Pertussis secondary prevention: Difference between revisions
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==Secondary Prevention== | ==Secondary Prevention== | ||
===Postexposure Prophylaxis=== | |||
*The primary objective of postexposure antimicrobial prophylaxis (PEP) should be to prevent death and serious complications from pertussis in individuals at increased risk of severe disease. | *The primary objective of postexposure antimicrobial prophylaxis (PEP) should be to prevent death and serious complications from pertussis in individuals at increased risk of severe disease. | ||
*With increasing incidence and widespread community transmission of pertussis, extensive contact tracing and broad scale use of PEP among contacts may not be an effective use of limited public health resources. | *With increasing incidence and widespread community transmission of pertussis, extensive contact tracing and broad scale use of PEP among contacts may not be an effective use of limited public health resources. | ||
| Line 21: | Line 21: | ||
:*Contacts who themselves have close contact with either infants under 12 months, pregnant women or individuals with pre-existing health conditions at risk of severe illness or complications | :*Contacts who themselves have close contact with either infants under 12 months, pregnant women or individuals with pre-existing health conditions at risk of severe illness or complications | ||
:*All contacts in high risk settings that include infants aged <12 months or women in the third trimester of pregnancy (e.g.: neonatal intensive care units, childcare settings, and maternity wards) | :*All contacts in high risk settings that include infants aged <12 months or women in the third trimester of pregnancy (e.g.: neonatal intensive care units, childcare settings, and maternity wards) | ||
===Antimicrobial Agents=== | |||
The recommended antimicrobial agents for chemoprophylaxis are the same as those used for the treatment of pertussis. These may vary depending on the individual's age: | The recommended antimicrobial agents for chemoprophylaxis are the same as those used for the treatment of pertussis. These may vary depending on the individual's age: | ||
=====Age ≥1 Month===== | =====Age ≥1 Month===== | ||
Revision as of 16:28, 14 January 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Luke Rusowicz-Orazem, B.S.
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Pertussis Microchapters |
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Treatment |
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Pertussis secondary prevention On the Web |
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American Roentgen Ray Society Images of Pertussis secondary prevention |
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Risk calculators and risk factors for Pertussis secondary prevention |
Overview
Effective measures of secondary prevention involve antibiotic prophylaxis, post exposure, for individuals infected with Pertussis or those who have come into contact with infected individuals. Antibiotic treatment and preventative measures vary in application based on the age of the patient.
Secondary Prevention
Postexposure Prophylaxis
- The primary objective of postexposure antimicrobial prophylaxis (PEP) should be to prevent death and serious complications from pertussis in individuals at increased risk of severe disease.
- With increasing incidence and widespread community transmission of pertussis, extensive contact tracing and broad scale use of PEP among contacts may not be an effective use of limited public health resources.
- While antibiotics may prevent pertussis disease if given prior to symptom onset, there are no data to indicate that widespread use of PEP among contacts effectively controls or limits the scope of pertussis outbreaks.
Individuals who should receive postexposure antibiotic prophylaxis include the following:[1]
- All household contacts of a pertussis case
- Within families, secondary attack rates have been demonstrated to be high, even when household contacts are current with immunizations.
- Administration of antimicrobial prophylaxis to asymptomatic household contacts within 21 days of onset of cough in the index patient can prevent symptomatic infection.
- Persons within 21 days of exposure to an infectious pertussis case who are at high risk of severe illness or who will have close contact with a person at high risk of severe illness
- Infants and women in their third trimester of pregnancy
- All persons with pre-existing health conditions that may be exacerbated by a pertussis infection (e.g.: immunocompromised persons and patients with moderate to severe medically treated asthma)
- Contacts who themselves have close contact with either infants under 12 months, pregnant women or individuals with pre-existing health conditions at risk of severe illness or complications
- All contacts in high risk settings that include infants aged <12 months or women in the third trimester of pregnancy (e.g.: neonatal intensive care units, childcare settings, and maternity wards)
Antimicrobial Agents
The recommended antimicrobial agents for chemoprophylaxis are the same as those used for the treatment of pertussis. These may vary depending on the individual's age:
Age ≥1 Month
- Erythromycin, clarithromycin, and azithromycin are preferred for the post exposure prophylaxis of pertussis in persons ≥1 month of age.[1]
- For persons ≥2 months of age, an alternative to macrolides is trimethoprim-sulfamethoxazole.[1]
Age <1 Month
- For infants younger than 1 month of age, azithromycin is preferred for post exposure prophylaxis and treatment because azithromycin has not been associated with infantile hypertrophic pyloric stenosis (IHPS), whereas erythromycin has.
References
- ↑ 1.0 1.1 1.2 Pertussis Postexposure Antimicrobial Prophylaxis. Centers for Disease Control and Prevention (2016). http://www.cdc.gov/pertussis/clinical/treatment.html. Accessed on January 14, 2016.