Whooping Cough – HPA Guidance

Bordetella Pertussis from Sanofi Pasteur (flikr website)

This is a summary of guidance from the HPA on how to manage Whooping Cough. A member forwarded this on to me and requested I pass on the information as it is so important - so please do the same if you have other stuff you think everyone should know! There is separate guidance for the management of Health Care Workers.

Over the last year an outbreak of Whooping Cough has been declared because of the large numbers of cases. In September of this year a vaccination programme for women between 28 and 38 weeks of pregnancy was announced. If your pregnant patient asks about the vaccination, there is a useful NHS leaflet.

Those most at risk of serious illness are infants under the age of 4 months who are unimmunised or have had partial immunisation. Most of the management of Whooping Cough is directed at trying to avoid infection in this age group. In adults and older children, illness is usually mild and treatment doesn't alter the course of illness if given more than 2/52 after the onset of illness.

What is the incubation period?

Between 5 and 21 days

How is a Case Defined?

Suspected Case:

  • Any person a Clinician suspects of having pertussis infection OR
  • Any person with acute cough lasting 14d or more, without an apparent cause, plus one or more of the following:
    • Paroxysms of coughing
    • Post-tussive Vomiting
    • Inspiratory Whoop

Confirmed Case:

  • Positive culture, serology or PCR.

Notifying

All suspected and confirmed cases must be notified to the HPA.

What Laboratory tests can be done?

Culture.  This should be of the posterior nasopharynx (ie not the anterior nasal space or the tonsils), either of the nasopharynx, or the postnasal space. Normally one of those swabs with the very thin wire stem would be used to take the swab. They should only be done in the first 2/52 of symptoms, as after that they are unlikely to be positive. In vaccinated and older children, the swab is less likely to be positive. A negative swab doesn't rule out infection.

Serology. This should only be done where the patient has been coughing for more than 2/52. It is likely to be difficult to interpret in infants under 3m old or in people who have had recent vaccination. It should not be done in people who have had vaccination within the last year. Generally if thinking about checking serology in those 6 years or younger, discuss it with microbiology. I discussed a case today and they advised not to bother doing serology and advised that it is being done more where there is clinical doubt in older people with cough.

PCR. This is done off swabs and can be useful for young infants, but we would not normally be doing this.

How do you manage people who are suspected or confirmed cases or contacts?

Management consists of 3 steps:

  1. Antibiotic treatment for some cases
  2. Chemoprophylaxis for some contacts
  3. Vaccination for some contacts.

Antibiotic treatment once the patient is past the first couple of weeks of symptoms is unlikely to alter the course of illness. If they are beyond 21d of symptoms they will also not be infective, so in most cases, antibiotics will be being used to reduce the chance of spread.

See the table below from the HPA for further management of cases and contacts:

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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2 Responses

  1. Dr Richard Fry
    Thanks Louise, useful. Hands up all those who have recently successfully taken per-nasal swabs in children......?!
  2. I love these articles! I'm always wary of the ethical connotations of "...antibiotics will be being used to reduce the chance of spread..." i.e. exposing an individual to an antibiotic knowing that it won't actually personally benefit them. Atleast with imms to create herd immunity, the risks are really tiny and there is benefit to the person.

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