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Pertussis (Whooping Cough)

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Reporting Obligations

Individuals who have or may have pertussis shall be reported to the local Health Unit.

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Epidemiology

Aetiologic Agent

Pertussis is caused by, a Gram-negative, bacillus, Bordetella pertussis, (B. pertussis).

Clinical Presentation

The clinical course of pertussis is divided into three stages:

  1. Catarrhal Stage – mild upper respiratory tract symptoms with a mild occasional cough that lasts about 1–2 weeks
  2. Paroxysmal Stage – increase in the severity and frequency of the cough; paroxysms are characterized by repeated violent coughs possibly with a high pitched inspiratory whoop commonly followed by vomiting and can last 1–2 months; fever is absent or minimal
  3. Convalescent Stage – gradual recovery period which can take weeks to months

The clinical course varies with age. In young infants, who are at the highest risk, clinical symptoms are frequently atypical and it is this group who has the most serious complications. Pertussis presentation may also be atypical in adults or among persons previously immunized.

Modes of Transmission

Direct contact with discharges from respiratory secretions of infected persons via droplets.

Incubation Period

Usually 9–10 days, can range from 6–20 days.

Period of Communicability

Highly communicable in the early catarrhal stage and beginning of the paroxysmal stage (first 2 weeks) and then decreases and becomes negligible in about 3 weeks.

No longer communicable after 5 days of effective treatment.

Risk Factors/Susceptibility

Non-immunized or partially immunized individuals are susceptible to pertussis. Previously immunized adolescents and adults (due to waning immunity) may also be susceptible. Infection does not induce long term immunity. Secondary attack rates can occur, of up to 90% in non-immune household contacts.

Diagnosis and Laboratory Testing

Consider Pertussis in an individual with a paroxysmal cough or a cough lasting 2 weeks or more. A nasopharyngeal (NP) swab specific for Bordetella pertussis, must be used to collect a specimen. A Bordetella Collection Kit can be ordered from Public Health Ontario.

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Treatment and Case Management

Advise cases to avoid contact with young children, infants, and women in their 3rd trimester of pregnancy until the completion of 5 days of treatment or 21 days post cough onset. Advise symptomatic individuals to remain at home until they are well.

Refer to the current Publicly Funded Immunization Schedules for Ontario for more information on adult immunization. Tdap can be safely administered regardless of the interval from the last tetanus-diphtheria booster.

Contacts: Antibiotic chemoprophylaxis is only recommended for the following contacts of a confirmed pertussis case:

  • Household contacts (including attendees at family day care centers) where there is an infant < 1 year of age (vaccinated or not) or a pregnant woman in the third trimester.
  • For out of household exposures, infants less than one year of age regardless of immunization status and pregnant women in their third trimester who have had face-to-face exposure and/or have shared confined air for > 1 hour.

Chemoprophylaxis should be implemented as soon as possible after exposure as efficacy is related to early implementation. It is not likely to be beneficial after 21 days since the first contact.

See chemoprophylaxis regimens for specific contacts page 7, Ministry of Health and Long-Term Care.

Contacts who meet the definition above will be contacted by Public Health staff.

Patient Information

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Additional Resources

Public Health Ontario. “Considerations for Public Health on Pertussis Case and Contact Management.”

Ontario Hospital Association. “Pertussis Surveillance Protocol for Ontario Hospitals.”

Ministry of Health and Long-Term Care. “Publically Funded Immunization Schedules for Ontario”, December 2016.

Public Health Agency of Canada. Canadian Immunization Guide, 7th ed., Pertussis Vaccine.”

References

Ministry of Health and Long-Term Care, Infectious Diseases Protocol, 2019.