Pertussis (aka whooping cough) has been on the rise in Marin and California. Outbreaks are commonly occur every 3 to 5 years. Compared to 44 cases of pertussis in 2017, we had 249 reported cases in 2018. In January 2019, we had 18 confirmed cases of pertussis in Marin County.
Pertussis is a common, highly contagious bacterial disease. Most adolescents and adults recover without complications, but it can be deadly for infants. Within 3-5 days of antibiotic treatment, the disease is no longer transmissible to others.
Pertussis vaccines are effective, but not perfect. They offer good levels of protection during the first two years after getting the vaccine, but the protection decreases over time ("waning immunity.") For this reason, we tend to see pertussis more in middle and high school age populations. Those who are vaccinated tend to have less severe disease.
Vaccination remains the best defense against pertussis, along with appropriate screening, treatment, and prophylaxis for high risk contacts. Anyone who is around an infant less than one year of age should have current pertussis vaccination.
It is most critical for ill persons who are either high risk or may expose someone who is high risk to be evaluated by their health care provider. Persons considered at "high risk" of pertussis include infants (< 1 year old), pregnant women (especially in the third trimester), and anyone who spends time with infants or pregnant women. Health care providers may prescribe antibiotics to treat ill individuals or to prevent illness in healthy high risk household members who have been in contact with a person who is sick.
Vaccinate infants, children, adolescents, and adults according to the ACIP schedule and implement cocooning around infants. Most importantly, pregnant women should receive the Tdap vaccine between 27-36 weeks of pregnancy to protect infants.
Think pertussis. If other household members are or have been recently sick with a respiratory illness, particularly if with violent coughing fits and vomiting after coughing, discuss with your health care provider. People who have been vaccinated for pertussis often present with mild symptoms.
Test for pertussis. People who have been vaccinated for pertussis often present with mild symptoms. Have a high index of suspicion and a low threshold for testing and evaluating individuals for pertussis. Testing is most critical for symptomatic persons who are either high risk or may expose someone who is high risk. Persons considered at "high risk" of pertussis include infants (< 1 year old), pregnant women (especially in the third trimester), and anyone who may expose infants or pregnant women.
Treat pertussis cases with a course of appropriate antimicrobial therapy. The recommended antimicrobial agents for treatment or chemoprophylaxis of pertussis are azithromycin, clarithromycin, and erythromycin.
Staying at home until at least 3 days of antibiotics are completed, or if the sick person did not receive antibiotics, stay at home until 21 days since the cough started.
Coughing and sneezing into the elbow, not the hand. Use tissues and put used tissues in the waste basket.
Please contact Marin County Communicable Disease Prevention and Control (CDPC), Monday through Friday 8:30 a.m. through 5:00 p.m., if you have any questions or concerns.