Alert from BCDH: Pertussis Outbreak

September 11, 2015

Once again, we are seeing an increase in cases of pertussis in Buncombe County, so please have a high index of suspicion for it as you are seeing patients.

Symptoms of pertussis:  In the absence of a more likely diagnosis, persons with the following symptoms should be suspected of having pertussis:

  • Cough lasting for >2 weeks PLUS 1 of the following
    • paroxysms (violent fits) of coughing
    • inspiratory whoop
    • post-tussive vomiting
    • apnea (with or without cyanosis) in an infant <1 year old
  • Keep in mind that infants <6 months of age, partially vaccinated children, adolescents and adults frequently do not have the characteristic whoop.

Per NC law, you must contact the Disease Control staff of your local health department within 24 hours if you SUSPECT someone of having pertussis.

  • By doing so, you help us prevent or stop the spread of pertussis in our community.
    • For Buncombe County Disease Control, call 250-5109 (available 24/7, even on holidays)
  • Please remember to tell those patients you suspect or know to have pertussis to stay home under respiratory isolation (no work, no school, no extracurricular activities, no grocery shopping, etc.) until they finish their course of antibiotics.
    • Most importantly, they should stay away from unvaccinated infants and all pregnant women in their 3rd trimester

Bottom line -- IF YOU SUSPECT PERTUSSIS:  TEST, TREAT, EXCLUDE AND NOTIFY THE HEALTH DEPARTMENT.

When health department nurses conduct pertussis investigations and find symptomatic contacts to suspected or known cases, we ask these persons to see their primary care provider for testing and evaluation, so you may be seeing an increase in patients fitting this description.

  • Testing for pertussis is NOT performed at the Buncombe County Dept. of Health, so please do NOT refer patients to us for testing.

Please also continue to encourage vaccination of your patients, co-workers, family and friends with Tdap, including pregnant women in their 3rd trimester.

  • If you are unable to provide your patients Tdap in your office, please send them to their local health department.
    • Buncombe County Health and Human Services’ Immunization Clinic (53 S. French Broad Ave., ground floor) is open Monday-Friday, 8am-5pm, no appointment necessary. 

Testing for pertussisAll persons suspected of having pertussis should have the following 2 tests:

1.       Culture of nasopharyngeal secretions for pertussis AND

2.       PCR testing of nasopharyngeal secretions for pertussis

Incubation period:  commonly 7-10 days


Communicability:  Highly contagious in the first 2 wks; negligible by 3 weeks.  

  • Patients are no longer contagious after 5 days of treatment with appropriate antibiotics.

TreatmentAzithromycin (x 5 days), clarithromycin (x 7 days) or erythromycin (x 14 days) to shorten the period of communicability. 

  • Respiratory isolation of suspected or known cases until antibiotic course is completed.  
  • Suspected or known cases should stay away from infants & young children, especially unvaccinated infants, until they have completed 5 days of appropriate antibiotics.
  • Suspected cases who do not receive antibiotics should be isolated for 3 weeks after the onset of cough or until the end of the cough, whichever comes first.

Please contact the Buncombe County Disease Control staff (#250-5109; available 24/7) if you have any questions regarding pertussis or any other communicable disease issue.

Thanks for your help in stopping the spread of pertussis,

Jennifer Mullendore, MD, MSPH

Medical Director

Buncombe County Health and Human Services

Office:  (828) 250-6308

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