Pertussis (Whooping Cough) Update

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Pertussis (Whooping Cough) Update

20-Sep-2017

A summary of symptoms, mode of transmission (communicability) and diagnostic/testing information.

Symptoms

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, gapping, gasping or apnea as prominent early manifestations, absence of whoop and prolonged convalescence.

Complications among infants include pneumonia, seizures, encephalopathy and death.

Complications in adolescents and adults include syncope, sleep disturbance, incontinence, rib fracture and pneumonia.

Incubation Period

6-20 days (average 9-10 days)

Reservoir/Source

Humans

Mode of Transmission

Person-to-person by direct contact with discharges from respiratory secretions via aerosolized droplet.

Period of Communicability:

  • Highly communicable in the early catarrhal stage and the beginning of the paroxysmal stage (first 2 weeks).
  • Communicability decreases after the catarrhal and paroxysmal stages and becomes negligible 3 weeks after onset of symptoms.
  • Case is no longer contagious after completing 5 days of treatment.

Laboratory Diagnosis

  1. Consider testing especially if patient is an infant or pregnant woman, or there is an infant or pregnant woman in the household.  
  2. A nasopharyngeal swab placed in Regan Lowe media is the preferred specimen for samples going to the Saskatchewan Disease Control Laboratory. PCR as well as culture is done on all samples. However, the culture is only reported if PCR negative.  
  3. If a case is confirmed in one household member, other symptomatic immediate household members may be assumed to be cases and do not need to be tested unless you feel there is an indication for doing so.  
  4. Symptomatic contacts who are not household members, e.g. classmates, should all be tested to ensure the correct diagnosis. (Swabbing may not be necessary after the first few confirmed diagnoses of pertussis if the clinical symptoms are very predictive).

Refer to the PDF document regarding “How to collect a NP swab & fill in requisition for pertussis 2017”.