HJAR Nov/Dec 2024

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2024 37 Jennifer Dillaha, MD Director Arkansas Department of Health to pass to the baby for some protection. • Adults who have not received Tdap get one dose of Tdap, followed by a teta- nus-diphtheria (Td) or Tdap booster every 10 years. In addition to vaccination, postexposure prophylaxis (PEP) with an appropriate an- tibiotic after an exposure, as well as respira- tory and hand hygiene can also help prevent the spread of pertussis. Healthcare workers also need to know the symptoms of pertussis and test for it. A history of vaccination should not rule out a diagnosis, especially when: • A coughing illness in patients of any age is characterized by one or more of the following: sudden coughing at- tacks, lasts two weeks or more, or when making a “whoop” sound, gagging, or vomiting after coughing. • Respiratory symptoms exhibit in in- fants, especially if accompanied by apnea. • Respiratory illness of any duration ex- hibits in patients who have had contact with someone known to have pertussis or symptoms consistent with pertussis. The ADH recommends clinicians: • Perform appropriate laboratory testing if pertussis is suspected. – A nasopharyngeal swab can be col- lected for pertussis polymerase chain reaction (PCR) testing, which is available commercially. Pertussis PCR is the most rapid test available and has excellent sensitivity. Follow- ing best practices can reduce the risk of inaccurate results. – Culture is considered the gold stan- dard for pertussis diagnosis. Culture is the only 100% specific method for identification, but it typically takes up to seven days to obtain results. • Promptly report any suspected cases to the ADH at (501) 661-2381 to help ADH start a rapid investigation and re- sponse to minimize the spread of the illness. Pertussis is a mandatory report- able disease. • Refer to pertussis treatment guidelines at https://www.cdc.gov/pertussis/hcp/ clinical-care/index.html. If given early, antibiotic treatment can reduce symp- tom severity and transmission. – Strongly consider treating before test results if there is a high sus- picion of pertussis or if the pa- tient or their household members are at high risk for severe disease. People at high risk include infants, pregnant women, and anyone immunocompromised. – Patients with pertussis are consid- ered infectious from the start of symptoms through the third week after the onset of worsening cough or until five days after the start of effective antimicrobial treatment. • Refer to pertussis PEP recommenda- tions at https://www.cdc.gov/pertussis/ php/postexposure-prophylaxis/ index.html. The primary objective of PEP is to prevent death and serious complications in people at high risk of severe pertussis infection. Broader use of PEPmay also be appropriate in certain settings. To learn more, please contact the ADH Outbreak Response at (501) 661-2381 or ADH.ORSNurses@arkansas.gov . You can also visit https://healthy.arkansas.gov/ programs-services/diseases-conditions/ communicable-diseases/pertussis- whooping-cough/. n the fit, have difficulty sleeping, struggle to breathe, and break ribs. Not all infants de- velop a cough, and they may look as if they are gasping for air and may stop breath- ing (apnea). The final stage of the illness is a gradual improvement of the cough over weeks to months. People vaccinated against pertussis may still experience illness, but symptoms are generally milder. Infants under 12 months and those with certain underlying health conditions have a high risk of developing severe pertussis infection. The younger the baby, the more likely they will need hospital treatment. Centers for Disease Control and Preven- tion (CDC) estimates that about 1 in 3 in- fants under 12 months who get pertussis will need hospital care. Of these patients, 2 in 3 have apnea, 1 in 5 have pneumonia, 1 in 50 have convulsions, and 1 in 150 have encephalopathy or disease of the brain. One in 100 infants who need hospitalization will die from their complications. Many babies who get pertussis are infected by older sib- lings, parents, or caregivers who don’t know they have it. Teens and adults can also get complications, like pneumonia, but they are usually less severe, especially in those vac- cinated against pertussis. Healthcare workers should talk to patients about the importance of getting vaccinated and staying up to date on their vaccinations. CDC and the Advisory Committee on Immunization Practices recommend: • Children complete the routine five- dose DTaPvaccination series beginning at age 2 months, then an adolescent booster Tdap vaccination. • Pregnant women receive Tdap dur- ing every pregnancy, ideally between weeks 27 and 36. This allows antibodies