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Vaccine Preventable Disease Control
County of Los Angeles
Department of Public Health
Vaccine Preventable Disease Control Program
3530 Wilshire Blvd. Suite 700
Los Angeles, CA 90010
Phone: (213) 351-7800
Email: ip@ph.lacounty.gov
Symptoms
Whooping cough usually starts with cold-like symptoms. These early symptoms can last for one to two weeks and usually include:
Later, the traditional symptoms of whooping cough appear, which include:
The coughing fits can last for up to 10 weeks or more. For teenagers and adults, especially those who have been vaccinated, the "whoop" is often not there, and the disease is generally less severe.
If you think you may have these symptoms, talk with your healthcare provider. If you are a provider whose patients have symptoms compatible with this disease, please report to DPH.
Complications
Whooping cough can cause serious illness, leading to hospital stays and even death. Severe illness is often seen in babies less than 6 months old. Many babies may have only congestion and a runny nose, while others may gasp or gag, be tired, vomit, have seizures, or stop breathing. Unfortunately, some babies die from whooping cough. If your baby has trouble drinking liquids or catching their breath, is breathing fast, often vomits after they cough, or seems more tired than usual, call your doctor right away or go to the nearest emergency room.
Whooping cough can easily spread through the air. When a person who has whooping cough sneezes or coughs, they can release small particles with the bacteria in them. Other people then breathe in the bacteria.
Some people have mild symptoms and don’t know they have whooping cough, but they can still spread it to others. Many babies who get whooping cough are infected by older siblings, parents, or caregivers who do not know they have it.
If you think you or your someone in your family may have whooping cough because you or they have symptoms:
If you think you have been exposed to someone with whooping cough:
If your doctor tells you that you have whooping cough, you should stay at home away from other people until the 6th day of your treatment with antibiotics prescribed by your doctor. This will help you make sure that you do not spread whooping cough to others.
Getting vaccinated is the best way to protect yourself from whooping cough. Pertussis shots are safe and effective at preventing severe infection.
There are two kinds of vaccines available in the United States to help protect against whooping cough, and both also provide protection against other diseases:
The American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) recommend pertussis vaccination for infants, children, teenagers, and adults.
Who SHOULD get the vaccine:
Who should NOT get the vaccine:
Who should talk to their doctor before getting the vaccine:
Talk to your doctor if you have any of these health conditions or other precautions for vaccination.
If you have insurance:
If you are uninsured or underinsured:
Locating Vaccine Clinics:
If you are unsure of your pertussis vaccination status, you can request a copy of your records.
To request your record:
If your vaccines are not listed, ask your doctor, pharmacist, or vaccine provider for a copy of your vaccine records. You can also ask them to add your vaccines to the California Immunization Registry (CAIR).
Other tips to find your records:
Pertussis Frequently Asked Questions (FAQs) (LAC DPH):
Resources for Parents:
Pregnancy and Pertussis Information and Resources:
Bordetella pertussis is a gram-negative bacteria that causes a highly contagious respiratory disease (whooping cough) that affects people of all ages, and can be very serious, even deadly, for infants fewer than 12 months old. People with whooping cough are most contagious early in the illness and can spread the infection for up to 3 weeks after coughing begins, or until 5 days after starting antibiotics. Clinical presentation may vary by age and immunization status.
Consider and evaluate patients for B. pertussis if the patient has a cough illness AND at least one of the following signs or symptoms:
Please contact the LAC DPH Vaccine-Preventable Disease Control Program to report a case or obtain technical assistance with specimen collection or completion of forms for pertussis, or for any other vaccine-preventable disease.
Suspected or confirmed pertussis cases are to be reported within 1 working day from identification by electronic transmission (email or digital fax) or telephone per Title 17, California Code of Regulations (CCR), Section 2500.
Please send the patient’s medical records and any available immunization records and/or laboratory results via secure email or fax.
A diagnosis of B. pertussis can be challenging based on clinical presentation alone. Multiple diagnostic laboratory tests are available to support as confirmatory evidence.
Culturing B. pertussis from a respiratory specimen is the gold standard with 100% specificity, but can be time intensive and is not widely available. Most commonly, providers obtain respiratory specimens for B. pertussis PCR, which is both highly sensitive and quick, allowing for prompt isolation and treatment of infected patients.
