What is the issue?
Pertussis is a highly contagious respiratory infection that is increasing in incidence.
Between 1 January 2014 and 6 January 2015 there were a total of 4,606 cases of pertussis notified to the Department of Health and Human Services which represents a 56 per cent increase in cases compared to the same time in 2013. In particular, between 2013 and 2014, cases amongst the 10-14 year age group increased by 43 per cent. Cases in infants aged less than six months increased by 38 per cent over the same time period with a total of 76 cases in 2014, compared with 55 in 2013.
Who is at risk?
Infants aged less than six months are most susceptible to the severe complications of pertussis. Adults are the main reservoir of infection due to waning immunity after vaccination in childhood.
Symptoms and transmission
Pertussis in adults is predominantly atypical, without the characteristic “whoop” and often presents as just a prolonged cough, which may go undiagnosed. This means that transmission to babies and other persons can occur readily.
Prevention and treatment
Consider a diagnosis of whooping cough in children and adults who present with a spasmodic cough, post-tussive vomiting and a post-tussive “whoop”. In addition, think of the diagnosis in any adult or child with a prolonged cough, without these features.
Attempt to confirm the diagnosis. The diagnosis of pertussis can be confirmed through:
- nucleic acid testing/PCR of naso-pharyngeal swabs (not throat) positive up to 4 weeks from onset
- or serology (note however, the lower sensitivity and specificity of this test).
Treat the patient with appropriate antibiotics. For details refer to the latest edition of Therapeutic Guidelines Antibiotic.
Notify the Department of Health and Human Services. Pertussis is a notifiable condition requiring written notification within five days of diagnosis. Notifications can be completed by post, by fax to 1300 651 170, online at health.vic.gov.au/ideas or by telephone on 1300 651 160. We would appreciate prompt notification by telephone of cases in high-risk settings, such as paediatric or neonatal health care settings.
The department will advise on prophylaxis for eligible contacts, and school or childcare exclusion if applicable.
Complete and timely immunisation of children remains the most important measure to control pertussis. Pertussis vaccine is offered as part of the National Immunisation Program for children at two (from six weeks), four, six months, and four years (from three years and six months of age). A booster dose for adolescents is scheduled at aged 15 to 16 years in 2014. In 2015, this booster dose will be offered to adolescents aged 12 to 16 years.
Check the immunisation status of all children and adolescents attending your practice and catch up any missed/overdue doses.
Women in their last trimester of pregnancy are recommended to receive a pertussis-containing vaccine if there has been an interval of five years or more since a previous dose and the expected date of delivery.
Alternatively a pertussis-containing vaccine is recommended for people planning a pregnancy or shortly after birth or for the partner at any time during the pregnancy.
Please also encourage adults working with or caring for very young babies, in particular health care and child care workers, to have an adult pertussis-containing vaccine. A pertussis containing vaccine should be used in place of dT booster at 50 years. Adults aged 65 years and over should be offered a single pertussis containing vaccine if they have not received one in the previous 10 years. Any adult who requires a dT vaccine is recommended to receive a pertussis-containing vaccine if they have not received one previously. (Source: The Australian immunisation handbook 10th Edition 2013 (updated January 2014)).
As pertussis vaccine is not fully protective, immunised people can still contract pertussis, but they are likely to have a less severe illness.
The Department of Health and Human Services fact sheet, Advice on pertussis (whooping cough) for clinicians.
If you require any further information or to notify a case, please call the Communicable Disease Prevention and Control Unit on 1300 651 160.