Health Advisory

Summary

• The Northern Virginia Health Region, including the Fairfax Health District, is experiencing a significant increase in pertussis case reports. As of August 2, 2024, the Fairfax County Health Department (FCHD) has investigated 40 pertussis cases in 2024, exceeding the previous five-year average (2019-2023) of 10 cases per year.
• Healthcare providers should maintain a high index of suspicion for pertussis, use prophylaxis appropriately for exposed individuals, and ensure patients are up to date on the DTaP or Tdap vaccine.

Suggested Actions

• Providers should adopt a high index of suspicion for pertussis, regardless of vaccination status, in patients who present with paroxysms of cough, inspiratory whoop, post-tussive vomiting, and/or apnea.
• Pertussis is a rapidly reportable disease in Virginia. Please report all suspected and confirmed cases to FCHD immediately. To report a case or for questions regarding case management, laboratory testing options, or postexposure antimicrobial prophylaxis, please call FCHD at 703-246-2433.
• Providers should ensure all patients are fully vaccinated according to the Advisory Committee on Immunization Practices guidelines. Updated pertussis vaccination guidance is available on the CDC website.
• Clinical and public health guidance for suspect pertussis cases who have been coughing for less than 21 days include:
  • Testing with a nasopharyngeal swab sent for pertussis PCR and culture, as serology is not reliable for the diagnosis of an acute case of pertussis. If you need advice on what specimens to collect or what test to order, please contact the FCHD.
  • Do not delay treatment with appropriate antibiotics while waiting for laboratory results if there is a known exposure or no alternative diagnosis.
  • Consider antibiotic prophylaxis for all household members for patients who meet the clinical criteria of pertussis.
  • Recommend exclusion from school, summer programs, work and other group activities until the patient has completed 5 days of appropriate antibiotic therapy or until 21 days has passed from the onset of cough if therapy is not administered.
  • Patients who have been coughing for more than 21 days are generally NOT recommended for laboratory testing, antibiotic therapy, or public health exclusion recommendations, though infants and pregnant people in their third trimester should be treated through 6 weeks after cough onset.
• Individuals who are identified as a close contact to a confirmed pertussis case should be evaluated by their healthcare provider for post-exposure prophylaxis (PEP). Macrolides are the preferred antimicrobial agents for PEP and treatment; dosage and administration guidance can be found on the CDC website.
• Contacts who are symptomatic should be tested to identify if they are a case and further assessment of exposures is needed. Testing is not needed for asymptomatic contacts.

Additional Information

• Immunity from vaccination and from infection wane with time; persons of any age and vaccination status may present with pertussis. Of the 40 Fairfax cases investigated this year, 24 cases (60%) were among school-aged children, ages 5 to 17 years, with 18 of those cases occurring among 13 to 17 year olds. Three cases were associated with known outbreaks in a high school and childcare setting.
• The Virginia Department of Health is reporting elevated levels of pertussis across the state. While cyclical increases of pertussis are expected every 3 to 5 years, cases have increased seven-fold compared to the same time last year, the greatest increase since 2015. This increase is linked to pertussis outbreaks in churches, universities, schools, and childcare settings, as well as a return to pre-pandemic levels.
• Some additional actions that you can take to ensure your facility is prepared include:
  • Inventory your personal protective equipment to adhere to standard precautions PLUS droplet precautions whenever respiratory illness is suspected (eye protection + mask)
  • Inventory your pertussis testing supplies and walk through testing and shipping processes.
  • Have FCHD contact information available and review reporting requirements.