Action requested: Consider pertussis when patients present with prolonged coughing.
Background & Recommendations
Pertussis continues to circulate in large numbers. The Snohomish Health District has received reports of more than 150 confirmed cases so far in 2015.
Suspect pertussis and test (PCR preferred) and treat immediately if a patient of any age presents prolonged coughing with any of the following: paroxysms of coughing, inspiratory “whoop”, or post-tussive vomiting. Infants younger than one year of age may present with apnea (with or without cyanosis). Regardless of other symptoms, when patients who are coughing present with a letter from the Health District about exposure or explicitly state they have been exposed to a case of pertussis, providers should strongly consider testing and treating immediately. If pertussis is suspected, exclude the patient from work, school, or child care until five days of appropriate antibiotic therapy have been completed (or until negative test results have been received).
Certain persons are at increased risk for severe pertussis or for transmitting pertussis to persons at increased risk for severe pertussis. This includes infants less than one year old, pregnant women (particularly those in the third trimester), and anyone who may expose infants or pregnant women (e.g., health care workers, grandparents).
Pertussis is spread by droplets. To decrease the risk of pertussis transmission in clinic or hospital settings, screen patients for cough, provide masks to patients with cough, move coughing patients into examination rooms as soon as possible, and clean rooms after examining coughing patients.
Health care workers who evaluate patients with cough illness should use appropriate infection control measures (masking is essential). Health care workers who develop a cough need to consider the possibility of pertussis—use appropriate infection control measures (mask), seek medical evaluation, and follow your employee health guidelines regarding continuing to work.
Universal vaccination remains a key strategy to protect the most vulnerable. In particular, pregnant women should get Tdap vaccination with each pregnancy, preferably in the third trimester. However, because the current pertussis vaccine does not provide complete protection, it is important to consider pertussis in someone with coughing illness even if that person has been vaccinated.
Action requested: Continue to screen for travel to western Africa, but be alert to causes of disease other than Ebola.
Background & Recommendations
The Centers for Disease Control & Prevention (CDC) recommends that healthcare providers consider not only Ebola virus disease (EVD), but also other much more likely infectious diseases, including malaria, when evaluating ill travelers from Western Africa to the United States. Signs and symptoms of EVD are non-specific and overlap with many other more prevalent infectious diseases in West Africa. For any patient returning from West Africa and presenting with non-specific signs and symptoms consistent with EVD, providers should take into account the patient's epidemiological history for management, diagnostic testing, and treatment and coordinate healthcare as needed with the state or local health department to ensure that these patients get appropriate care without delay. For further guidance, see http://www.cdc.gov/vhf/ebola/exposure/persons-under-investigation-low-exposure-ebola.html.