Pertussis (Whooping Cough)

Pertussis is a reportable disease under the Ontario Health Protection and Promotion Act (HPPA). Report all suspected and confirmed cases of pertussis to public health.

Options for reporting to OPH include:

  • Monday to Friday from 8:30 am to 4:30 pm:
    • Call 613-580-2424, extension 24224, and leave a detailed, confidential message including your contact information and a public health nurse will call you back; or
    • Fax 613-580-9640
  • After hours, on weekends, or holidays: Call 3-1-1 and ask to speak to Public Health on call.
  • A web-form is available for your convenience (This document is currently not in an accessible format).

If you are a reporting a case known to have close contact with infants or a pregnant person(s) in their third trimester, please include this information when reporting to ensure prompt follow up.

Clinical Presentation:

The clinical course of pertussis is divided into three stages.

  1. Catarrhal stage: Characterized by mild upper respiratory tract symptoms with a mild occasional cough that lasts approximately 1-2 weeks and then progresses to the next stage. At this stage, symptoms can be difficult to distinguish from mild upper respiratory tract infection (URTI).
  2. Paroxysmal stage: Presents with an increase in the severity and frequency of the cough which can last 1 to 2 months and sometimes longer. Paroxysms are characterized by repeated violent coughing and this is where the high pitched inspiratory whoop may occur, commonly followed by vomiting. Fever is absent or minimal.
  3. Convalescent stage: The gradual recovery period where the cough becomes less paroxysmal and disappears. This may take weeks to months.

The clinical course varies with age. In young infants, who are at the highest risk, clinical symptoms are frequently atypical, and it is this group that has the most serious complications. Pertussis presentation may be atypical in adults or among persons previously immunized.

Pertussis should be considered for any cough that lasts 2 weeks or longer, is paroxysmal, is associated with an inspiratory “whoop”, ends in vomiting or gagging, or is associated with apnea.

Laboratory Testing

Optimal timing for collecting the NP swab (for PCR testing) is within 3 weeks of cough onset. Laboratory testing, using an NP swab (PHO Bordetella pertussis collection kit, order# 390052), should only be performed on patients with appropriate clinical signs and symptoms. Note: swabs for pertussis testing are specific for pertussis, and other respiratory swabs cannot be used.

Public health follow up with pertussis contacts focuses on those at highest risk of severe disease so you may consider this when making testing decisions where the primary concern is transmission to contacts.

Ottawa Public Health does not supply testing kits. Public Health Ontario has information on Kit and Test Ordering Instructions. Public Health Ontario has information on testing information and can be contacted for any questions.

Management of Pertussis

Antimicrobials indicated for treatment of pertussis

The choice of treatment is a clinical decision, considering the case's age, the cost of the medication and the potential side effects. 

Individuals are considered no longer infectious after 5 days of appropriate antibiotic therapy. Antibiotics help to reduce pertussis transmission, and may reduce the duration and severity of symptoms.

For recommended antimicrobial agents for treating pertussis, refer to CDC Guidelines.

Exclusion from Child Care Facility, Healthcare Settings, or Similar Settings 

Anyone tested for pertussis should be counselled to avoid contact with young children, infants, and women in their third trimester of pregnancy and to stay home as much as possible, avoiding non-essential activities.

Persons under investigation for pertussis:

  • Exclude from childcare settings, healthcare settings, or similar settings until the etiology has been evaluated.
  • They may return once assessment is completed and any necessary measures have been instituted, or the diagnosis of pertussis is ruled out.

Confirmed or probable pertussis:

  • Exclude from childcare settings, healthcare settings, or similar settings until completion of 5 days of appropriate antibiotic therapy.
  • If no treatment is received, exclude until 21 days from cough onset.

For more details, please see Ottawa Public Health’s Pertussis Case & Contact Management Guidelines.

Contact Management

Exclusion is not required for asymptomatic contacts of pertussis.

Public health management of pertussis contacts focuses on reducing the risk of transmission to those at highest risk of severe disease. Chemoprophylaxis is recommended for:

  • Household contacts (including attendees at home child care settings) where there is a vulnerable person defined as an infant less than 1 year of age (immunized or not) or a pregnant woman in the third trimester
  • Non-household contacts who are vulnerable persons, defined as infants less than one year of age (immunized or not) and pregnant women in their third trimester who have had face-to-face exposure and/or have shared confined air for more than 1 hour

Chemoprophylaxis is most effective when initiated early and is unlikely to be of any benefit after 21 days have elapsed since first contact with the person diagnosed with pertussis.

For a list of recommended antibiotic chemoprophylaxis regimens, see Table 1 in the Ministry of Health’s Infectious Disease Protocol Appendix 1: Pertussis or Ottawa Public Health’s Case & Contact Management Guidelines.

Immunization 

Acellular pertussis-containing vaccines are recommended for routine immunization of infants and children, including an adolescent booster dose. Timely primary immunization with four doses of an acellular pertussis-containing vaccine is estimated to be 90% effective in preventing pertussis during the first 4 to 6 years of life. Timely administration of these early doses is most critical in reducing infant mortality and hospitalization rates from pertussis.

The Ontario Publicly Funded Immunization Schedule includes pertussis vaccine at 2, 4, 6, and 18 months, and booster doses at 4-6 years and 14-16 years.

One dose of Tdap vaccine should be administered in every pregnancy, ideally between 27 and 32 weeks of gestation. Tdap immunization in pregnancy is estimated to protect approximately 90% of infants less than 3 months of age.

Adults who have not previously received a dose of pertussis-containing vaccine in adulthood should receive a dose. In Ontario, this is typically given at age 24-26 years old (10 years after the adolescent booster dose).

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