Guidelines for the public health management of pertussis
SHPN guide to using the external guidance

Overview

The 2018 UK Health Security Agency (UKHSA) pertussis guidance previously recommended for use in Scotland has been retired. It has been updated with guidance for use during times of high activity.

This guidance should now be followed in Scotland.

View the updated UKHSA guidance.

The Public Health Scotland (PHS) Vaccination and Immunisations Division (VAID) and Guidance Team have reviewed the UKHSA guidance.

This guidance publication provides additional advice on how to apply it in Scotland.

Intended audience

This guidance is for health professionals only.

Health professionals who require further advice should contact their local health protection team.

For the public

Members of the public can find advice on pertussis (whooping cough) on NHS inform.

If they have suspected pertussis – or have a positive pertussis result – their local health protection team may contact them with additional advice. This could be by phone or by text message.

What the guidance covers

This guidance covers the investigation and management of suspected cases of pertussis and their close contacts.

Guide for use in Scotland

Guidance for health protection professionals

Health protection teams should review the updated guidance in full, but updates are summarised below.

Case management

Antibiotic therapy can be considered for clinical indications within 14 days of onset of cough in a case (from the previously recommended 21 days).

However, where the case has a household or other close contact who falls into priority group 1 (see section 2.2.3 of the UKHSA guidance for definitions) for public health action, antibiotic therapy is recommended for all cases within 21 days of onset of cough.

Contact tracing and follow-up

Close contacts of confirmed, suspected or epidemiologically linked pertussis cases who are in priority groups will be eligible for chemoprophylaxis for a maximum of 14 days after onset of cough in the case, rather than the previously recommended 21 days.

This change takes account of evidence suggesting limited effectiveness of chemoprophylaxis in contacts at longer time durations from point of exposure.

Outbreak management

Where cases and outbreaks occur in settings where it is unlikely that those exposed will be members of a priority group – for example, school settings – investigation and active intervention are not now routinely recommended.

Enhanced surveillance

Health protection teams (HPTs) are reminded to submit completed enhanced surveillance forms for cases under 1 year to PHS.

Download the pertussis incident form for infants under one year.

Guidance for laboratory testing

Laboratories should continue to expect increasing numbers of samples for diagnostic primary testing of suspected pertussis.

The updated UKHSA guidance seeks to prioritise diagnosis and testing in particular groups.

Clinicians and the HPT should work with the microbiology team to ensure appropriate testing is undertaken in line with updated guidance considering increase in pertussis cases.

Different tests are available depending on the timing of the infection.

• PCR may be performed locally or referred to another laboratory, in those with symptoms for less than 3 weeks.
• Serology for pertussis toxin IgG is available at Scottish Microbiology Reference Laboratory (SmiRL) Glasgow for those with symptoms for more than 3 weeks.
• Oral-fluid testing for surveillance is not a requirement in Scotland. References to oral-fluid testing in the UKHSA guidance are not relevant to Scotland.

Please note that the sensitivity and specificity of pertussis laboratory tests are not 100%. Therefore, negative results cannot be used to exclude pertussis infection.

Public health action should proceed based on a risk assessment of the clinical and epidemiological factors.

Guidance for other healthcare professionals

All healthcare professionals are requested to note the following.

Updated UKHSA guidance

UKHSA guidance on antibiotic prescribing for pertussis has been updated in Pertussis: guidelines for public health management.

This includes:

• updated advice on duration of antibiotic therapy for cases
• recommendations regarding prophylaxis for contacts

Updated NICE Clinical Knowledge Summary

NICE Clinical Knowledge Summary (CKS) on whooping cough has been updated to clarify approaches to, and requirements for, testing for case confirmation and surveillance purposes.

Further updates to align with revisions to the UKHSA guidance are planned.

Prompt identification

All healthcare professionals are encouraged to continue promptly identifying and treating suspected cases of pertussis.

Pertussis can present atypically but classical symptoms are outlined in the NICE Clinical Knowledge Summary.

Additional information on case definitions is available in UKHSA pertussis guidance.

Report to local HPT

Pertussis is a notifiable disease and should be reported where suspected to your local HPT.

View the health protection team contact information.

Testing

Oral-fluid testing for surveillance is not a requirement in Scotland.

References to oral-fluid testing in the UKHSA guidance are not relevant to Scotland.

Treatment

A Medicines Supply Alert Notice was issued on 14 June 2024 relating to the availability of erythromycin 250mg tablets.

Interruption to supply for this antimicrobial is anticipated to be short-term.

UKHSA guidance outlines alternatives within the macrolide class if the first-choice antimicrobial is not available or contra-indicated.

Advice for patients

Find out further advice for patients with pertussis on NHS inform.

Vaccination

All healthcare professionals are requested to carry out the following actions.

Encourage uptake in pregnant women

Strongly encourage and promote uptake of maternal vaccinations, including pertussis.

Women in pregnancy will typically be offered a pertussis-containing vaccination between 20 and 32 weeks’ gestation but can receive it as early as week 16.

They should be vaccinated in each pregnancy.

NHS inform provide resources to support informed consent and communication around vaccines with pregnant women.

Routine vaccination programme

Bolster uptake through the routine programme if working in primary care settings.

Vaccination against pertussis through the routine programme is offered at 8, 12 and 16 weeks of age with a booster offered preschool, in primary care settings.

This offers direct protection to infants and children against severe outcomes from pertussis.

Every effort should be made to identify and offer vaccination to unimmunised and under-immunised individuals.

Signpost to further patient information

Signpost to where they can gain further information on getting vaccinations in their board.

Occupational health

NHS Occupational Health departments are asked to note updated UKHSA advice on the occupational vaccination of healthcare workers.

Eligibility

The UKHSA guidance on occupational vaccination for healthcare workers has been updated in line with recent JCVI advice. Eligibility for occupational vaccination now includes healthcare workers in both Groups 1 and 2 who have not received a pertussis-containing vaccine in the last 5 years.

Prioritisation of the occupational pertussis vaccination offer is as follows:

• all HCWs in priority group 1 to receive a first dose if not vaccinated in the last 5 years
• all HCWs in priority group 2 to receive a single vaccination dose, provided they have not received a pertussis-containing vaccination in the preceding 5 years
• HCWs in priority group 1 to receive a further booster if more than 5 years since their first occupational dose

Group 2 HCWs should be given a single booster dose. There are currently no recommendations for additional booster doses for healthcare workers in priority group 2.

Schools, nurseries and childcare settings

Local authority and other education or childcare colleagues should be aware of the current increase in pertussis activity and potential for cases to be reported to schools, nurseries, and other childcare settings.

Support

There is guidance available to support those working in children and young people settings, including education settings.

View the guidance on health protection in children and young people settings.

Action to be taken

Children

Children with pertussis should be excluded from schools or nurseries for:

• 48 hours following commencement of recommended antibiotic therapy
• 14 days following the onset of coughing if they are not being treated

See managing specific infectious diseases (whooping cough) for information.

Staff

Staff working in nurseries and other childcare settings providing close personal care to children aged under one (for example, in nursery baby rooms) should be excluded for:

• 48 hours following commencement of recommended antibiotic therapy
• 21 days following the onset of cough if untreated

Staff in other nursery and childcare settings, schools and other educational settings should be excluded for:

• 48 hours following commencement of recommended antibiotic therapy
• 14 days following the onset of cough if untreated

View the external guidance

This external guidance should be used together with the guide for use in Scotland provided on these pages.