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62 CPD ACTIVITY FROM PAGE 61 immune responses, and the results can be affected by other antibody treatments.6 Serology testing may be used to identify and evaluate the spread of a pertussis outbreak.6 Diagnosed cases should be excluded from school/work and should severely minimise contact with others.5 As this is a droplet transmission disease, it’s recommended the patient wear a face mask when in contact with others. Infected patients should not be in contact with infants and young children as these are the highest risk groups.5 Identifying patients suspected of having pertussis requiring referral to a doctor High-risk patients include:1 • Small infants who have not been vaccinated or who have not completed their vaccination schedule. • Household contacts of patients with pertussis. • Patients who have not received their pertussis booster in the last 10 years. • It’s especially important to remind patients to have their pertussis booster, especially if they are in regular contact with newborn children or infants. Children who do not complete the series of pertussis vaccinations are at higher risk of becoming infected.6 • The following patients should be referred to a doctor or hospital if suspected of having pertussis5: • Infants less than six months of age. • Any child or adult with complications (apnoea, cyanosis, pneumonia, encephalopathy). • Any child/adult with comorbidities, eg, immunosuppression. Treatment of pertussis Antibiotics may be given to treat pertussis:1,5 • In the early stage of the disease, ie, catarrhal or paroxysmal stage, to reduce disease severity.1,5 • If the cough has been present for less than 14 days, as this may assist in reducing the spread of the disease and reduce the school/work exclusion period. • If the patient has been admitted to hospital. • If the patient has developed complications, eg, apnoea, cyanosis, pneumonia. The patient may require hospitalisation, including intensive care with assisted breathing, depending on the severity of disease.1 ,5 Pregnant women and small children in contact with a person who has pertussis may be given preventative antibiotic treatment (prophylaxis).6 Transmission of the disease requires close contact (ie, exposure within one metre for more than one hour) but can be less for young infants.5 Treatment and prophylaxis antibiotic guidelines are identical.7 Treatment should be commenced early to improve symptoms and decrease the infectious period.7 Prophylaxis is aimed at preventing the spread to infants less than six months of age.5 There is scant evidence to recommend prophylaxis outside of the household setting.5 Antibiotic therapy for whooping cough can cause adverse effects, especially gastrointestinal. There are certain subgroups of the population, eg, patients in advanced renal failure, immunocompromised, who will require reduced doses of the antibiotic. It’s necessary to have a full medical history of the patient before prescribing these antibiotics. The recommended antibiotics for prophylaxis and treatment are:7 Azithromycin a. Adults – oral 500mg on day one then 250mg once daily for four days. b. Children – <6 months, oral 10mg/kg once daily for five days. c. Children – >6 months, oral 10mg/kg (maximum 500mg) on day one, then 5mg/kg. (maximum 250mg) once daily for four days. Clarithromycin d. Adults – 500mg twice daily for seven days. e. Children – >1 month, oral 7.5mg/kg (maximum of 500mg) twice daily for seven days. Trimethoprim and sulfamethoxazole (second line if macrolides are contraindicated) f. Adult–oral160/800mgevery12hours for seven days. g. Children – oral 40/20mg/kg (maximum 160/800 mg) every 12 hours for seven days. Some patients may experience a long- term cough even after the major disease has been eradicated.1 Management of the long-term cough is extremely difficult, with symptom relief with cough lozenges and/or syrup often limited in efficacy. Prevention of pertussis Pertussis infection and vaccination leads to immunity, but this may wane over time.3 Pertussis is always present in the community and epidemics occur in Australia every three to four years.3,4 In 2008-2012 all Australian states and territories experienced an increase in pertussis cases. This was partly identified by a more vigilant national reporting program plus an increase in the sensitivity of the laboratory tests to identify pertussis.3 The surveillance that accompanied the compulsory reporting identified that there was an issue with waning immunity in the Australian community.3 The immunisation schedule was altered to ensure adults who were in regular contact with infants and small children were immunised or received a booster shot to improve their immunity.3 Tightening of policy for families expecting a newborn resulted in a dramatic increase in adults receiving pertussis vaccine. It takes two weeks for the vaccine to become active. Therefore, adults who will be in contact with newborns need to be immunised at least two weeks before the baby’s arrival. Immunisation The Australian Immunisation Handbook recommends acellular pertussis–containing vaccine for the following: 4,7 • Routine vaccination in infants, children and adolescents. • Routine booster vaccination in adults, including those in special risk groups or in contact with a special risk group, such as: Ի Women who are pregnant or breastfeeding. Ի Healthcare workers. Table 1. Prophylaxis table from Royal Children’s Hospital Melbourne5 Antibiotics Close contact with confirmed case of pertussis while index case infectious (ie, <21 days of cough and <5 days effective antibiotics) AND First contact was within 14 days (or within 21 days for infants <6 months) AND No antibiotics Contact with index case while no longer infectious (ie, >21 days of cough and >5 days effective antibiotics) OR First contact was >14 days (or >21 days for infants <6 months) Children: • • • • • • • • • Age <6 months OR <3 doses pertussis vaccine OR Household member age <6 months OR Attend childcare in same room as infant <6 months Adults (regardless of immunisation status) Expectant parents in last month of pregnancy OR Healthcare worker in maternity hospital or newborn nursery OR Childcare worker in close contact with infants <6 months OR Household member aged <6 months Adults (regardless of immunisation status) • Expectant parents in last month of pregnancy OR • Healthcare worker in maternity hospital or newborn nursery OR • Childcare worker in close contact with infants <6 months OR • Household member aged <6 months RETAIL PHARMACY • JAN/FEB 2021