Pertussis, or whooping cough, is a highly contagious bacterial infection that causes an uncontrollable, violent
cough lasting several weeks or even months. It is caused by a bacterium that is found in the mouth, nose
and throat of an infected person. Pertussis may begin with cold-like symptoms or a dry cough that progress
Pertussis can occur at any age. Children who are too young to be fully vaccinated and those who have not
yet completed the primary vaccination series are at highest risk for severe illness. Since the 1980s, the
number of reported pertussis cases has gradually increased in the United States. In 2005, over 25,000 cases
of pertussis cases were reported in the United States, the highest number of reported cases since 1959.
Approximately 60 percent of the cases were in adolescents and adults and may be a result of decreasing
Pertussis is primarily spread from person to person by direct contact with mucus or droplets from the nose
and throat of infected individuals. Frequently, older siblings who may be harboring the bacteria in their nose
and throat can bring the disease home and infect an infant in the household.
Pertussis 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 mucous may be discharged from the nose. These episodes may recur for one to
two months, and are more frequent at night. Older people or partially immunized children generally have
How soon after infection do symptoms appear?
The incubation period is usually seven to ten days with a range of four to 21 days and rarely may be as long
When and for how long is a person able to spread pertussis?
If untreated, a person can transmit pertussis from onset of symptoms to three weeks after the onset of
coughing episodes. The period of communicability is reduced to five days after treatment with antibiotics.
What are the complications associated with pertussis?
Major complications of pertussis are more common among infants and young children and may include
pneumonia, middle ear infection, loss of appetite, sleep disturbance, syncope (temporary loss of
consciousness), dehydration, seizures, encephalopathy (a disorder of the brain), apneic episodes (brief delay
The recommended antibiotics for the treatment and postexposure prevention of pertussis include
azithromycin (Zithromax), erythromycin and clarithromycin (Biaxin). Alternately, trimethoprim-
Does past infection with pertussis make a person immune?
Neither vaccination nor natural infection with pertussis guarantees lifelong protective immunity against
pertussis. Since immunity decreases after five to ten years from the last pertussis vaccine dose, older
children, adolescents and adults are at risk of becoming infected with pertussis and need vaccination.
The childhood vaccine for pertussis is usually given in combination with diphtheria and tetanus. Immunization
authorities recommend that DTaP (diphtheria, tetanus, acellular pertussis) vaccine be given at two, four, and
six and 15 to 18 months of age and between four and six years of age.
In 2005, a new vaccine was approved as a single booster vaccination for adolescents and adults called Tdap
(tetanus, diphtheria, and acellular pertussis).
The preferred age for routine vaccination with Tdap is 11 or 12 years old. Adolescents, aged 11 through 18
should receive a single dose of Tdap instead of Td (tetanus, diphtheria) for booster immunization against
tetanus, diphtheria, and pertussis if they have completed the recommended childhood DTP/DTaP vaccination
For adults who are 19 through 64 years of age and have not previously received a dose of Tdap, a single
dose of Tdap should replace a single dose of Td for booster immunization if the most recent tetanus toxoid-
containing vaccine was received at least ten years earlier.
Adults in close contact with an infant aged under 12 months who have not previously received Tdap should
receive a dose of Tdap; an interval as short as two years since the most recent Td is suggested.
Healthcare personnel in hospitals and ambulatory care settings with direct patient contact who have not
previously received Tdap should receive a dose of Tdap; an interval as short as two years since the most
In New York State, pertussis vaccine is required of all children born after 1/1/2005 who will be enrolled in
pre-kindergarten programs and schools. Tdap vaccine is required for children born on or after 1/1/1994 and
What can be done to prevent the spread of pertussis?
The single most effective control measure is maintaining the highest possible level of immunization in the
community. Treatment with appropriate antibiotics, such as Zithromax, will shorten the time a person can
spread pertussis to five days after the beginning of treatment. People who have or may have pertussis
should stay away from young children and infants until properly treated. Treatment of people who are close
contacts of pertussis cases is also an important part of prevention.
Parapertussis is a bacterial illness that is similar to pertussis (whooping cough) but is not as common and
generally causes less severe symptoms. Up to 40 percent of all cases of parapertussis will present with no
symptoms. Very young infants (less than six months of age) may have a more severe course of
parapertussis than older persons. Parapertussis is spread through the air in droplets produced during
coughing and sneezing. A person can be infected with parapertussis and pertussis at the same time.
Parapertussis can be distinguished from pertussis by certain laboratory tests. Antibiotic treatment should be
started as soon as parapertussis is suspected. All infants less than six months of age should receive
antibiotics as a preventive measure if they have been in contact with a person who has parapertussis.
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