Pertussis secondary prevention
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Serge Korjian M.D.; Aditya Govindavarjhulla, M.B.B.S. [2]; Luke Rusowicz-Orazem, B.S.; Yazan Daaboul, M.D.
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Overview
Patients who had been infected with pertussis or have received vacccination against pertussis in the past may be re-infected (milder symptoms upon re-infection). Effective measures of secondary prevention include post-exposure antibiotic prophylaxis for individuals who are considered high-risk for developing the disease or having serious complications. Antibiotic prophylaxis regimens are similar to those used for treatment, and vary with the individual's age.
Secondary Prevention
Postexposure Prophylaxis
- The primary objective of postexposure antimicrobial prophylaxis (PEP) should be to prevent death and serious complications from pertussis in individuals at increased risk of severe disease.
- With increasing incidence and widespread community transmission of pertussis, extensive contact tracing and broad scale use of PEP among contacts may not be an effective use of limited public health resources.
- While antibiotics may prevent pertussis disease if given prior to symptom onset, there are no data to indicate that widespread use of PEP among contacts effectively controls or limits the scope of pertussis outbreaks.
Individuals who should receive postexposure antibiotic prophylaxis include the following:[1][2]
- All household contacts of a pertussis case
- Within families, secondary attack rates have been demonstrated to be high, even when household contacts are current with immunizations.
- Administration of antimicrobial prophylaxis to asymptomatic household contacts within 21 days of onset of cough in the index patient can prevent symptomatic infection.
- Persons within 21 days of exposure to an infectious pertussis case who are at high risk of severe illness or who will have close contact with a person at high risk of severe illness
- Infants and women in their third trimester of pregnancy
- All persons with pre-existing health conditions that may be exacerbated by a pertussis infection (e.g.: immunocompromised persons and patients with moderate to severe medically treated asthma)
- Contacts who themselves have close contact with either infants under 12 months, pregnant women or individuals with pre-existing health conditions at risk of severe illness or complications
- All contacts in high risk settings that include infants aged <12 months or women in the third trimester of pregnancy (e.g.: neonatal intensive care units, childcare settings, and maternity wards)
Timing
- Patients with pertussis are infectious from the beginning of the catarrhal stage (runny nose, sneezing, low-grade fever, symptoms of the common cold) through the third week after the onset of paroxysms (multiple, rapid coughs) or until 5 days after the start of effective antimicrobial treatment.
- Administer a course of antibiotics to close contacts within 3 weeks of exposure, especially in high-risk settings.
Antimicrobial Agents
The recommended antimicrobial agents and doses for chemoprophylaxis are the same as those used for the treatment of pertussis. These may vary depending on the individual's age:
Age ≥1 Month
- Erythromycin, clarithromycin, and azithromycin are preferred for the post exposure prophylaxis of pertussis in persons ≥1 month of age.[1]
- For persons ≥2 months of age, an alternative to macrolides is trimethoprim-sulfamethoxazole.[1][2]
Age <1 Month
- For infants younger than 1 month of age, azithromycin is preferred for post exposure prophylaxis and treatment because azithromycin has not been associated with infantile hypertrophic pyloric stenosis (IHPS), whereas erythromycin has.[2][3]
References
- ↑ 1.0 1.1 1.2 Pertussis Postexposure Antimicrobial Prophylaxis. Centers for Disease Control and Prevention (2016). http://www.cdc.gov/pertussis/clinical/treatment.html. Accessed on January 14, 2016.
- ↑ 2.0 2.1 2.2 Tiwari T, Murphy TV, Moran J, National Immunization Program, CDC (2005). "Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines". MMWR Recomm Rep. 54 (RR-14): 1–16. PMID 16340941.
- ↑ Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L; et al. (1999). "Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study". Lancet. 354 (9196): 2101–5. PMID 10609814.