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From January 1 to July 9, 2010, a total of 135 pertussis cases have been identified among San Diego County residents, compared to 43 cases identified during the same time period last year. In addition, there have been five fatal cases in California this year, all among Hispanic infants less than three months of age.
Pertussis should be considered in adults and adolescents with unexplained cough illness lasting at least two weeks. A diagnosis of pertussis is often challenging in young infants given that the cough may be undetectable or mild and fever is usually not present. Mild illness may quickly transform into respiratory distress and include apnea, hypoxia or seizures. Because delays in treatment may increase the risk of fatal illness in young infants, suspected cases should be promptly treated with azithromycin, monitored closely, and possibly hospitalized in a facility with direct access to intensive care, especially if the infant is less than three months of age. A white blood cell count of greater than or equal to 20,000 cells/mm3 with greater than or equal to 50% lymphocytes is a strong indication of pertussis.
Patients being treated for pertussis should be asked to stay home until five days of appropriate treatment are completed. Contact with infants and others susceptible to the disease should be avoided during this time. Persons who have had direct contact with respiratory, oral, or nasal secretions from a symptomatic case should receive chemoprophylaxis within 21 days of exposure. Antimicrobial agents and dosing regimens for postexposure prophylaxis (PEP) are the same as for treatment of pertussis. More information about pertussis treatment and PEP is available here. [2]
All suspected and confirmed pertussis cases should be promptly reported to the San Diego County Immunization Program via Confidential Morbidity Report (CMR) by FAX to (619) 692-5677 or by calling (866) 358-2966 (select option #5). To confirm a pertussis diagnosis, a nasal aspirate (preferable) or a nasopharyngeal swab should be obtained for PCR testing and/or culture (available at reference laboratories). Serological tests are not recommended.
Children should receive five doses of DTaP by kindergarten: one dose at two months, four months, six months, 15–18 months, and four to six years. A Tdap booster is recommended at age 11 or 12 and for adults <65 years of age who have not yet received a booster. As part of the “cocooning” strategy, all close contacts of infants (e.g., parents, siblings, grandparents, child care providers, etc.) and all healthcare workers should be immunized against pertussis with Tdap or DTaP vaccine, as age appropriate. Ideally, women should be vaccinated before pregnancy, but can also be vaccinated during pregnancy or immediately post-partum.