Pertussis (whooping cough) Alert

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Pertussis (whooping cough) Alert

06-Mar-2017

This is to alert you that there have been cases of pertussis (whooping cough) in our Region. Please be on the alert for patients presenting with symptoms consistent with pertussis. If you suspect pertussis, please test and treat appropriately.

Early diagnosis and treatment is essential to prevent further spread of this vaccine preventable disease. The information below should help you identify the symptoms of pertussis as well as identify testing and treatment. As with anyone who is ill, please advise them to stay at home until they are better and if pertussis is suspected, they should avoid vulnerable persons.Infants less than one year of ageand pregnant women in their last trimester are most vulnerable to complications of pertussis.

Symptoms of pertussis include:

  • fever,
  • runny nose,
  • cough
    • dry irritating
    • paroxysms (sudden bouts of coughing)
    • coughing so hard it causes vomiting or gagging or associated with apnea spells
    • whoop-sounding cough
    • disturbed sleep due to cough and/or
    • chronic cough lasting 2 or more weeks

Typically presents in three stages:

Catarrhal Stage: starts with mild respiratory symptoms of cough, rhinorrhea and possible fever.

Paroxysmal Stage: paroxysms of cough characterized by inspiratory whoop and vomiting after cough.

Convalescent Stage: gradual recovery with cough lasting 1-2 months or longer.

Infants less than 6 months can have an atypical presentation with short catarrhal stage, gagging, gasping or apnea as prominent early manifestations, absence of whoop and prolonged convalescence. Older children or adults may only have a persistent cough or prolonged cold like symptoms.

Testing:

Test for pertussis with a nasopharyngeal swab placed in Regan Lowe media and send swab to the Saskatchewan Disease Control Laboratory. 

Treatment:

See attached treatment/prophylactic recommendations from the Saskatchewan Communicable Disease Control Manual, which can be found at the following link:

https://www.ehealthsask.ca/services/manuals/Pages/CDCManual.aspx

Attachment – Pertussis Treatment and Chemoprophylaxis Guidelines

Drug

Dosage

Comments

Azithromycin

 

Children: 10 mg/kg/day orally on the first day followed by 5mg/kg/day once a day for the next 4 days (5 days total).

 Adults: 500 mg orally on the first day followed by 250 mg daily for the next 4 days (5 days total)

Preferred antibiotic for infants under 1 month of age.

Data on the safety of Azithromycin in pregnancy is limited however, it appears to be safe.

Clarithromycin

Children: 15 mg/kg/day provided in a divided dose bid for 7 days(not to exceed maximum of adult dose).

Adults: 250-500 mg po bid x 7 days 

Data on the safety of Clarithromycin in pregnancy is limited however, it appears to be safe.

Erythromycin

Children: Erythromycin estolate: 40 mg/kg/day provided in a divided dose tid for 7 days. The estolate is a liquid preparation, only used for children or people with difficulty swallowing.

Adults: Erythromycin 250 mg qid x7 days to maximum of 1 g per day. Some experts recommend 2 g daily in divided doses, for example:

a) The Anti-infective Guidelines for Community Acquired Infections: 2001, recommends 1-2 g po daily in divided doses.

b) The Sanford Guide to Antimicrobial Therapy, 2002, recommends 500 mg qid po.

When prescribing erythromycin prophylactically for neonates one should consider that there have been reports of infantile hypertrophic pyloric stenosis (IHPS) associated with its use in the newborns prophylaxed to prevent pertussis. The risk of IHPS after treatment with azithromycin and clarithromycin is unknown.

Erythromycin estolate  is contraindicated in individuals with existing liver disease or dysfunction, and pregnancy (CPS, 2010).

Infants <2 months of age on macrolide antibiotics should be monitored for symptoms and signs of pyloric stenosis.

For those who are allergic to macrolides, the following may be used although its efficacy is not proven:

1. Children: trimethoprim 8mg/kg/day-sulfamethoxazole 40mg/kg/day for 10 days.
2. Adults: 2 tabs bid or 1 double strength (DS) tab bid.