LiamG at 10:21, 24 September 2024

2024-09-24T10:21:10Z

← Older revision		Revision as of 10:21, 24 September 2024
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	Maintain High Index of Suspicion		'''Maintain High Index of Suspicion'''
	~~1. Classic findings include inspiratory whoop and staccato cough.~~
	~~2. Infants often do not have the “whoop.” [https://www.youtube.com/watch?v=S3oZrMGDMMw This video] from the Mayo Clinic is a great example of a classic infant presentation.~~
	~~3. Pertussis is predominantly a clinical diagnosis: if you are very suspicious (especially in babies), treat empirically while awaiting test results.~~
	~~4. Highest index of suspicion for pertussis in patients from cluster villages.~~

	~~Protect Yourself~~		# Classic findings include inspiratory whoop and staccato cough.
	1. ~~Consider using droplet precautions for all respiratory patients~~.		# Infants often do not have the “whoop.” [https://www.youtube.com/watch?v=S3oZrMGDMMw This video] from the Mayo Clinic is a great example of a classic infant presentation.
	2. ~~Check your Tdap status on Immuware~~. ~~Reach out to Employee Health~~ if you are ~~behind~~.		# Pertussis is predominantly a clinical diagnosis: if you are very suspicious (especially in babies), treat empirically while awaiting test results.
			# Highest index of suspicion for pertussis in patients from cluster villages.

	~~Prevention~~
	~~1. Update DTaP and Tdap for anyone eligible. [https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent.html Here] are the CDC vaccine schedules, including catch-up.~~
	~~2. Remember that pregnant patients are due for Tdap after 28 weeks. This gives protection to the baby.~~

	Testing (as of 9/24/2024, but should change in 2025 when we have validated respiratory PCR)		'''Protect Yourself'''
	~~(This is subject to change. Here is the strategy we are starting with. Stay tuned as things evolve.)~~
			# Consider using droplet precautions for all respiratory patients.
			# Check your Tdap status on Immuware. Reach out to Employee Health if you are behind.


			'''Prevention'''

			# Update DTaP and Tdap for anyone eligible. [https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent.html Here] are the CDC vaccine schedules, including catch-up.
			# Remember that pregnant patients are due for Tdap after 28 weeks. This gives protection to the baby.


			'''Testing'''

			''(as of 9/24/2024, but should change in 2025 when we have validated respiratory PCR)''

	There are two tests orderable in RAVEN:		There are two tests orderable in RAVEN:
	-ANMC Respiratory Panel: Expensive but faster. Use only for infants <6 months.
	-B pertussis and B parapertussis LC: Goes to LabCorps, much cheaper, but takes longer to result (2-7 days). Use for patients >6 months.		* ANMC Respiratory Panel: Expensive but faster. Use only for infants <6 months.
			* B pertussis and B parapertussis LC: Goes to LabCorps, much cheaper, but takes longer to result (2-7 days). Use for patients >6 months.

	Who to test:		Who to test:
	~~-Babies <6 months with suspicious symptoms: Test with ANMC respiratory panel.~~
	~~-Older patients with suspicious symptoms: Test with LapCorps test.~~
	~~-Any patient with a possible exposure AND any symptoms: Test with LabCorps test. Do not test completely asymptomatic people.~~
	~~-Any household contact of a known case may be treated without a test.~~
	~~-Exposed healthcare providers may be treated without a test.~~

	Treatment		* Babies <6 months with suspicious symptoms: Test with ANMC respiratory panel.
	(per the CDC)		* Older patients with suspicious symptoms: Test with LapCorps test.
	-Patients <12 months within 6 weeks of cough onset. If high level of suspicion for patients at high risk, treat empirically while awaiting test result.		* Any patient with a possible exposure AND any symptoms: Test with LabCorps test. Do not test completely asymptomatic people.
	-Patients >12 months within 3 weeks of cough onset. If high level of suspicion for patients at high risk, treat empirically while awaiting test result.		* Any household contact of a known case may be treated without a test.
	-Pregnant patients (especially if near term) within 6 weeks of cough onset.		* Exposed healthcare providers may be treated without a test.
	-Any household contact of a known case may be treated without a test.
	-Exposed healthcare providers may be treated without a test.
			'''Treatment'''

			''(per the CDC)''

			* Patients <12 months within 6 weeks of cough onset. If high level of suspicion for patients at high risk, treat empirically while awaiting test result.
			* Patients >12 months within 3 weeks of cough onset. If high level of suspicion for patients at high risk, treat empirically while awaiting test result.
			* Pregnant patients (especially if near term) within 6 weeks of cough onset.
			* Any household contact of a known case may be treated without a test.
			* Exposed healthcare providers may be treated without a test.


