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Pertussis epidemic - Chief Health Officer Advisory for health professionals - 28 January 2011
In the past two years, the incidence of pertussis in Victoria has increased dramatically, with 1673 cases notified in 2008, 3741 cases in 2009 and 6736 cases in 2010.
In 2010, 66 per cent of cases were in adults. 201 cases (3 per cent of the total) were in children under the age of 12 months, of whom 40 per cent were hospitalised.
Pertussis is a highly contagious respiratory infection. Babies under six months of age are most susceptible to the severe complications of pertussis. Adults are the main reservoir of infection due to waning immunity after vaccination in childhood.
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.
What should you do?
Think, Test, Treat and Notify
Consider the 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 nasal-pharyngeal swabs (not throat), aspirates or culture or serology.
Treat the patient with appropriate antibiotics.
Notify the Department of Health. 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, completed online at health.vic.gov.au/ideas or telephone 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.
Immunisation
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, four, six months, at four years and in year 10 of secondary school (or 15 years of age).
Check the immunisation status of all children and adolescents attending your practice and catch up any missed/overdue doses.
In addition, parents of newborn babies are eligible for a free dose of pertussis containing vaccine, Boostrix, which also contains diphtheria and tetanus.
Please also encourage adults working with or caring for very young babies, especially health care and child care workers to have an adult pertussis vaccine.
As pertussis vaccine is not fully protective, immunised people can still contract pertussis, but they are likely to have a less severe illness.
Resources
The Department of Health has prepared a fact sheet Could it be whooping cough? for health practitioners with more detailed information on early detection of pertussis. Order free hard copies from the Infectious Diseases Epidemiology & Surveillance website.
If you require any further information, please call the Communicable Disease Prevention and Control Unit on 1300 651 160.
