eradicate the organism and limit ongoing transmission. The effect of treatment on reducing symptoms however, is limited or lacking especially when given late during the disease and therefore antibiotic treatment for the case is recommended within 3 weeks of onset of illness according to national guidelines. Management of contacts should proceed for all clinically suspected, epidemiologically linked and laboratory confirmed cases. Priority groups for public health action are those considered at high risk of severe disease (infants under 1 year who have received less than 3 doses of pertussis-containing vaccine) and those considered to be at increased risk of transmitting to such infants.