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Health Advisory: Pertussis Increasing in Washington

Summary

  • From May 2023 to May 2024, pertussis cases in Washington increased 6-fold.
  • Pertussis symptoms:
    • Early symptoms can be cold-like.
    • Cough that lasts longer than 2 weeks, up to 10 weeks or longer.
    • Uncontrolled coughing.
    • “Whooping” sound on inhalation after coughing.
    • Difficulty breathing.
    • Vomiting during or after coughing fits.
    • Apnea.
  • At high risk for pertussis:
    • Infants under 1 year old are at highest risk for severe disease and death.
    • Pregnant people at 27–36 weeks gestation (third trimester).
    • Healthcare workers who come into direct contact with patients.
    • People who come into direct contact with infants under 1 year old or pregnant people, like childbirth educators, childcare workers, and members of a household with an infant.
  • All children and adults should be up to date on recommended pertussis vaccine.
  • Pregnant people at 27–36 weeks gestation (third trimester) should receive 1 dose of Tdap (tetanus, diphtheria, pertussis) vaccine (during each pregnancy).

Current situation in Washington

In 2023 CDC (Centers for Disease Control and Prevention) week 1–18, healthcare providers reported 24 cases of confirmed or probable pertussis in Washington. In this same period in 2024, providers reported 170 cases. This is a 6-fold increase. Multiple health jurisdictions reported increases.

DOH (Washington State Department of Health) updates its weekly pertussis update every Friday.

Recommendations for healthcare providers

  • Consider pertussis in:
    • Respiratory illness in infants under 1 year old, especially when paired with difficulty feeding or apnea.
    • Cough illness, in patients of any age, paired with any of these:
      • Paroxysmal cough.
      • Gagging, post-tussive emesis, or inspiratory whoop.
      • Lasts 2 weeks or longer.
    • Respiratory illness of any duration in patients who came into direct contact with someone with pertussis or pertussis symptoms.
  • Consider testing. Collect a nasopharyngeal swab for pertussis PCR (polymerase chain reaction) or culture. PCR is the most sensitive and fastest diagnostic test. While culture is the most specific option, it is not the most sensitive and is rarely done. Do not use serology to diagnose pertussis in Washington.
    • Negative pertussis PCR or culture cannot rule out pertussis. Treatment and case reporting may still be warranted, per clinician’s assessment.
  • Treat following CDC’s treatment guidance.
  • Instruct people with suspected pertussis to stay home from work, school, or childcare. Advise them that they are considered contagious until they complete 5 full days of prescribed antibiotics.
  • Notify Tacoma-Pierce County Health Department at (253) 649-1412 of suspected or confirmed cases within 24 hours. We will help you determine prophylaxis and exclusion recommendations.
  • Consider preventive antibiotics for the entire household if a member meets any high-risk criteria.
  • Keep in mind, diagnosing pertussis can be difficult. During the early (catarrhal) stage of illness, symptoms may be non-specific and may not include cough. When a patient has respiratory symptoms and known or suspected exposure to pertussis, include pertussis in the differential diagnosis. The incubation period for pertussis is 5–21 days. The duration of the cough (usually longer than 2 weeks, up to 10 weeks or longer) can distinguish pertussis from other respiratory illnesses.

Vaccine recommendations

  • All children and adults should be up to date on recommended pertussis vaccines. See CDC’s recommended vaccine schedule.
    • Prioritize vaccinating people who come into direct contact with infants under 1 year old.
    • Pregnant people at 27–36 weeks gestation (third trimester) should receive 1 dose of Tdap vaccine (during each pregnancy).

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