Letter of Guidance for Parents and Clinicians during Outbreaks

About the letter

This draft letter can be adapted for use during pertussis outbreaks in schools or other closed or contained settings.

The front page provides guidance to parents or guardians of an exposed child. View the front of the letter below.

The back page provides detailed guidance to healthcare providers for the testing, treatment and/or postexposure prophylaxis of sick or exposed patients. Schools can use this page when students need to follow-up with a healthcare provider. View the back of the letter below.

Download the letter.

Front of letter

Dear Parent or Guardian:

Your child may have been exposed to whooping cough (pertussis). Since [insert date], the [insert health department] has seen an increased number of whooping cough cases in [insert location]. Whooping cough is an infection that affects the airways. The bacteria that cause whooping cough can easily spread from person to person by coughing or sneezing. Whooping cough can cause a severe cough that lasts for weeks or months, sometimes leading to coughing fits or vomiting. Anyone can get whooping cough, but it can be very dangerous for babies and people with certain health conditions that may be worse with whooping cough. Family members with whooping cough, especially siblings and parents, can spread the disease to babies.

Recommendations:

1. If your child has a cough:
   • Keep your child home from school and activities, such as sports or play groups. See items 4 and 5 about when your child can return to these activities.
   • Make an appointment with your child’s doctor as soon as possible and tell the doctor that your child may have been exposed to whooping cough.
2. If your child has a health condition that may be worse with whooping cough, such as asthma, ask your child’s doctor to prescribe antibiotics to your child as soon as possible to prevent whooping cough. Doctors should give antibiotics to a child with certain health conditions if they may have been exposed to whooping cough, even if he or she is not coughing.
3. If your child lives with any of the following people, ask your child’s doctor to prescribe antibiotics as soon as possible to your child, even if he or she is not coughing:
   • A woman who is pregnant
   • A baby younger than 12 months old
   • Anyone with health conditions that may be worse with whooping cough, such as asthma
4. If your child has been diagnosed with whooping cough by their doctor:
   • Tell the school that a doctor diagnosed your child with whooping cough.
   • School officials may request that you keep your child home from school and activities, such as sports or play groups, until your child has been on appropriate antibiotics for five days to treat whooping cough.
   • Ask your child’s doctor for a note that states your child has whooping cough.
5. If your child’s doctor says your child does NOT have whooping cough:
   • Ask for a note from the doctor telling the school that your child’s cough is NOT whooping cough and that your child can return to school and other activities at any time.

Please make sure your family’s whooping cough vaccinations are up to date. Protection against whooping cough from the childhood vaccine, DTaP, decreases over time. Older children and adults, including pregnant women, should get a whooping cough booster shot called “Tdap” to help protect themselves and babies. If you need Tdap, contact your doctor or call [insert contact] to find a vaccine provider near you.

If you take your child to a doctor for whooping cough, please show the reverse side of this letter to him or her. If you have any questions or concerns, please call us at [insert contact].

Sincerely,

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Back of letter

Dear Colleague:

Your patient may have been exposed to pertussis.

For Exposed Patients without Symptoms:

As a precaution to help protect vulnerable individuals, we are recommending antibiotic prophylaxis for this patient if he or she shares a household with a woman who is pregnant or an infant less than 12 months old. Alternatively, we are referring this patient to you because he or she has an immunodeficiency or lives with a person with an immunodeficiency and may require antibiotic prophylaxis to help prevent pertussis.

For Exposed Patients with Symptoms:

For patients coughing less than 21 days:

1. Collect nasopharyngeal swabs or aspirate for pertussis PCR testing and/or culture.
2. Do not delay treatment with appropriate antibiotics while waiting for laboratory results if there is no alternative diagnosis.
3. Document and communicate all clinical decisions related to pertussis to the school (this includes children for whom you have ruled out pertussis).
4. Strongly consider antibiotic prophylaxis for all household members if a pregnant woman, an infant less than 12 months old, or anyone with an immunodeficiency lives in the household.

For patients coughing 21 days or more:

1. Laboratory testing for pertussis is not necessary. CDC does not recommend laboratory testing after 3 weeks of cough since PCR and culture are only sensitive during the first 2 to 3 weeks of cough when bacterial DNA is still present in the nasopharynx.
2. For most patients, antibiotic treatment is not required. Antibiotics are no longer necessary after 21 days of cough, with the following exception: you should treat infants and pregnant women in their third trimester up through 6 weeks after cough onset.
3. The patient is no longer infectious and can return to school.

For all households:  Ensure everyone is up to date with their pertussis vaccination. For those who aren’t, either administer the appropriate vaccine or refer them to [insert contact] for vaccination.

You can find additional clinical and laboratory guidance on the CDC website.

Should you have any questions or concerns, please call [insert contact]

Sincerely,

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