We have noted an increase in reported cases of pertussis. In July, we had 3 reports of confirmed pertussis cases (confirmed is defined as either laboratory-confirmed or an epidemiological link to a laboratory-confirmed case). In August (as of August 23), there have been 12 confirmed pertussis cases reported. Some of these cases are connected to each other and others are not. The cases range in age from babies to adults in their late thirties. Six of the 12 confirmed cases are unvaccinated. Increases in pertussis cases are also being noted elsewhere in Ontario, Canada and the United States. Several approaches are being recommended to try and control the spread of pertussis as follows:
Vaccination:
Please be sure to offer pertussis-containing vaccine to those who require it. Tetanus-Diphtheria-Acellular Pertussis (Tdap - Boostrix or Adacel) is recommended for the 14-16 years old adolescent booster and for adults who have not previously received an adult dose of pertussis-containing vaccine (including adults who need a tetanus shot for wound management).
There is no minimum interval between two tetanus-containing vaccines if the second vaccine is indicated for pertussis protection. Even if a tetanus-containing vaccine was just administered, a vaccine that contains tetanus and pertussis can be given to provide pertussis protection. If a very significant local reaction resulted after the first tetanus-containing vaccine, consultation should be sought before the second tetanus-containing (and pertussis-containing) vaccine is given.
It is particularly important to protect young infants from pertussis by vaccinating them as soon as possible at 2, 4 and 6 months of age and by ensuring vaccination of those in contact with infants. Based on current Canadian recommendations, pregnant women who have not previously received a pertussis-containing vaccine should be vaccinated as soon as possible after delivery.
Watching for cases and swabbing them:
Please be on the alert for possible symptoms of pertussis, including a persistent cough. If pertussis is suspected, please obtain a nasopharyngeal swab for pertussis testing and contact the Health Unit at 519-663-5317 ext. 2330. Swabs can be obtained by calling the Public Health Laboratory at 519-455-9310 or by calling the Health Unit 519-663-5317 ext. 2330.
Treating cases:
The US Center for Disease Control and Prevention (CDC) recommends that clinicians strongly consider treating prior to test results if the clinical history is strongly suggestive or the patient is at risk for severe or complicated disease (e.g. infants).
Ontario guidelines state that antibiotics should be administered as soon as possible after onset of illness; there is no limit to the start date for treatment of symptomatic, untreated cases of pertussis whose culture or PCR results are positive.
Drugs and dosages for treatment can be found in the attached document.
Prophylaxis of contacts:
Prophylaxis of contacts is designed to prevent transmission to infants (less than 1 year of age) who are most vulnerable to complications from pertussis. The Health Unit will assist with the identification of contacts for prophylaxis by their health care provider. The drugs and dosages for prophylaxis are the same as for treatment (see attached document).
Additional information can be found on the following web sites:
Bryna