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Clinical Practice Guidelines

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RCH </> > Division of Medicine </> > General Medicine
</genmed> > Clinical Practice Guidelines
</clinicalguide/> > Whooping Cough (Pertussis)

In this section
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Guidelines Index </clinicalguide/ >

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Whooping Cough (Pertussis)
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/This guideline has been adapted for statewide use with the support
of the Victorian Paediatric Clinical Network/
Background
o Caused by the bacterium /Bordetella pertussis/ (occasionally
/Bordetella parapertussis/)
o Infants less than 6 months of age are at greatest risk of
complications (apnoea, severe pneumonia, encephalopathy) and are
most commonly infected by spread from family members.
o Can occur in immunised children but the illness is generally
less severe.
o Patients are infectious just prior to and for 21 days after the
onset of cough, if untreated.
Assessment
Diagnosis is largely clinical.
History:
o Classic whooping cough: Cough and coryza for one week (catarrhal
phase), followed by a more pronounced cough in spells or
paroxysms (paroxysmal phase).
o Pertussis can also present as a non-specific persistent cough
o Vomiting often follows a coughing spasm.
o Infants may develop apnoea and/or cyanosis with coughing spasms.
o Close contact with a case of Pertussis may raise suspicion.
o Other family members frequently have a cough (>70% of household
contacts are also infected).
Examination:
o Often, there are no clinical signs. Children are usually well
between coughing spasms.
o Observation of coughing spasms may be helpful
o Fever is uncommon.
Investigations:
o Laboratory confirmation is not necessary for diagnosis, but may
be helpful for infection control.

o A nasopharyngeal aspirate/swab for PCR is the investigation of

choice. The test is usually negative after 21 days, or 5-7 days
after effective antibiotic therapy has been commenced.
o Pertussis serology (IgA) may be detectable 2 weeks after the
onset of the illness but rarely affects clinical management.
Management of patient
Antibiotics
Consider antibiotics if:
o Diagnosed in catarrhal or early paroxysmal phase (may reduce
severity)
o Cough for less than 14 days (may reduce spread; reduces school
exclusion period)
o Admitted to hospital
o Complications (pneumonia, cyanosis, apnoea)
Antibiotic options:
o Neonates
+ Azithromycin 10 mg/kg oral daily for 5 days
o Children who cannot swallow tablets:
+ Clarithromycin liquid 7.5 mg/kg/dose (max 500mg) oral BD for
7 days
# (PBS authority required. Indication: Bordetella pertussis)
o Children who can swallow tablets:
+ Azithromycin (for children = 6 months old): 10mg/kg (max 500
mg) oral on day 1, then 5mg/kg (max 250mg) daily for 4 days
# (PBS authority required. Indication: lower respiratory
tract infection)
o If macrolides are contraindicated:
+ Trimethoprim-sulphamethoxazole (8mg-40mg per ml)
# 0.5ml/kg (max 20ml) BD for 7 days
Control of diagnosed case
o Exclude from school and presence of others outside the home
(especially infants and young children) until received 5 days of
therapy, or coughing for more than 21 days.
Vaccination
o Unimmunised or partially immunised children diagnosed with
pertussis should still complete the pertussis immunisation schedule.
Notification
Notify all cases (suspected or confirmed) of pertussis to the
Communicable Diseases Section, DHS, Victoria. Tel: 1300 651 160 or
Fax: 1300 651 170.
DHS information on pertussis
<http://ideas.health.vic.gov.au/diseases/pertussis.asp>

 Notification info <http://ideas.health.vic.gov.au/notifying.asp>,

and notification form
<http://docs.health.vic.gov.au/docs/doc/Notifiable-Conditions-Form>

Treatment of Contacts
Antibiotic Prophylaxis:
Notes:
o Prophylaxis is aimed at preventing spread to infants <6 months.
o There is little evidence that antibiotics prevent transmission
outside of household settings, and side effects (especially
gastrointestinal) are relatively common.
o Transmission requires close contact (exposure within 1 metre for
more than 1 hour) but can be less for young infants.
o Most school-aged children who are fully vaccinated and do not
have symptoms do not require prophylaxis.
o Management of immunodeficient contacts should be made on a case
by case basis.
o Management of outbreaks may differ from below and will be
conducted by DHS.
Prophylaxis table:
*Antibiotics*
*No antibiotics*
Close contact with confirmed case of pertussis whilst index case
infectious (< 21 days of cough and < 5 days effective antibiotics)
*AND*
Contact with index case while no longer infectious ( > 21
days of cough and >5 days effective antibiotics)
*OR*
First contact was within 14 days (or within 21 days for infants < 6
months)
*AND*
First contact was > 14 days (or > 21 days for infants < 6
months)
*Children:*
o Age <6 months OR
o <3 doses pertussis vaccine OR
o Household member age <6 months OR
o Attend childcare in same room as infant <6 months
*Adults (regardless of immunisation status) *
o
o
o
o

Expectant parents in last month of pregnancy OR

Health care worker in maternity hospital or newborn nursery OR
Childcare worker in close contact with infants <6 months OR
Household member aged <6 months

Antibiotic options:
o Prophylaxis regimen same as for treatment (refer above)

Vaccination:
o Close contacts that are not up to date with their pertussis
immunisation should be given DTPa or dTpa as soon after exposure
as possible.
o Consider dTpa for adults who have not had pertussis-containing
vaccine in the last 10 years.
School exclusion:
o Unimmunised (< 3 doses) household and close childcare contacts
less than 7 years of age must be excluded from school or child
care for 14 days from the last exposure to infection OR until
they have taken 5 days of effective antibiotics.
When to admit/consult local paediatric team:
o Infants less than 6 months of age
o Any child with complications (apnoea, cyanosis, pneumonia,
encephalopathy)
When to consider transfer to tertiary centre:
o Any child with complications (apnoea, cyanosis, pneumonia,
encephalopathy)
For advice and inter-hospital (including ICU level) transfers ring
the Sick Child Hotline: (03) 9345 7007
Parent information sheet
o Parent Information
<http://www.rch.org.au/kidsinfo/fact_sheets/Whooping_cough/>
Information Specific for RCH
_Specimen collection and results:
_
Pertussis PCR testing: Send dry (non-charcoal or flocked swabs) from
nasopharynx (preferably) or nose, or nasopharyngeal aspirate (NPA)
Monday-Friday: specimens received in lab by 10am reported by 2pm.
Specimens received by 2pm reported by 5pm. Saturday: Specimens
received by 10am reported by 2pm. Sunday: No routine testing.

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