Pertussis

The causative agent of pertussis is a small, immobile, aerobic, gram-negative rod (Bordetella (B.) pertussis).

Where do pertussis pathogens occur?

• Humans are the only reservoir for B. pertussis.
• B. parapertussis is found in humans and sheep.
• The highest number of new cases is observed in Central Europe in autumn and winter, but seasonality is not very pronounced.

How does the infection occur?

Transmission occurs by droplet infection, through contact with an infectious person, within a distance of up to about 1 meter by coughing, sneezing, or talking. The incubation period (time of ingestion of the pathogens until illness) is 7-20 days.

How long does the contagiousness last?

Contagiousness begins at the end of the incubation period, peaks during the first two weeks of illness, and can last up to 3 weeks after onset. When antibiotic therapy is administered, the duration of contagiousness is shortened to about 5 days after the start of therapy.

What are the symptoms?

Pertussis is usually an illness lasting several weeks to months. The typical initial infection in pertussis is divided into three stages.

Stage catarrhale (duration 1-2 weeks):

• Is characterized by flu-like symptoms such as a cold, mild cough, weakness, and no or only moderate fever.

Stage convulsivum (duration 4-6 weeks):

• In this stage, there are episodic coughing episodes followed by inspiratory dragging. The coughing attacks are often accompanied by regurgitation of viscous mucus followed by vomiting. Attacks may be numerous and occur more frequently at night. Fever is absent or mild. When fever is present, it usually indicates a secondary bacterial infection.

Stage decrementi (duration 6-10 weeks):

• There is a gradual subsiding of the coughing episodes.

Preventive measures - How can I protect myself?

For prophylaxis, acellular vaccines in combination with other antigens are available in Germany. One vaccination each at the age of 2, 3 and 4 months and another vaccination at the age of 11 to 14 months are recommended. The vaccination is carried out with combination vaccines (e.g. against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, Haemophilus influenzae type b). Furthermore, a booster vaccination is recommended at the age of 5 to 6 years in combination with tetanus and diphtheria. Between 9 and 17 years, another booster is recommended.

Since 2004, the STIKO has explicitly recommended vaccination also for persons in the home environment of infants who do not have adequate immune protection against pertussis. The vaccination strategy in Germany is therefore to provide complete vaccination protection as early as possible for infants and young children who are particularly at risk (basic immunization), which should be refreshed both in preschool and adolescence.

What measures apply to patients and contacts?

Patients with pertussis who are hospitalized should be kept separate from other patients for 5 days after starting antibiotic treatment. According to § 34 IfSG, persons who have or are suspected of having pertussis may not perform any teaching, educational, nursing, supervisory or other activities in community facilities in which they have contact with the people cared for there until, according to medical judgment, a further spread of the disease through them is no longer to be feared. Accordingly, persons with pertussis who are cared for in community facilities may not enter rooms used for the operation of the community facility, may not use facilities of the community facility and may not participate in events of the community facility. Re-admission to community facilities may occur no earlier than 5 days after the start of effective antibiotic therapy. A written doctor's note is not required. Without antimicrobial treatment, readmission is possible no sooner than 3 weeks after the onset of the first symptoms.

What measures should be taken in case of outbreaks?

It is essential to inform the responsible public health and consumer protection office of any accumulation of disease in order to be able to initiate measures to prevent further spread (e.g. via chemoprophylaxis) (see also obligation to report in accordance with Section 34 (6) of the Infection Protection Act (IfSG).