Former foe pertussis on the rise againBy Barbara Barzoloski-O’Connor, RN, MSN
November 1, 2004 Print ArticleReply to ArticleE-Mail article Bordetella pertussis
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Respiratory etiquetteTo prevent the transmission of all respiratory infections in health care settings, including influenza, the following infection control measures should be implemented at the first point of contact with a potentially infected person or those with signs and symptoms of a respiratory infection.
During periods of increased respiratory infection activity in the community (e.g., when there is increased absenteeism in schools and work settings and increased medical office visits by persons complaining of respiratory illness), offer masks to people who are coughing. Either procedure masks (i.e., with ear loops) or surgical masks (i.e., with ties) may be used to contain respiratory secretions (respirators such as N-95 or above are not necessary for this purpose). When space and chair availability permit, encourage people who are coughing to sit at least 3 feet away from others in common waiting areas.
Source: These recommendations are based on the Draft Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee, CDC. Available at www.cdc.gov/flu. Accessed October 18, 2004.Most nurses know about pertussis from the stories their parents have told them about the breathtaking whooping cough that accompanies the disease. When respiratory illness season peaks, nurses pay more attention to common ailments like influenza and respiratory syncytial virus (RSV). For many practitioners, pertussis is a non-issue. They know that children receive a vaccine to prevent it, and that’s where their knowledge ends.What they don’t know is, despite high vaccination rates, immunity wanes after five to 10 years, leaving adolescents, adults, and unimmunized infants open to contracting the infection.1 When they care for patients with an illness characterized by a prolonged cough, they should explore the possibility of pertussis.Pertussis was first described in the early 16th century and was a major cause of childhood mortality in the United States during the 20th century. Incidence has decreased more than 98% since widespread vaccinations, but pertussis continues to be a problem in developing countries.2The frequency of reported pertussis has been on the rise in the United States since the 1980s, with an epidemic every three to five years.1Whooping coughPertussis, caused by the bacterium Bordetella pertussis, is commonly called “whooping cough.” The characteristic paroxysm of coughs followed by a long inspiratory effort sounding like a high-pitched whoop points to the possibility that pertussis has been on board for several weeks. Pertussis is spread through contact with respiratory droplets or airborne droplets of respiratory secretions of an infected individual. Secondary attack rates in susceptible household contacts have been as high as 80%, but, unfortunately, it is most communicable before the onset of the paroxysmal coughing stage.1After exposure, the incubation period is seven to 10 days, with a range of four to 21 days, but it may extend as long as 42 days. At the onset, or catarrhal stage, symptoms are similar to the common cold with coryza (runny nose), sneezing, low-grade fever, and mild unproductive cough. These symptoms last one to two weeks, after which the paroxysmal stage begins.The paroxysmal stage often lasts from one to six weeks, but it can last up to 10 weeks. Although the patient may appear normal between coughing episodes, cyanosis may occur during a spell, followed by post-tussive vomiting and exhaustion, which can lead to anorexia and dehydration. Attacks of paroxysmal coughing caused by efforts to expel thick mucus from the tracheobronchial tree are often nocturnal and may hit as frequently as 15 times in a 24-hour period. Paroxysmal coughing may be absent in infants but may show up in episodes of apnea instead.1Secondary bacterial pneumonia is the most common and deadly complication of pertussis. Seizures and encephalopathy also may occur as a result of apnea. Sleep disturbance accompanies the nocturnal attacks. The forceful coughing may result in pneumothorax, epistaxis, subdural hematomas, hernias, and rectal prolapse.2