Whooping Cough (Pertussis)—Child Care and Schools

What is whooping cough?

Whooping cough is a contagious bacterial infection that causes a range of illnesses, from mild cough to severe disease.

What are the signs or symptoms?

• Begins with cold-like signs or symptoms.

• Coughing that may progress to sudden, severe coughing, which may cause

  • – Vomiting while coughing

  • – Loss of breath; difficulty catching breath

  • – Cyanosis (ie, blueness)

• Whooping (ie, high-pitched crowing) sound when inhaling after a period of coughing (may not occur in very young children).

• Coughing persists for weeks to months.

• Fever is usually absent or minimal.

• Symptoms more severe in infants (those younger than 12 months).

• Infants younger than 6 months may develop complications and often require hospitalization.

What are the incubation and contagious periods?

• Incubation period: 5 to 21 days; usually 7 to 10 days.

• Contagious period: From the beginning of symptoms until 3 weeks after the cough begins, depending on age, immunization status, previous episodes of infection with pertussis, and antibiotic treatment. An infant who has no pertussis immunizations may remain infectious for 6 weeks or more after the cough starts.

How is it spread?

Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet and fall onto the ground.

How do you control it?

• Whooping cough is a vaccine-preventable disease; however, protection against infection is incomplete and decreases over time. Over the past several years, there has been a substantial increase in the number of whooping cough cases nationally as vaccination rates have declined. Vaccination significantly decreases the severity of disease.

• Follow the most current immunization schedule for children ( www.aap.org/immunizationschedule ) and adults ( https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/immunization-schedules/adult-immunization-schedule.html ). Make sure all are up to date with their vaccine that protects against pertussis. For Tdap (tetanus, diphtheria, and acellular pertussis):

  • – Children: Those who are at least 7 years old and underimmunized for pertussis should receive a Tdap dose. Later, they can receive another Tdap booster when they turn 11 years of age.

  • – Adolescents: One dose at 11 to 12 years of age

  • – Adults: Anyone who has never had a Tdap vaccine should get a vaccine at their next tetanus booster (usually every 10 years).

  • – Anyone caring for infants: Should get a Tdap dose, even if their last tetanus (Td) booster was recent.

  • – Pregnant individuals should get a Tdap vaccine from their health care professional during every pregnancy to protect the newborn.

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Preventative antibiotics are recommended for household members, other close contacts (including staff), and any exposed children in the program who are underimmunized, if they have had to close or extended contact with someone with confirmed pertussis.

• Household members and close contacts who are underimmunized should have a pertussis immunization as soon as possible as well as receive the preventive antibiotic treatment if exposure has occurred.

• Consult the local or state department of health on preventative antibiotics or postexposure prophylaxis (PEP) in school settings. PEP is not routinely given to general school contacts who are low risk.

• Testing staff members who develop respiratory symptoms after exposure to someone with confirmed pertussis may be recommended by the local health department.

Coughing baby

BROWN UNIVERSITY

Three images side-by-side of a nude, coughing baby, their skin flushed and pink and their mouth open as if coughing more intensely in each photo, their tongue protruding in the final photo.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education (ECE) program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members and parents of underimmunized children to watch for symptoms and notifies the Child Care Health Consultant.

• All exposed individuals need monitoring for 21 days regardless of immunization status for pertussis. If symptoms develop, they should be treated with antibiotics.

• Report the infection to the local health department. The health professional who makes the diagnosis may not report that the infected child is a participant in an ECE program or school, and this could lead to delay in controlling the spread.

• Ensure all children have received their immunization series according to the current schedule.

• Ensure staff members have a record of receiving Tdap vaccine unless contraindicated.

Exclude from educational setting?

Yes.

• Pertussis is a highly contagious illness for which routine exclusion of infected children is warranted.

• Exclude close contacts (including educators) who are coughing until they receive appropriate evaluation and treatment.

• Exposed contacts that have no symptoms do not need to be excluded, regardless of immunization status

Readmit to educational setting?

Yes, when all the following criteria are met:

• After 5 days of appropriate antibiotic treatment.

• Untreated children should be excluded from educational settings for 21 days after the onset of cough.

• When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.