			'''Hospitalization'''

	~~Hospitalization~~		* Infants <4 months:
	-Infants <4 months:		** Check CBC with diff.
	Check CBC with diff.		** Low threshold to hospitalize these infants until they have begun to show some improvement.
	Low threshold to hospitalize these infants until they have begun to show some improvement.		** Risk factors for significant morbidity (including “rapid, unpredictable deterioration”): apnea, cyanosis, and WBC >30K. If any of these are present, consider transfer to a facility with a PICU. (Note: We are using prolonged cyanosis as a criterium rather than brief, self-limited perioral cyanosis with coughing.)
	Risk factors for significant morbidity (including “rapid, unpredictable deterioration”): apnea, cyanosis, and WBC >30K. If any of these are present, consider transfer to a facility with a PICU. (Note: We are using prolonged cyanosis as a criterium rather than brief, self-limited perioral cyanosis with coughing.)		* Older patients: Consider hospitalization and/or empiric treatment for patients with history of prematurity, chronic lung disease, neuromuscular disorders, etc. Feel free to consult Peds Wards on Duty with any questions.
	-Older patients: Consider hospitalization and/or empiric treatment for patients with history of prematurity, chronic lung disease, neuromuscular disorders, etc. Feel free to consult Peds Wards on Duty with any questions.

	[https://www.cdc.gov/pertussis/php/postexposure-prophylaxis/index.html Here] is a CDC page on post-exposure PPX for more information		[https://www.cdc.gov/pertussis/php/postexposure-prophylaxis/index.html Here] is a CDC page on post-exposure PPX for more information

LiamG: Created page with "Maintain High Index of Suspicion 1. Classic findings include inspiratory whoop and staccato cough. 2. Infants often do not have the “whoop.” [https://www.youtube.com/watch?v=S3oZrMGDMMw This video] from the Mayo Clinic is a great example of a classic infant presentation. 3. Pertussis is predominantly a clinical diagnosis: if you are very suspicious (especially in babies), treat empirically while awaiting test results. 4. Highest index of suspicion for pertussis in p..."

2024-09-24T10:15:48Z

Created page with "Maintain High Index of Suspicion 1. Classic findings include inspiratory whoop and staccato cough. 2. Infants often do not have the “whoop.” [https://www.youtube.com/watch?v=S3oZrMGDMMw This video] from the Mayo Clinic is a great example of a classic infant presentation. 3. Pertussis is predominantly a clinical diagnosis: if you are very suspicious (especially in babies), treat empirically while awaiting test results. 4. Highest index of suspicion for pertussis in p..."

New page

Maintain High Index of Suspicion
1. Classic findings include inspiratory whoop and staccato cough.
2. Infants often do not have the “whoop.” [https://www.youtube.com/watch?v=S3oZrMGDMMw This video] from the Mayo Clinic is a great example of a classic infant presentation.
3. Pertussis is predominantly a clinical diagnosis: if you are very suspicious (especially in babies), treat empirically while awaiting test results.
4. Highest index of suspicion for pertussis in patients from cluster villages.

Protect Yourself
1. Consider using droplet precautions for all respiratory patients.
2. Check your Tdap status on Immuware. Reach out to Employee Health if you are behind.

Prevention
1. Update DTaP and Tdap for anyone eligible. [https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent.html Here] are the CDC vaccine schedules, including catch-up.
2. Remember that pregnant patients are due for Tdap after 28 weeks. This gives protection to the baby.

Testing (as of 9/24/2024, but should change in 2025 when we have validated respiratory PCR)
(This is subject to change. Here is the strategy we are starting with. Stay tuned as things evolve.)
There are two tests orderable in RAVEN:
-ANMC Respiratory Panel: Expensive but faster. Use only for infants <6 months.
-B pertussis and B parapertussis LC: Goes to LabCorps, much cheaper, but takes longer to result (2-7 days). Use for patients >6 months.
Who to test:
-Babies <6 months with suspicious symptoms: Test with ANMC respiratory panel.
-Older patients with suspicious symptoms: Test with LapCorps test.
-Any patient with a possible exposure AND any symptoms: Test with LabCorps test. Do not test completely asymptomatic people.
-Any household contact of a known case may be treated without a test.
-Exposed healthcare providers may be treated without a test.

Treatment
(per the CDC)
-Patients <12 months within 6 weeks of cough onset. If high level of suspicion for patients at high risk, treat empirically while awaiting test result.
-Patients >12 months within 3 weeks of cough onset. If high level of suspicion for patients at high risk, treat empirically while awaiting test result.
-Pregnant patients (especially if near term) within 6 weeks of cough onset.
-Any household contact of a known case may be treated without a test.
-Exposed healthcare providers may be treated without a test.

Hospitalization
-Infants <4 months:
Check CBC with diff.
Low threshold to hospitalize these infants until they have begun to show some improvement.
Risk factors for significant morbidity (including “rapid, unpredictable deterioration”): apnea, cyanosis, and WBC >30K. If any of these are present, consider transfer to a facility with a PICU. (Note: We are using prolonged cyanosis as a criterium rather than brief, self-limited perioral cyanosis with coughing.)
-Older patients: Consider hospitalization and/or empiric treatment for patients with history of prematurity, chronic lung disease, neuromuscular disorders, etc. Feel free to consult Peds Wards on Duty with any questions.

[https://www.cdc.gov/pertussis/php/postexposure-prophylaxis/index.html Here] is a CDC page on post-exposure PPX for more information

Pertussis - Revision history

LiamG at 10:21, 24 September 2024