Another vaccine may be recommended for health care workers to protect them against the increasing risk of pertussis. This infection known as "whooping cough" is especially dangerous for infants. The FDA is expected to approve two new pertussis vaccines in the next year. There will be a vaccine for adolescents and another for adolescents and adults. The booster vaccine contains three antigens of pertussis and will be combined with diphtheria and tetanus boosters.
The numbers of pertussis cases have been increasing due to waning immunity in adolescents and adults. Infants are at greatest risk. Infants two months old and younger can't receive the vaccine and account for the greatest number of deaths from this infection. Pertussis is transmitted by aerosolized respiratory droplets and is highly communicable during the catarrhal stage and first three weeks after cough onset.
The standard for laboratory diagnostic testing is to isolate Bordetella pertussis by culture. Testing after antibiotics or beyond the first three weeks of illness reduces the success of isolating the organism. PCR testing and enzyme-linked immunosorbent assay for antipertussis toxin IgG are not yet nationally validated or standardized.
Clinical presentation begins with a 7-10 day incubation followed by a 1-2 week catarrhal stage with symptoms of coryza, mild fever and mild cough. The next stage presents with a paroxysmal cough lasting for 1-6 weeks followed by the convalescent stage as the cough lessens over a greater than three week period.
The preferred treatment is with macrolides (erythromycin, azithromycin or clarithromycin) but trimethoprim- sulfamethoxazole is an alternate for those patients who can't tolerate macrolides. There is currently a vaccine for prevention available for children in a five dose series. Healthcare workers with pertussis-like symptoms should be tested and treated. Employees with pertussis should be excluded from work until five days after antibiotic treatment is initiated. If no antibiotic treatment is given, the employee should be excluded from work for 21 days after the onset of symptoms. Droplet precautions are used for patients with pertussis infection. Patients are separated from others by three feet and surgical masks are worn by care providers of these patients.