Consult expert advice
Management of contacts should proceed for all clinically suspected epidemiologically linked and laboratory confirmed cases:
- close contacts:
- family members or people living in the same household
- contacts in institutional settings with overnight stays in the same room e.g. boarding school dormitories during the infectious period
Chemoprophylaxis
- Antibiotic prophylaxis should only be offered to close contacts when both of the following conditions apply:
- onset of disease in the index case is within the preceding twenty one days and
- there is a close contact in one of the priority groups
- Where both these conditions are met, all close contacts (regardless of age and previous immunisation history) should be offered chemoprophylaxis.
- The dose of antibiotics for use as chemoprophylaxis is the same as for the treatment of cases.
- Chemoprophylaxis is not required where there are no close contacts in the priority groups.
Note: the following individuals who are at increased risk of complications following pertussis as well as those at risk of transmitting the infection to others at risk of severe disease are considered as priority groups.
- Group 1. Individuals at increased risk of severe complications ('vulnerable'):
- unimmunised infants (born after 32 weeks) less than 2 months of age whose mothers did not receive pertussis vaccine after 16 weeks of pregnancy and at least 2 weeks prior to delivery
- unimmunised infants (born £ 32 weeks) less than 2 months of age regardless of maternal vaccine status
- unimmunised and partially immunised infants (less than 3 doses of vaccine) aged 2 months and above regardless of maternal vaccine status
- Group 2. Individuals at increased risk of transmitting to 'vulnerable' individuals in 'group 1' who have not received a pertussis containing vaccine more than 1 week and less than 5 years ago:
- a. pregnant women (> 32 weeks gestation)
- b. healthcare workers working with infants and pregnant women
- c. people whose work involves regular, close or prolonged contact with infants too young to be fully vaccinated (< 4 months)
- d. people who share a household with an infant too young to be fully vaccinated (< 4 months)
Immunisation
Immunisation should be considered for those who have been offered chemoprophylaxis.
- Unimmunised and partially immunised contacts up to the age of ten years should complete the schedule with the appropriate vaccine.
- A booster dose of pertussis containing vaccine is recommended for individuals aged 10 years or older (including pregnant women >32 weeks gestation), who have not received a dose of pertussis-containing vaccine in the last five years and no Td-IPV vaccine in the preceding month.
Pregnant women
- Chemoprophylaxis is recommended for women exposed after 32 weeks of pregnancy, who have not received a pertussis containing vaccine more than one week and less than five years prior; erythromycin should be offered.
- For individuals who fall into groups 2b, 2c or 2d who happen to be pregnant, chemoprophylaxis and vaccine is recommended at any stage of pregnancy. A further dose of vaccine will be required after 16 weeks pregnancy.
- Newborn infants born to women with suspected / confirmed pertussis should be given chemoprophylaxis.
Reference:
(1) Public Health England (PHE) 2018. Guidelines for the Public Health Management of Pertussis in England