Ask the Experts: Pertussis: Disease Issues

Results (6)

Since the 1980s, the number of reported pertussis cases has increased in children, adolescents and adults. The most recent overall peaks in disease were seen between 2010 and 2014. The incidence in all age groups has decreased since 2014 and preliminary surveillance data indicate that incidence declined precipitously during the COVID-19 pandemic in 2020 and 2021. In 2019, CDC received reports of more than 18,000 cases of pertussis, with preliminary estimates of 5,398 reported cases in 2020 and just 1,609 in 2021. COVID-19 control measures such as wearing masks in public, social distancing, and other interventions designed to reduce the spread of COVID-19 also helped reduce the spread of pertussis and other respiratory infections. However, with the discontinuation of these measures, the prevalence of infections like pertussis that are transmitted by respiratory droplets is likely to increase.

The incidence of pertussis remains highest in young infants. Approximately 1 in 10 U.S. pertussis cases were among infants. Infants are at greatest risk for serious disease and death from pertussis. An increase in the number of reported deaths from pertussis among very young infants has paralleled the increase in the number of reported cases.

Reasons for the increases in pertussis seen since the 1980s are not completely clear; however, multiple factors have likely contributed to the increase, including waning immunity from the pediatric acellular vaccine (DTaP), increased recognition of pertussis, and improved diagnostic testing and reporting.

Last reviewed: March 31, 2022

Reinfection appears to be uncommon but does occur. Reinfection may present as a persistent cough rather than typical pertussis.

Last reviewed: March 31, 2022

Immunity to pertussis following infection is not life-long. Persons with a history of pertussis should continue to receive pertussis-containing vaccines according to the recommended schedule. (Note: This answer is based upon recommendations of the AAP’s Committee on Infectious Diseases.)

Last reviewed: March 31, 2022

Yes. Adolescents or adults who have a history of pertussis disease generally should receive Tdap according to the routine recommendation. This practice is recommended because the duration of protection induced by pertussis disease is unknown (waning might begin as early as 7 years after infection) and because diagnosis of pertussis can be difficult to confirm. Administering pertussis vaccine to people with a history of pertussis presents no theoretical risk. For details, visit CDC’s published recommendations on this topic at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf.

Last reviewed: March 31, 2022

Tdap vaccination status does not change the approach to evaluating postexposure prophylaxis when HCWs are exposed to pertussis. Tdap vaccines have an uncertain role in the prevention of transmission of pertussis and herd protection. Antipertussis antibody levels begin to decline precipitously after the first year following a single Tdap vaccination. Healthcare facilities should follow the post-exposure prophylaxis protocol for pertussis exposure recommended by CDC regardless of a HCW’s vaccination status (see www.cdc.gov/pertussis/php/postexposure-prophylaxis). HCW can either receive postexposure prophylaxis or be carefully monitored for 21 days after pertussis exposure. Health care personnel should be treated with antibiotics at the onset of signs and symptoms of pertussis and excluded from work for the first 5 days while receiving appropriate antibiotics. CDC supports targeting postexposure antibiotic use to people at high risk of developing severe pertussis, as well as people who will have close contact with others at high risk of developing severe pertussis.

Last reviewed: October 31, 2023

Recent Tdap vaccination does not affect PCR testing. PCR tests are used to detect DNA sequences of the Bordetella pertussis bacterium. PCR tests are very sensitive and could give a false positive result for other reasons. For more information on best practices when performing PCR testing for pertussis see www.cdc.gov/pertussis/php/pcr-bestpractices.

Last reviewed: October 31, 2023

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