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Health Provider Information about Pertussis

A marked increase in pertussis cases and school outbreaks has recently been noted by several local health jurisdictions, primarily in the Bay Area. Pertussis is cyclical with peaks every 3-5 years. As you know, California experienced a pertussis epidemic in 2010 when >9,100 cases were reported and many other states experienced epidemics in 2012. California Department of Public Health advises that the reported increase in cases in California may signal the start of another epidemic. The most severe cases of pertussis occur in young infants. Infants <6 months of age are most likely to be hospitalized and infants <3 months of age are most likely to die from pertussis infection.

Health care providers can protect the lives of their patients by taking the following steps:

Clinical Action Steps to Prevent Pertussis and Pertussis-associated Complications

Think pertussis

Consider the diagnosis of pertussis in your patients and their close contacts:

  • Inform your staff to increase awareness to patients calling for advice/appointments with the symptoms listed below:
    • Paroxysmal cough characterized by bursts of rapid cough
    • High-pitched, inspiratory "whoop"
    • Apnea and/or Cyanosis (especially age < 3 months)
    • Post-tussive vomiting or gagging
    • Between paroxysms of cough, infant may appear healthy.
    • Unvaccinated infants may have a marked lymphocytosis indicative of pertussis.
  • Symptomatic persons should be offered priority access to care and separated from others.
  • Immunized children can get pertussis. Vaccine is 60-90% effective in preventing moderate to severe pertussis and immunity to pertussis has been shown to wane 6-12 years after vaccination.
  • Young infants: The diagnosis of pertussis is often delayed or missed because of a deceivingly mild onset of runny nose. There usually is no fever. Cough may be undetectable or mild. Illness may present as apnea, hypoxia or seizures. After a few days, mild illness may suddenly transform into respiratory distress. A white blood cell count of ≥ 20,000 cells/mm³ with ≥ 50% lymphocytes is a strong indication of pertussis.
    • Clinicians should have a low threshold for testing in infants and pregnant women in their third trimester who have an acute cough illness > 5 days without other explanation.
      Infants <6 months of age infected with pertussis typically have a different clinical presentation than older children and adults. They may have no apparent cough and parents may describe episodes in which the infant’s face turns red or purple. Leukocytosis is typically present in unvaccinated infants. Recent studies indicate that white blood cell counts should be carefully monitored in infected infants as an indicator of illness severity and that if exchange transfusion is to be beneficial, it should be done before organ failure has occurred and immediately if shock or hypotension occur.
      Clinical guidance on pertussis recognition and treatment in young infants is available at:
  • Adolescents and adults: Most cases are not diagnosed. A misdiagnosis of bronchitis or asthma is common. The patient may report of episodes of a choking sensation or of sweating. Leukocytosis/lymphocytosis is not likely to occur in this population.

Test for pertussis

Delays in recognition of pertussis may contribute to adverse clinical outcomes:

Treat for pertussis

Delays in treatment before or after hospitalization may increase the risk of fatal illness:

  • Young infants: Because pertussis may progress rapidly in young infants we suggest that you treat suspected and confirmed cases promptly with azithromycin, monitor them very closely, and consider hospitalization in a facility that has direct access to intensive care (especially if the infant is < 3 months of age). The white blood cell count may increase substantially during the illness. Almost all fatal cases have extreme leukocytosis with lymphocytosis, pneumonia, and pulmonary hypertension.
  • Treat cases and prophylax close contacts promptly. For treatment and prophylaxis information by age group, see the Pertussis Treatment Chart.

Report pertussis

Prompt reporting supports prevention and control efforts:

  • To assist in preventing additional cases, please report promptly suspected and confirmed cases of pertussis to Contra Costa Public Health by phone, 925-313-6740 and/or fax: 925-313-6465.

Prevent pertussis

The most important strategy to prevent infection in vulnerable infants is Tdap vaccination of pregnant women and should be prioritized.

Assess pertussis immunization status, and use every patient encounter to vaccinate:

  • Studies have shown that half of the infants with pertussis are infected by their parents, particularly their mothers. All pregnant women should receive Tdap vaccine during each pregnancy, preferably in the third trimester, regardless of their vaccination history. It is hoped that transplacentally transferred antibodies will protect young infants against pertussis until they can be immunized. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks gestation. Fathers may be vaccinated at any time, but preferably before the birth of their baby.
  • All close contacts to infants and health care workers should be immunized against pertussis with Tdap or DTaP vaccine, as age appropriate.
    • All contacts 7 years and up should receive one dose of Tdap if indicated for immunization.
  • Tdap for Pregnant Women.
  • Vaccinate for pertussis at the earliest opportunity, especially during hospitalization for birth and clinic visits for wound management, checkups or acute care.

Additional Resources

Physicians who need to report a suspected public health emergency should contact the Public Health division immediately at 925-313-6740; or after hours, call the sheriff's dispatch at 925-646-2441 and ask for the Health Officer On Call.

See more information designed specifically for health care providers.