[6-24-2017: Please see all the outstanding CDC recommendations on Pertussis beginning at Pertussis (Whooping Cough). See also Clinical Features as Best Practices for Healthcare Professionals on the Use of Polymerase Chain Reaction (PCR) for Diagnosing Pertussis recommends:
Early signs and symptoms of pertussis are often non-specific, making it difficult to determine clinically who has pertussis in the earliest stages. However, only patients with signs and symptoms consistent with pertussis should be tested by PCR to confirm the diagnosis. Testing asymptomatic persons should be avoided as it increases the likelihood of obtaining falsely-positive results. Asymptomatic close contacts of confirmed cases should not be tested and testing of contacts should not be used for post-exposure prophylaxis decisions.
Here are Tips from the CDC page Clinical Features [of Pertussis]:
- Once pertussis is diagnosed in a household, consider pertussis in coughing close contacts.
- In the youngest infants, atypical presentation is common – the cough may be minimal or absent and the primary symptom can be apnea.
- Remember, infants are at risk for severe or fatal pertussis. When you suspect a case in an older child, adolescent, or adult, inquire about contact with infants or pregnant women and consider prophylaxis.
And here are some related pages from the Clinical Features page:
CDC Expert Commentary in partnership with Medscape, 3:36 minutes
- Red Book 2009
2010 JAMA article with CME
Every resource in the above section was added 6-24-2017
In 2010 there were 27,000 cases of pertussis (commonly called whooping cough) reported in the United States. Since 2004, there have been more than 100 infant deaths from pertussis. And in 2010 alone, there were more than 20 infant deaths according to Dr. Jennifer Liang, of the Center’s for Disease Control. (1)
Pertussis (whooping cough) is most dangerous in newborns (infants less than 30 days old) and in infants less than 4 months old and it is these groups that are at greatest risk for serious complications including death from whooping cough.
And so we vaccinate infants (beginning at 2 months old), older children, and adults to prevent newborns (who have not yet been immunized) and younger infants who have not yet completed pertussis immunization from getting pertussis.
Pertussis immunity from infant vaccination wears off with time. And that is why we recommend a dose of pertussis vaccine at age 11 or 12 years. Adults who have not received pertussis vaccination in the past should receive a dose. (2)
Pertussis symptoms occur from 5 to 21 days after the patient is exposed to pertussis (average time from exposure to symptoms is 7 to 10 days).
During the first week or two of symptoms the patient will have mild cold-type symptoms (stuffy nose, runny nose, sore throat [mild], a mild regular cough [dry], and no fever or a low-grade fever. Infants can have apneic spells before the onset of the typical whooping cough which is a paroxysmal cough. The paroxysmal cough lasts two to six weeks. Following that there can be 2 to 6 more weeks of a regular cough. (3)
Laboratory diagnosis of pertussis is difficult and experts emphasize clinical diagnosis. The reason we want to diagnose and treat pertussis is because prompt treatment will cut short the time that a person can spread pertussis and thus can help prevent infants from catching the disease.
Details on treatment of pertussis are available from the Centers for Disease Control. (3)
How do we make a diagnosis of pertussis, whooping cough?
Well, one thing you can do is to use your phone to video the child’s coughing spell and then you can show the video to the doctor when you take the child in. This is very important because the child can look completely normal when he is not having the paroxysmal cough.
Also it turns out that the whoop which comes at the end of a series of hard coughs (the paroxysmal cough) only occurs in about half of the patients with “whooping cough”. So the absence of a whoop in no way rules out pertussis.
The outstanding website www.whoopingcough.net has a number of outstanding resources for parents and doctors. To see a video and some audios of whooping cough you can go to the page “Symptoms, sounds, and a video”. (4)
There is a letter that you can print out for your doctor if you think your child has pertussis. (5)
Dr. Doug Jenkinson is an expert on Pertussis and the author of the website, www.whoopingcough.net. I urge everyone to take a look at this wonderful site which will help doctors and parents diagnose whooping cough.
(1) Tdap: Now for Pregnant Women and 65 Plus from CDC Expert Commentary, October 2011 at https://www.medscape.com/viewarticle/749020 .
(2) FDA Approval of Expanded Age Indication for a Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine. MMWR Sept 23, 2011 at https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6037a3.htm?s_cid=mm6037a3_w .
(3) Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis. MMWR Dec 9, 2005 at https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htms_cid=rr5414a1_e#tab4.
(4) Symptoms, sounds, and a video at https://www.whoopingcough.net/symptoms.htm .
(5) Whooping Cough Printout for Doctors at https://www.whoopingcough.net/For_doctors.htm.