Public Health Provider Alert from BCHHS: Update on Pertussis Outbreak

December 21, 2017

As of yesterday, Henderson County’s pertussis outbreak had increased to 52 cases, mainly in school-aged children. So far, in Buncombe County, we have had 1 probable case (lab negative, but symptoms consistent with pertussis).

Please remain vigilant and continue to promote pertussis immunization for everyone, but especially those in their 3rd trimester of pregnancy or in contact with infants.

  •          BCHHS Immunization Clinic (53 S. French Broad Ave., ground floor) is open Monday-Friday, 8am-5pm, no appointment necessary. We will be closed 12/25-12/27 and 1/1/18.

 

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 and may have other atypical features.

As a reminder, if you suspect someone of having pertussis, please do all 4 of the following steps:

  1.        Test
    •          Collect both a PCR and culture of nasopharyngeal secretions for Bordetella pertussis.
    •          Please note that we do NOT perform testing for pertussis at Buncombe County Health and Human Services.
    •          If you have to send a patient suspected of having pertussis elsewhere for lab work, please be sure to provide them a mask to wear.

 

  1.        Treat
    •          Macrolides are first-line treatment. For adults, the easiest option is Azithromycin 500 mg PO x 1 day, then 250 mg PO daily on days 2-5.
    •          If allergic to macrolides, prescribe TMP/SMX (160 mg/800 mg) PO BID x 14 days.
    •          See Table 4 at this link for dosing regimens for children as well as other macrolide dosing https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4

 

  1.        Exclude
    •          Persons suspected of having pertussis should refrain from all public activities, staying home from school, childcare, extracurricular activities, places of worship, and work until they have completed the first 5 days of appropriate antibiotics.
      • They especially should avoid contact with infants & young children and pregnant women.
    •          Persons suspected of having pertussis who choose not to take antimicrobial treatment should stay isolated at home for 21 days from their onset of cough or until their cough resolves, whichever occurs first.

 

  1.        Report
    •          Per NC law, medical providers must report all suspected and confirmed cases of pertussis to your local health department within 24 hours.
      • For Buncombe County, call our Communicable Disease nurses at 250-5109 (available 24/7/365).
      • It is very helpful to our investigation if you can tell us if the person suspected of having pertussis has any high-risk contacts (infants, pregnant women, or persons with an underlying medical condition that may be worsened by pertussis).
      •   Be aware that when BCHHS Communicable Disease 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.

For more details on pertussis, see https://www.cdc.gov/pertussis/clinical/  

Our Communicable Disease nurses are also available for consultation if you are uncertain of how to proceed or want to talk through a scenario. Please call them at 828-250-5109 anytime you have questions.

 

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