What are the recommendations for close contact with a person who tested positive for Pertussis (Whooping Cough)?

From the Guidelines

If you've had close contact with someone who tested positive for pertussis (whooping cough), you should take preventive antibiotics as soon as possible, even if you're vaccinated, to reduce the risk of developing the disease and its complications, especially in high-risk individuals such as infants aged <12 months or women in the third trimester of pregnancy. The recommended approach is based on the most recent guidelines, which suggest that a macrolide can be administered as prophylaxis for close contacts of a person with pertussis if the person has no contraindication to its use 1. Some key considerations for postexposure prophylaxis include:

• The infectiousness of the patient and the intensity of the exposure
• The potential consequences of severe pertussis in the contact
• Possibilities for secondary exposure of persons at high risk from the contact The benefits of administering an antimicrobial agent to reduce the risk for pertussis and its complications should be weighed against the potential adverse effects of the drug 1. Administration of postexposure prophylaxis to asymptomatic household contacts within 21 days of onset of cough in the index patient can prevent symptomatic infection, and coughing (symptomatic) household members of a pertussis patient should be treated as if they have pertussis 1. Although an earlier guideline also recommended administering a macrolide to any person who has had close contact with persons with pertussis and who does not have hypersensitivity or intolerance to macrolides 1, the more recent guideline provides a more comprehensive approach to postexposure prophylaxis 1. It is essential to monitor yourself for symptoms like runny nose, mild cough, or low-grade fever for 21 days after exposure, and if symptoms develop, seek medical attention immediately.

From the FDA Drug Label

Erythromycin is effective in eliminating the organism from the nasopharynx of infected individuals, rendering them noninfectious Some clinical studies suggest that erythromycin may be helpful in the prophylaxis of pertussis in exposed susceptible individuals.

The recommended approach for close contact with a person who tested positive for Pertussis (Whooping Cough) is to consider prophylaxis with erythromycin for exposed susceptible individuals to prevent the development of the disease. This is based on the fact that erythromycin can eliminate the organism from the nasopharynx of infected individuals, rendering them noninfectious 2. Key points to consider include:

• Erythromycin may be helpful in preventing pertussis in exposed susceptible individuals
• The goal of prophylaxis is to prevent the development of the disease in close contacts.

From the Research

Recommendations for Close Contact with a Person who Tested Positive for Pertussis

• When there is close contact with a person who tested positive for Pertussis, antibiotic prophylaxis is recommended for household contacts of someone with pertussis and for those exposed to pertussis who are at high risk of severe illness 3
• Azithromycin is the preferred antibiotic for treatment or prophylaxis 3
• High post-exposure prophylaxis (PEP) uptake among household contacts of pertussis patients has been observed, with very high PEP uptake among household contacts of pertussis patients 4
• Daily symptom monitoring without PEP was considered noninferior to PEP after pertussis exposure if the lower limit of the 1-sided 95% confidence interval (CI) for the reduction in pertussis was greater than -7% 5
• Short-term antibiotics (azithromycin for three days, clarithromycin for seven days, or erythromycin estolate for seven days) were equally effective with long-term antibiotic treatment (erythromycin estolate or erythromycin for 14 days) in the microbiological eradication of Bordetella pertussis (B. pertussis) from the nasopharynx 6
• Effective regimens include: three days of azithromycin, seven days of clarithromycin, seven or 14 days of erythromycin estolate, and 14 days of erythromycin ethylsuccinate 6
• Short-term treatment with clarithromycin or azithromycin is expected to be equal or superior to the standard long-term erythromycin regimen for pertussis 7

Key Considerations

• Patients 11 years or older should receive at least one dose of Tdap, although Tdap may replace any dose of the tetanus and diphtheria toxoids (Td) vaccine 3
• All pregnant patients should receive Tdap between 27 and 36 weeks' gestation with each pregnancy to convey immunity to the newborn 3
• Cocooning (vaccinating close contacts of high-risk individuals) is no longer recommended because immunized patients can still contract and transmit pertussis 3