What counselling should be provided to parents of a child diagnosed with pertussis?

Parental Counseling for Pertussis in Children

Parents of a child diagnosed with pertussis must understand that their child is highly contagious during the first 3 weeks of illness, requires immediate antibiotic treatment to prevent transmission (though it won't shorten the disease course), and that household contacts need prophylactic antibiotics regardless of vaccination status. 1, 2

Disease Course and What to Expect

Parents should be counseled that pertussis progresses through three distinct phases over 6-10 weeks total:

• Catarrhal phase (1-2 weeks): The child will have mild cold-like symptoms including runny nose, sneezing, and mild cough with minimal or no fever—this is when the child is MOST contagious 3, 4
• Paroxysmal phase (4-6 weeks): Severe coughing fits will develop, often followed by vomiting and the characteristic "whoop" sound when gasping for breath; coughing episodes worsen at night 3, 5
• Convalescent phase (2-6 weeks or longer): Gradual improvement occurs, though cough may persist for months 5, 6

Critical warning: In infants under 6 months, especially those under 2 months, the disease can present atypically with life-threatening apnea (stopping breathing) instead of cough—this requires immediate emergency evaluation 3, 4

Isolation and Transmission Prevention

The child must be isolated from others, especially infants and pregnant women, for 5 days after starting antibiotics (or for 3 weeks from cough onset if no antibiotics are given). 5, 4

• Pertussis spreads through respiratory droplets with secondary attack rates exceeding 80% among unprotected contacts 4
• The child should not attend school or daycare during the isolation period 1
• Visitors with respiratory symptoms should be prohibited from the home 1
• Parents are frequently the source of pertussis in infants—in 24% of infant cases, a parent or grandparent had a recent cough illness 1

Antibiotic Treatment

Parents must understand the dual purpose of antibiotics:

• Azithromycin is the preferred antibiotic and must be started immediately 3, 5, 4
• Antibiotics eliminate the bacteria and stop transmission to others, but will NOT significantly improve the child's cough or shorten the illness duration once the paroxysmal stage begins 5, 4, 2
• Early treatment (within the first 1-2 weeks) may reduce symptom severity, but treatment after 3 weeks primarily prevents spread rather than helping the patient 5, 2

Household Contact Management

All household contacts require prophylactic antibiotics regardless of vaccination status, as vaccinated individuals can still contract and transmit pertussis: 2

• Azithromycin prophylaxis should be given to ALL close contacts 1, 2
• Erythromycin (40-50 mg/kg/day for 14 days) is an alternative for children, or clarithromycin for 10-14 days 1
• For those with macrolide allergies, trimethoprim-sulfamethoxazole can be used (except in pregnant women at term, nursing mothers, or infants under 2 months) 1, 6

Vaccination Counseling

Parents should understand vaccination realities:

• Tdap vaccination should be updated for all household members who haven't received it 5, 2
• Vaccine protection wanes over time, which is why adolescents and adults can still get pertussis and transmit it to infants 2, 7
• The "cocooning" strategy (vaccinating everyone around the baby) is no longer the primary recommendation because vaccinated people can still transmit disease 2
• All pregnant women should receive Tdap between 27-36 weeks of each pregnancy to protect newborns 4, 2

Monitoring for Complications

Parents must watch for warning signs requiring immediate medical attention:

• Apnea or pauses in breathing (especially in infants under 6 months) 3
• Signs of pneumonia: fever, increased work of breathing, chest pain 3
• Dehydration from persistent vomiting after coughing 3, 6
• Seizures or altered mental status 3
• Inability to feed or significant weight loss 3

Infants under 6 months, particularly those under 2 months, have the highest risk of severe complications including pneumonia (13% of cases), hospitalization (63% of cases), and death (case-fatality ratio 1.8%) 1, 3

Prognosis and Recovery

Parents should have realistic expectations:

• The paroxysmal cough typically persists for 4-6 weeks regardless of treatment 3, 5
• Complete recovery may take 2-3 months total 5, 6
• Coughing episodes will gradually decrease in frequency and severity during the convalescent phase 5
• Physical examination between coughing fits is often surprisingly normal 5, 4

Special Considerations for High-Risk Infants

For infants under 6 weeks with pertussis, parents should be counseled that:

• Hospital admission lasting 2-6 weeks may be required depending on severity 3
• Premature infants (gestational age <37 weeks) are at higher risk for severe disease 1, 3
• Two to three doses of DTaP vaccine (given at 2,4, and 6 months) provide protection against severe pertussis 1