Pertussis Update

Although pertussis (whooping cough) occurs less often today because most children are immunized, it is still very serious disease, especially in infants. Over half of the children who have pertussis are hospitalized and each year some die of the disease. Pertussis is spread by contact with infected people or their contaminated dishes, tissues, etc. Teenagers and adults can also catch pertussis and spread it to other individuals and small children in the home. Often, pertussis is not recognized in teenagers and adults, so the disease continues to spread in a community.

Home Care for the Pertussis Patient

Pertussis is a highly communicable disease. Therefore, visitors should not enter the home of a patient, especially during the early stages of the disease when the patient is most contagious. Anyone can catch pertussis- infants, preschoolers, school children, teenagers, and adults. Sometimes the disease even effects fully immunized children, but their disease will be much milder. The vaccine to prevent pertussis is not given after 6 years of age, so older children, teenagers, and adults can all easily catch the disease, but is normally not as serious in them.

Isolate the Patient

The pertussis patient (or anyone suspected of having pertussis) should be kept at home until at least 5 to 7 days of treatment with the antibiotic, erythromycin, have been completed. They should not attend school, a day care, work, Sunday school, or participate in any other group activities during the treatment period. Patients should not go shopping during this time since they might spread the disease to others in the store or check-out line.

Provide Bed Rest

The patient should be kept in bed as long as a fever is present. The temperature should be taken frequently. An elevated temperature may be a signal of the onset of pneumonia. The patient’s room should be kept well-ventilated. Activities which provoke coughing should be avoided- smoking, dusting, sudden changes in room temperature, laughing, and excessive movement. Between coughing attacks a patient may appear to be perfectly well.

Prepare Light Meals

A pertussis patient’s diet should be planned to avoid crumbly foods (bread, crackers) which may provoke coughing. Small frequent feedings of soft food and clear liquids (Jell-O, juice) are best. If an infant vomits after feeding, make sure that the throat is clear and offer food right away before the infant falls asleep. Giving fluids hourly will help prevent dehydration.

Clear the Breathing Passage

Infants and small children may choke on food or mucous which is loosened during a coughing attack. A soft bulb syringe made out of a single piece of material with no pieces that can come apart can be used to suction mucus out of the throat. (Your physician can show you how that is done.) Suctioning helps the patient breathe by clearing the airway. Suctioning before feeding or giving medicine helps to prevent vomiting.

Give Medicine on Time

The treatment for a pertussis patient and close contacts (even those without symptoms) is erythromycin given orally for 14 days. While this medicine may shorten the time a patient is contagious, it may not change the symptoms or improve the cough. Giving erythromycin to close household and other contacts may prevent infection. When giving erythromycin, follow your doctor’s instructions carefully and finish the prescription. It often helps to eat at the same time the erythromycin is taken.

Wash Your Hands

After each contact with the patient, wash your hands thoroughly with soap and hot water. Dispose of used tissues, paper cups, etc.,. in a plastic bag. Wash used dishes and linens in hot, soapy water.

Complications

The most common complication of pertussis is pneumonia, especially dangerous to infants under 6 months of age. If the patient develops a fever, contact you doctor at once, since it may be a sign of pneumonia. Other complications include middle ear infection; convulsions after severe coughing attacks; hemorrhages of the eyes, skin and even brain from the pressure of coughing; hernia and weight loss from vomiting.

Culturing, Treating and Immunizing Close Contacts

In addition to culturing the patient, family members and close contacts of the patient should also be cultured to determine if they are infected (even if they are not coughing). The culture is taken with a nasal swab by a doctor or health care worker. If the culture is positive, treatment with erythromycin for 14 days should be started immediately. Because the tests for pertussis are not yet perfect, your doctor may want to treat all family members for pertussis anyway to prevent spread of the disease.

For more information on Pertussis, contact your doctor, public health agency, or
Maine Department of Human Services, Bureau of Health

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Pertussis Update