Pertussis (whooping cough)

Potential pertussis cases could present with:

• Patient describes ‘coughing fits’
• ‘whoop’ sound at end of coughing fit
• Patient goes blue in face or lips after coughing
• Patient or referring clinician thinks ‘might be pertussis/whooping cough’
• Patient states has been in contact with confirmed case

Patients are considered contagious for three weeks from the start of cough

• Inform NIC/EPIC as soon of suspicion of pertussis is raised
• Place patient in isolated clinical area according to availability (normally room 16)
• Care providers must be confirmed as fully vaccinated against pertussis
• Clinical contact will require level 2 PPE : disposable apron, gloves, FFP3 mask
• Diagnostic testing is by PCR test, swab from oropharyngeal mucosa. Oral treatment can be started if the clinical case is compelling. Swabs generally reported within 48 hours.
• Antibiotics can be considered if a patient presents within 2 weeks of cough starting
  • See the antibiotic section below for caveats and notes on special groups
  • The role of treatment is to reduce spread rather than limiting symptoms, and this should be explained clearly to patients.
  • Advise patient that they should consider themselves contagious, and should isolate until they have taken at least two days/48 hours of clarithromycin therapy.
• If diagnosed more than three weeks after cough started, there is no benefit from antibiotics and patients are not considered contagious.
• All paediatric cases should be discussed with paeds on call.

Note that pertussis is a notifiable disease in Scotland. See the handbook page on notifiable diseases for further information, and action on calling the public health team.

• Antibiotic therapy can be considered for clinical indications within 14 days of onset of cough in a case (this is a reduction from the previously recommended 21 days).
• However, where the case has a household or other close contact who falls into priority group 1 (see high priority group section below), antibiotic therapy is recommended for all cases within 21 days of onset of cough.
• Treatment is oral clarithromycin 500mg bd for 7 days (or appropriate paediatric dose – see BNF)
• For pregnant patients please see the references on the side of the page for more information

From section 2.2.3 of the June 2024 revision of the UK Health Security Agency "Pertussis: guidelines for public health management", the high priority groups are:

• Group 1: Individuals at increased risk of severe complications (‘vulnerable’)
  1. Unimmunized infants (born at less than 32 weeks) under 2 months of age regardless of maternal vaccine status.
  2. Unimmunized infants (born from 32 weeks) under 2 months of age whose mothers did not receive maternal pertussis vaccine after 16 weeks and at least 2 weeks before delivery.
  3. Infants from 2 months to less than 5 months of age, regardless of maternal vaccination status or gestational age at delivery.
  4. Infants from 5 months to less than 1 year of age who have received less than 3 doses of a pertussis-containing vaccine (for example, DTaP/IPV/Hib/HepB), regardless of maternal vaccination status or gestational age at delivery.
• Group 2: Individuals at increased risk of transmitting to ‘vulnerable’ individuals in ‘group 1’ if they have pertussis, who have not received a pertussis-containing vaccine more than one week and less than 5 years ago
  1. Pregnant women who have reached 32 weeks’ gestation.
  2. HCWs who provide close personal care to infants (as defined in Group 1 above) and pregnant women.
  3. People whose work involves regular, close and prolonged contact with infants as defined in Group 1 above (for example, nursery workers in baby rooms).
  4. People who share a household with an infant as defined in ‘vulnerable’ infants in Group 1 above