Increase in Confirmed Cases of Pertussis Throughout Buncombe County

May 23, 2018

This month, and especially in the past week, we have seen an increase in confirmed cases of pertussis throughout Buncombe County, mainly in school-aged children. Our Communicable Disease Control staff are working with school nurses and school administration to inform parents of exposed students, identify additional symptomatic individuals, and provide prophylaxis for high-risk contacts. Letters have been sent to parents of students who may have been exposed to pertussis. The letter asks them to contact their child’s doctor to prescribe prophylactic antibiotics against pertussis to their child if the child:

  • has a weakened immune system or a pre-existing health condition that may be worsened by a pertussis infection; or
  • lives with or has close contact with any of the following people:
    • A woman who is in her third trimester of pregnancy,
    • An infant younger than 12 months old, or
    • Anyone with a weakened immune system or other pre-existing health condition that may be worsened by a pertussis infection.

 

The letter also instructs parents that if their child has recently started coughing, they should keep them out of school & group activities and inform their child’s health care provider of their symptoms and that they might have been exposed to pertussis. They have also been given a “Dear Colleague” letter (attached) to share with their provider that outlines clinical recommendations for testing, treatment and exclusion.

 

Please consider pertussis in your differential when seeing anyone who has the symptoms listed below. Test, treat, exclude & report whenever you suspect a case of pertussis. (More details below.) It is critical that you notify our Communicable Disease Control nurses immediately whenever you suspect a patient of having pertussis – this enables us to stop the spread of infection in our schools and community. For Buncombe County Communicable Disease staff, call 250-5109 (available 24/7/365).

 

Please promote pertussis immunization for everyone, but especially for those who are in their 3rd trimester of pregnancy or in contact with infants.

  • BCHHS Immunization Clinic (53 S. French Broad Ave., ground floor) is open Monday-Friday, 8am-5pm, no appointment necessary. We will be closed Memorial Day. We are able to provide low- or no-cost Tdap to clients who are under- or uninsured.

 

Symptoms of pertussis:  In the absence of a more likely diagnosis, persons with the following symptoms should be suspected of having pertussis:

·         Cough lasting for > 2 weeks PLUS 1 of the following

o   paroxysms (violent fits) of coughing

o   inspiratory whoop

o   post-tussive vomiting

o   apnea (with or without cyanosis) in an infant < 1 year old

·         Keep in mind that infants < 6 months of age, partially vaccinated children, adolescents and adults frequently do not have the characteristic whoop and may have other atypical features.

If you suspect someone of having pertussis based on their signs/symptoms, please DO ALL 4 of the following steps:

  1. Test
    • Collect both a PCR and culture of nasopharyngeal secretions for Bordetella pertussis.

o For the PCR test, consider ordering a PCR Respiratory Panel that offers same-day results for common respiratory pathogens, including Bordetella pertussis. Clearly, use your clinical judgment to balance the costs of any tests you order with the utility it can offer in the diagnosis & management of your patient. PCR tests can be falsely negative or falsely positive if not ordered appropriately, so make sure to order only in patients who have the signs & symptoms of pertussis.

  1.  
    • Please note that we do NOT perform testing for pertussis at Buncombe County Health and Human Services.
    • If you have to send a patient suspected of having pertussis elsewhere for lab work, please be sure to provide them a mask to wear.

 

  1. Treat
    • Macrolides are first-line treatment. For adults, the easiest option is Azithromycin 500 mg PO x 1 day, then 250 mg PO daily on days 2-5.
    • If allergic to macrolides, prescribe TMP/SMX (160 mg/800 mg) PO BID x 14 days.
    • See Table 4 at this link for dosing regimens for children as well as other macrolide dosing https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4

 

  1. Exclude
    • Persons suspected of having pertussis should refrain from all public activities, staying home from school, childcare, extracurricular activities, places of worship, and work until they have completed the first 5 days of appropriate antibiotics.

o They especially should avoid contact with infants & young children and pregnant women.

  1.  
    • Persons suspected of having pertussis who choose not to take antimicrobial treatment should stay isolated at home for 21 days from their onset of cough or until their cough resolves, whichever occurs first.

 

  1. Report
    • Per NC law, medical providers must report all suspected and confirmed cases of pertussis to your local health department within 24 hours.

o For Buncombe County, call our Communicable Disease Control nurses at 250-5109 (available 24/7/365).

o It is very helpful to our investigation if you can tell us if the person suspected of having pertussis has any high-risk contacts (infants, pregnant women, or persons with an underlying medical condition that may be worsened by pertussis).

§  Be aware that when BCHHS Communicable Disease nurses conduct pertussis investigations and find symptomatic contacts to suspected or known cases, we ask these persons to see their primary care provider for testing and evaluation.

 

For more details on pertussis, see https://www.cdc.gov/pertussis/clinical/  

 

Our Communicable Disease nurses are also available for consultation if you are uncertain of how to proceed or want to talk through a scenario. Please call them at 828-250-5109 anytime you have questions.

 

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