Pertussis more commonly called whooping cough is a highly contagious infectious disease that can spread rapidly from person-to-person through contact with droplet infection e.g. coughing, sneezing, etc. It is a bacterial infection affecting the lungs and respiratory tract.
When some has a pertussis infection, they are most infectious during the early catarrhal phase but remain infectious for up to 21 days following the onset of coughing.
Babies under six months old are most at risk and the illness start with cold like symptoms. What is distinctive about pertussis is the ‘whooping’ sound of the cough and this can difficulty in breathing after a bout of coughing, with thick mucus and phlegm. This cough can also make the baby the vomit and/or their face may turn red after the cough due to the increased blood supply or blue if the infection is preventing them from breathing as a sign of too little oxygen. In very severe cases babies under 6 months they can have fits, dehydration and either of these symptoms or blue skin requires urgent medical assistance.
For babies over 6 months the infection is usually less severe and the older the child or adult the less problematic in terms of long-term complications. Longer terms symptoms from the cough include sore ribs, hernia, middle ear infections and slight incontinence as the wee leaks out after a violent cough.
As per the NHS website:
Call 999 or go to A&E if:
your or your child’s lips, tongue, face or skin suddenly turn blue or grey (on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet)
you or your child are finding it hard to breathe properly (shallow breathing)
you or your child have chest pain that’s worse when breathing or coughing – this could be a sign of pneumonia
your child is having seizures (fits)
Please use https://www.nhs.uk/service-search/find-an-accident-and-emergency-service to find your nearest A&E department.
Pertussis is a bacterial infection so it can be treated with antibiotics. After 21 days the individual is no longer infectious so antibiotics are not required.
Otherwise, the general treatment is to drink plenty of fluids, get plenty of rest and take paracetamol or ibuprofen to relieve the symptoms.
If you are not prescribed antibiotics then adults should not attend work if they are in close proximity to others and children should not attend school. If antibiotics are prescribed the then adult can attend work or the child can attend work 48 hours after taking the antibiotics as the antibiotics will stop the spread of infection. Please note the course of antibiotics MUST be completed.
The pertussis (whooping cough) vaccine has been part of the vaccine programme in the UK since the 1950’s. The current UK immunisation schedule is for babies at 8, 12 and 16 weeks to have pertussis (whooping cough) vaccine in their 6-in1 vaccines and then at 3 years and 4 months pertussis (whooping cough) is include in the 4-in-1 vaccine.
It is recommended that women are offered the vaccine between weeks 16 to 32 of pregnancy, women may still be immunised after week 32 of pregnancy until delivery. However, this may not offer as high a level of passive protection to the baby, particularly if they are born pre-term.
Post-natal vaccination-Women who did not receive pertussis containing vaccine during pregnancy can be offered it in the 2 months following birth (up until their child receives their first dose of pertussis containing vaccine). This will protect the woman and may prevent her from becoming a source of infection for the infant but will not provide direct protection for the infant.
If a pregnant woman received pertussis containing vaccine before week 16 of her pregnancy, either in error or for occupational or contact reasons, then she should be offered a second dose when she reaches 16 weeks of pregnancy or around the time of her antenatal fetal anomaly scan.
The dose should be repeated to maximise the antibodies she can transfer across the placenta to her unborn baby. If a repeat dose is required, there should be an interval of at least 4 weeks from the previous dose to minimise the risk of local reaction.
If a pregnant woman has received a dose of pertussis containing vaccine after week 16 of pregnancy for occupational or contact reasons this should be counted as a valid dose and she would not need a repeat dose.
The purpose of the pertussis vaccination programme is to boost immunity in women during pregnancy so that pertussis antibodies are passed from mother to baby to passively protect infants in the first months of life before they reach the age of routine infant vaccination.
This is achieved by vaccinating pregnant women from 16 weeks of pregnancy in order to maximise the transplacental transfer of pertussis antibodies. Therefore, it is important for all women to be offered the pertussis vaccine, ideally between weeks 16 and 32, of every pregnancy. So these vaccines should be administered for each pregnancy.
Special considerations apply to healthcare workers (HCWs) who provide close personal care to infants or pregnant women because of the nature of their interactions with vulnerable individuals meeting priority group definitions, the priority groups are:
• Priority group 1: HCWs with regular and close clinical contact with severely ill young infants (under 3 months) and women in the last month of pregnancy- This includes clinical staff working with women in the last month of pregnancy (for example, in midwifery, obstetrics and maternity settings) and neonatal and paediatric intensive care staff who are likely to have close and/or prolonged clinical contact with severely ill young infants (under 3 months of age).
• Priority group 2: HCWs with regular clinical contact with young, unimmunised infants in hospital or community settings- This includes general paediatric, paediatric cardiology, paediatric surgery and health visitor staff.
• Priority group 3: HCWs with intermitted clinical contact with young, unimmunised infants in the community- This includes HCWs in general practice.
For exposed HCWs, the objective of contact tracing is to minimise the risk of further onward transmission to vulnerable individuals. For HCWs in this category, a significant exposure is defined as either:
1. Contact with a pertussis case within their own household.
Or
2A. Unprotected, direct, face-to-face contact in their place of work (a healthcare setting) for greater than a cumulative period of one hour with a pertussis case who is within 14 days of the onset of their cough.
Or
2B. Direct contact with respiratory secretions from a pertussis case within 14 days of onset of their cough (for example, when performing aerosol-generated procedures or examination of the nose and throat in a healthcare setting without appropriate personal protective equipment (PPE); or exposure to infectious respiratory particles from case with active coughing at less than 2 metre distance).
Prolonged contact at close proximity of the kind described in 2A above is more likely to occur in inpatient settings than in outpatient settings, primary or ambulatory care, but risk assessment may be required where vulnerable (unimmunised or partially immunised) infants are concerned.
For HCWs in their place of work, close contact is likely to occur through either a single exposure, or on an intermittent basis. Time since exposure is therefore defined as the time that has elapsed since the most recent exposure to the index case, where the day of the most recent exposure is defined as day 0.
If the case (suspected, epidemiologically linked or confirmed) is a healthcare worker providing close personal care to infants in priority Group 1, or to pregnant women, they should be excluded from work as soon as a diagnosis of pertussis is suspected, until 48 hours following commencement of recommended antibiotic therapy, or for 21 days following the onset of cough if untreated. The HCW should in addition inform their occupational health department and infection prevention control team as soon as possible – and should do so even if beyond 21 days from the onset of coughing as vulnerable contacts may still be within their incubation period.
Green Book https://www.gov.uk/government/publications/pertussis-the-green-book-chapter-24
The current UKHSA advice please see https://www.gov.uk/government/collections/immunisation#pertussis-(whooping-cough)
The information for public health is at https://www.gov.uk/government/publications/pertussis-guidelines-for-public-health-management
The information about Health care workers is at https://www.gov.uk/government/publications/pertussis-occupational-vaccination-of-health-care-workers/occupational-pertussis-vaccination-of-healthcare-workers
The information for pregnant women is at https://www.gov.uk/government/publications/vaccination-against-pertussis-whooping-cough-for-pregnant-women