Culture
Optimal timing of pertussis specimen for culture is within the first 2 weeks following cough onset, and before initiation of antibiotic therapy.
Collect a nasopharyngeal (NP) swab and place immediately into transport medium for delivery to laboratory services.
Culture testing can take up to 7 days to provide results.
PCR
Obtain a nasopharyngeal (NP) swab or aspirate within the first 3 weeks after cough onset (may be performed up to 4 weeks, though sensitivity decreases), and before initiation of antibiotic therapy.
A positive PCR result for B. pertussis is confirmatory in a patient with cough illness.
PCR testing is not recommended for asymptomatic individuals or for patients who have completed 5 days of appropriate antibiotic therapy, as results may be unreliable.
Early treatment of pertussis is most effective for reducing symptom severity and contagiousness. Treating B. pertussis early with antibiotics may decrease morbidity and transmission.
Patients should stay home from work or school until they have completed 5 days of appropriate antibiotic treatment, or for 21 days after cough onset if untreated.
Chemoprophylaxis treatment is recommended to contacts at high risk for severe disease (e.g. infants, persons in 3rd trimester of pregnancy, persons with chronic lung disease), household members of patient, and to persons who will have close contact with those at high risk of developing severe pertussis (e.g., healthcare workers, infant daycare workers). Refer to the CDPH Pertussis (Whooping Cough) Prevention, Evaluation, & Treatment Guidelines for detailed guidance regarding elevated pertussis risk factors.
For recommended antimicrobial agents for treatment and post-exposure prophylaxis, dosing and duration, please see the following table, adapted from the Pertussis chapter in the AAP Red Book 2024-2027:
Recommended Treatment and Post-Exposure Prophylaxis, by Age Group
| Age Group |
Recommended Drugs |
Alternative |
||
|---|---|---|---|---|
| Azithromycin |
Erythromycin |
Clarithromycin |
TMP-SMX* |
|
| Infants younger than 1 month |
10 mg/kg per day as a single dose daily for 5 days§,** |
If azithromycin is unavailable, 40 mg/kg per day in 4 divided doses for 14 days** |
Not recommended |
Contraindicated |
| Infants 1 to 2 months old |
40 mg/kg per day in 4 divided doses for 14 days |
15 mg/kg (maximum 1 g) per day in 2 divided doses for 7 days |
||
| Infants 2 to 5 months old |
TMP, 8 mg/kg per day; SMX, 40 mg/kg per day in 2 divided doses for 14 days |
|||
| Infants 6 months or older and children |
10 mg/kg (maximum 500 mg) as a single dose on day 1, then 5 mg/kg (maximum 250 mg) per day as a single dose on days 2 through 5§,†† |
40 mg/kg (maximum 2 g) per day in 4 divided doses for 7-14 days |
||
| Adolescents and adults |
500 mg as a single dose on day 1, then 250 mg as a single dose on days 2 through 5§,†† |
2 g per day in 4 divided doses for 7-14 days |
1 g per day in 2 divided doses for 7 days |
TMP, 320 mg per day; SMX, 1600 mg per day in 2 divided doses for 14 days |
| *SMX indicates sulfamethoxazole; TMP indicates trimethoprim. § Azithromycin should be used with caution in people with prolonged QT interval and certain proarrhythmic conditions. ** Azithromycin is the preferred macrolide for infants under 1 month old because of risk of idiopathic hypertrophic pyloric stenosis (IHPS) associated with erythromycin. If infants under 1 month old are prescribed erythromycin, they should be monitored for IHPS. †† A 3-day course of azithromycin for PEP or treatment has not been validated and is not recommended. |
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The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend routine pertussis vaccination across the lifespan. Children younger than 7 years of age should receive DTaP (diphtheria, tetanus, acellular pertussis), while older children and adults should receive Tdap (tetanus, diphtheria, acellular pertussis) or Td (tetanus and diphtheria). See the table below for a list of pertussis-containing vaccines and the recommended schedules.
Multiple combination vaccines containing pertussis are available for use. Use of combination vaccines are also useful in reducing the number of injections in a single visit.
Immunity from vaccination or prior infection decreases over time, so people can become infected even if they have been vaccinated or had pertussis before. For this reason, fully vaccinated individuals with pertussis-like symptoms should receive evaluation and testing, especially if they have been exposed.
