Pertussis cases in Idaho
To: Health care Providers
From: Southeastern Idaho Public Health
Subject: Pertussis cases
Recently, we have seen an increase in pertussis cases in Southeastern Idaho. There have been 3 new cases of PCR positive pertussis cases reported in the month of May. Ages of these cases range from infants to adolescents, and and we must assume that other cases are present in our communities. Southeastern Idaho Public Health (SIPH) is asking you for your cooperation in early identification, reporting, and prophylaxis of immediate/household contacts.
The following are current recommendations:
1. Report all presumptive cases of Pertussis at the time of identification. This identification may include a reasonable suspicion of Pertussis based on clinical symptoms (see clinical case definition). Waiting for laboratory confirmation may delay control measures and allow spread to other community members.
2. Obtain PCR or culture testing on possible cases of Pertussis. This is most important if day care, school or other congregate settings are involved.
3. Prescribe prophylactic antibiotics to all household members of a confirmed case of Pertussis (see prophylaxis recommendations chart below).
4. All presumptive cases of Pertussis must receive 5 days of appropriate antibiotics prior to resuming work, day care or school activities.
Clinical case definition:
A cough illness lasting at least 2 weeks with one of the following: paroxysms of coughing, inspiratory “whoop”, or post-tussive vomiting, and without other apparent cause. Presumptive diagnosis may be made on the basis of clinical symptoms, however confirmation of pertussis is based on laboratory testing.
Laboratory recommendations:
Testing for Pertussis should be limited to PCR and culture. According to the Centers for Disease Control, serologic testing should be interpreted with caution.
Several studies have shown that specimens obtained for culture within 3 weeks of cough
onset had a higher proportion of culture-positive results compared with specimens taken
later in the illness.
Prophylaxis recommendations for all patients and household contacts:
The following is the recommendation of the American Academy of Pediatrics in the 2009 Red Book. (Table 3.44, pg. 507)
Dosages of prophylactic medication
|
Recommended Drugs |
Alternative |
|
Age group |
Azithromycin |
Erythromycin |
Clarithromycin |
TMP-SMZ |
|
Younger than 1 month |
10 mg/kg/day as a single dose for 5 days |
40mg/kg/day in 4 divided doses for 14 days |
Not recommended |
Contraindicated at younger than 2 mo of age |
|
1 through 5 months |
See above |
see above |
15 mg/kg/day in 2 divided doses for 7 days (maximum 1 g/day) |
2 mo of age or older; TMP, 8 mg/kg/day;SMX, 40 mg/kg/day in 2 doses for 14 days |
|
6 mo or older children |
10 mg/kg as a single dose on day 1 (maximum 500 mg); then 5 mg/kg/day as a single dose on days 2-5 (maximum 250 mg/day) |
40 mg/kg/day in 4 divided doses for 14 days (maximum 2 g/day) |
15 mg/kd/day in 2 divided doses for 7 days (maximum 1 g/day) |
See above |
|
Adolescents and adults |
500 mg in a single dose on day 1, then 250 mg per day on days 2-5 |
2 g/day in 4 divided doses for 14 days |
1 g/day in 2 divided doses for 7 days |
TMP, 200 mg/day; SMX, 1600 mg/day in 2 divided doses for 14 days |
Reporting:
24 hour recorded reporting: 1-800-632-5927
24 hour emergency contact: 1-800-632-8000
Local contact 208-478- 6303
Thank you for your cooperation in this matter. SIPH will continue to update you as more information becomes available. For more information, please call 208-478-6303