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Department of public


Communicable Disease Control
(whooping cough)

What is Pertussis?
Pertussis, or whooping cough, is one of the most deadly diseases of infants and young children. It is a highly contagious
disease involving the respiratory tract (throat and lungs). It is caused by a bacteria that is found in the mouth, nose and throat
of an infected person. Ten to 30 cases reported each year in Montana.
Who gets pertussis?
Pertussis can occur at any age. Seventy-five percent of reported cases occur in children under one year of age.
How is pertussis spread?
Pertussis is primarily spread by direct contact with discharges from the nose and throat of infected individuals. It is usually
spread through the air by coughing or sneezing. Frequently, older siblings who may have the bacteria in their nose and throat,
bring the disease home and infect an infant in the household.
What are the symptoms of pertussis?
Pertussis usually begins as a mild upper respiratory infection. Initially, symptoms resemble those of a common cold, including
sneezing, runny nose, low-grade fever and a mild cough. Within two weeks, the cough becomes more severe and is
characterized by episodes of numerous rapid coughs followed by a crowing or high pitched whoop. A thick, clear mucus may
be discharged by coughing. These episodes may continue or recur for one to two months, and are more frequent at night.
Older people or children who have received some pertussis vaccine generally have milder symptoms.
How soon after infection do symptoms appear?
The incubation period is usually five to ten days but may be as long as 21 days.
When and for how long is a person able to spread pertussis?
A person can transmit pertussis from seven days following exposure to three weeks after the onset of coughing episodes. The
period of communicability is reduced to between five and seven days when antibiotic therapy is begun.
Does past infection with pertussis make a person immune?
One attack usually confers prolong immunity.
What are the complications associated with pertussis?
Complications of pertussis may include severe brain damage, convulsions, pneumonia, middle ear infection, loss of appetite,
dehydration. apneic episodes (period when one cannot breath) and death.
What is the vaccine for pertussis?
The vaccine for pertussis is usually given in combination with diphtheria and tetanus. The American Academy or Pediatrics
and the Advisory Committee on Immunization Practices recommends the DtaP (diphtheria. tetanus, acellular pertussis)
vaccine be routinely given at two, four, six and 15-18 months of age and with an additional dose given between four and six
years of age.
What can be done to prevent the spread of pertussis?
The single most effective control measure is having children less than seven years of age immunized on schedule and
maintaining the highest possible level of immunization in the community. Treatment of cases with certain antibiotics can
shorten the contagious period. People who have or may have pertussis should stay away from all young children and infants
until properly treated and they are no longer infectious which may be 5-7 days after treatment.
Administrative Rules of Montana 37.114.563 state, “an individual identified by the
local health officer as a close contact must be referred by the officer to a physician for
chemoprophylaxis”. In addition, rules require symptomatic close contacts to be evaluated
for Pertussis.
Health Department Recommendation(s): contact person with SYMPTOMS, Prophylaxis
and Medical Evaluation.
If Pertussis is highly suspected we encourage provider to prophylaxis household members as
soon as possible. If an infant is in the household prophylaxis house hold members immediately.

Close contacts who display symptoms of pertussis should be tested for pertussis with a NP swab
culture. The following symptoms are consistent with early pertussis in the catarrhal stage (first
one –two weeks:

The following symptoms are consistent with pertussis in the Paroxysmal stage ( >5 weeks)
Cough illness lasting 2 weeks with paroxysms of coughing Inspiratory whoop Post-tussive vomiting Afebrile or low grade fever With the cough symptoms, an elevated WBC (elevated WBC by itself is not indicative of
Close contacts with pertussis symptoms: Must avoid contact with anyone outside of the contact’s
immediate family until a medical evaluation indicates that the contact is not developing pertussis.
Close contacts without pertussis symptoms: Do not need to avoid contact outside of the
immediate family setting. Attendance at work, school and daycare is
not prohibited.
Treatment/Chemoprophylaxis Recommendations:
The Centers for Disease Control and the American Academy of Pediatrics recommend the
following chemoprophylaxis treament options for all close contacts regardless of
immunization status.

Erythromycin: For Children 40-50 mg/kg per day in 4 divided doses for 14 days.
For adults 1 - 2 grams/day orally in 4 divided doses for 14 days (maximum 2 gm/day).
Tremethoprim-sulfamethoxazole (TMP-SMZ): For children trimethprim 8 mg/kg/day,
sulfamethoxazole 40 mg/kg/day in two divided doses for 14 days.
In adults trimethoprim 320mg/day sulfamethoxazole 1600 mg/day in two divided doses for 14
Azithromycin (Zithromax): 10-12 mg/kg per day, orally, in 1 dose for 5 days; maximum 600
Clarithromycin: 15-20 mg/kg per day, orally, in 2 divided doses; maximum 1g/day for 7 days.

If you have ANY questions please call the public health nurse at: 247-3357


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