MEDICAL ADVISORY: Recent Pertussis Cases in Niagara

Issued by: Dr. Jessica Jackman, MD MPH FRCPC FACPM DipABLM, Associate Medical Officer of Health

Date: August 12, 2024

Niagara Region Public Health and Emergency Services has seen several pertussis cases in recent weeks. While there is no outbreak activity in Niagara Region, given the recent increase in pertussis activity across Ontario, we would like to provide recommended actions for health care providers. This includes recommendations for vaccination, testing and reporting suspect cases to Public Health.

About Pertussis

Pertussis is a respiratory infection caused by the bacteria Bordetella pertussis
The incubation period ranges from six to 20 days
Pertussis is transmitted through contact with respiratory droplets. Patients are highly communicable during the first two weeks of illness. Communicability gradually decreases and becomes negligible in about three weeks.
The clinical course of pertussis is divided into three stages:
- Catarrhal stage: characterized by mild upper respiratory tract symptoms, with a mild cough that lasts one to two weeks
- Paroxysmal stage: characterized by repeated and violent coughing (paroxysms), often accompanied by a high-pitched inspiratory whoop and post-tussive vomiting; fever is absent or minimal. This stage lasts one to two months, or longer.
- Convalescent stage: this marks a gradual period of recovery where the cough becomes less paroxysmal and disappears over the course of weeks to months
Young infants are at highest risk of developing severe complications from pertussis

Actions for Health Care Providers

Please ensure your patients are up-to-date with their routine vaccinations, including pertussis, as per Ontario's routine immunization schedule. This is particularly important as we approach the start of a new school year. Routine immunizations include:
- A series of DTaP-IPV-Hib for infants at two, four, six and 18 months; a booster of Tdap-IPV at four years of age; and an adolescent Tdap booster at 14 – 16 years of age
- A booster dose of Tdap for adults, typically given at 24 – 28 years of age, 10 years from adolescent booster
- One dose of Tdap vaccine should be administered in every pregnancy, ideally between 27 and 32 weeks of gestation. This helps confer protection against pertussis for the infant.
You may see an increase in the number of calls to your office from parents/legal guardians seeking vaccinations for their child/children. Please ensure your office has enough vaccine to accommodate this potential increased demand. Use the General Vaccine Order Form for Immunization of School Pupils Act (ISPA) required vaccines.
Consider pertussis in your differential diagnosis, particularly in patients with coughing spells that end in a high-pitched whoop or vomiting, shortness of breath or exhaustion from coughing, or with a cough lasting two weeks or longer

Pertussis Testing

Patients with symptoms consistent with pertussis should have a NP swab collected and sent for PCR testing as soon as possible, within the first three weeks of illness
Please ensure you have the appropriate kit available at your office for testing: Bordetella pertussis Kit (2 Pack) order#: 390052 | Public Health Ontario
Due to the risk of false positive results, testing is not recommended for asymptomatic patients
Refer to Bordetella - Respiratory - PCR | Public Health Ontario for more information

Infection Prevention and Control

Suspect cases should be placed under droplet precautions, in addition to routine practices. This includes masking of the patient and modifying patient flow to minimize potential exposure to others.

Reporting

All suspect and confirmed cases of pertussis are to be reported to the Medical Officer of Health as per the Health Protection and Promotion Act. To report, please contact the Infectious Disease Program at:
- 905-688-8248 ext. 7330 (8:30 a.m. to 4:30 p.m.)
- Toll free: 1-888-505-6074
- After-hours: 905-984-3690

For More Information