Adults
Administer a single dose of Tdap to adults who have never received Tdap regardless of when they last received Td. This should be followed by a Tdap booster every 10 years.
Catch-Up Guidance for Children 4 Months through 18 Years
Review the catch-up guidance for diphtheria, tetanus, and pertussis vaccination for children and adolescents whose vaccinations have been delayed.
Pertussis Vaccine Recommendations for Children and Adults
| Pertussis-Containing Vaccines and Brands* |
Number of Doses |
Recommended Age for All Doses |
Dose & Route |
||||
|---|---|---|---|---|---|---|---|
| Dose 1 |
Dose 2 |
Dose 3 |
Dose 4 |
Booster |
|||
| DAPTACEL® (DTaP) Sanofi Pasteur |
5 |
6 wks-2 mos |
4 mos |
6 mos |
15-20 mos |
4-6 yrs |
0.5mL Intramuscular (IM) |
| INFANRIX (DTaP) Sanofi Pasteur |
5 |
6 wks-2 mos |
4 mos |
6 mos |
15-20 mos |
4-6 yrs |
0.5mL IM |
| PEDIARIX (DTaP-HepB-IPV) GlaxoSmithKline (GSK) |
3 |
6 wks-2 mos |
4 mos |
6 mos |
Not recommended** |
0.5mL IM |
|
| Pentacel® (DTaP-IPV/Hib) Sanofi Pasteur |
4 |
6 wks-2 mos |
4 mos |
6 mos |
N/A |
15-18 mos |
0.5mL IM |
| VAXELIS® (DTaP-IPV-Hib-HepB)*** MSP Vaccine Company |
3 |
6 wks-2 mos |
4 mos |
6 mos† |
N/A |
N/A |
0.5mL IM |
| KINRIX (DTaP-IPV) †† GlaxoSmithKline (GSK) |
1-2 |
N/A |
N/A |
N/A |
4-6 yrs †† |
0.5mL IM |
|
| Quadracel® (DTaP-IPV)††† Sanofi Pasteur |
1-2 |
N/A |
N/A |
N/A |
4-6 yrs ††† |
0.5mL IM |
|
| Adacel® (Tdap) § Sanofi Pasteur |
Booster |
N/A |
N/A |
N/A |
N/A |
7-64 yrs‡ |
0.5mL IM |
| BOOSTRIX (Tdap) § GlaxoSmithKline (GSK) |
Booster |
N/A |
N/A |
N/A |
N/A |
7-64 yrs‡ |
0.5mL IM |
| *Pertussis-containing vaccines can be co-administered with other vaccines. **Because the pertussis antigens contained in INFANRIX and KINRIX are the same as those in PEDIARIX, these children should receive INFANRIX as their fourth dose of DTaP and either INFANRIX or KINRIX as their fifth dose of DTaP. KINRIX or Quadracel® may be used to complete the 4-dose IPV series. ***Preferred for American Indian and Alaska Native infants based on the Haemophilus influenzae type b component. † The recommended minimum age for dose 3 of VAXELIS® is 24 weeks, the minimum age for completion of the hepatitis B vaccine series. †† KINRIX is approved only for dose 5 of DTaP and dose 4 of IPV. ††† Quadracel® is approved only for dose 5 of DTaP and dose 4 or 5 of IPV. § Children 7-9 years old who have never been vaccinated against pertussis, tetanus, or diphtheria should receive a series of three tetanus and diphtheria toxoid-containing vaccines, which includes at least one dose of Tdap. ‡ Either Tdap vaccine administered to a person age 65 years or older is immunogenic and would provide protection; a dose of either vaccine would be considered valid. |
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Administration Data: California healthcare providers are required to report data on all valid immunizations that they administer to their patients into the California Immunization Registry (CAIR) within 2 weeks of administration per AB 1797.
Administration Errors: Healthcare providers are strongly recommended to report all vaccine administration errors to the Institute for Safe Medication Practices.
Adverse Events: Healthcare providers are required to report any adverse event on the reportable events list to the Vaccine Adverse Event Reporting System (VAERS) per HR 5546.
Storage and Handling: For general recommendations and guidance access the Vaccine Storage and Handling Job Aids.
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