Post-exposure prophylaxis (PEP) for pertussis — whooping cough — means giving antibiotics to people who have been exposed, before they fall ill. Its main goal is to prevent death and serious complications in the people at highest risk of severe infection. Public health professionals can help work out who needs it, and in some settings wider use may be reasonable.
At the same time, antibiotics should be prescribed and taken only when necessary, to limit antibiotic resistance and spare people side effects.
Who CDC supports giving PEP to
| Group | Window |
|---|---|
| All household contacts without symptoms of a person with pertussis | within 21 days of the start of the patient's cough |
| People at high risk of severe pertussis | within 21 days of exposure to someone infectious |
| People who will be in contact with those at high risk | within 21 days of exposure |
PEP can be considered for other contacts too.
Why households
Studies show that pertussis spreads readily within families — secondary attack rates are high even when household members are up to date on pertussis vaccination.
Who is at high risk
- Infants under 12 months. Severe and sometimes fatal complications occur in babies under a year old, and especially under 4 months.
- People with conditions pertussis could worsen — including, but not only, people with immunocompromising conditions or moderate to severe asthma that needs medical treatment.
Who counts as a close contact of someone at high risk
- Pregnant women in the third trimester, who could pass pertussis to their newborn.
- Everyone in high-risk settings — above all places with infants under 12 months or women in their third trimester, such as:
- neonatal intensive care units
- childcare settings
- maternity wards
When broader use makes sense — and when it doesn't
In a limited, closed setting, broader PEP may be appropriate when the number of known cases is small and there is no community-wide outbreak. But if transmission keeps going, repeated rounds of antibiotics are not recommended; instead, providers should watch exposed people for signs and symptoms of pertussis for 21 days.
When pertussis is widespread in the community, extensive contact tracing and broad PEP for contacts may not be a good use of limited public health resources. Antibiotics can prevent pertussis if given before symptoms start, but no data show that widespread PEP among contacts controls or limits outbreaks.
CDC also tracks antibiotic-resistant Bordetella pertussis.
Sources
Based on "Postexposure Antimicrobial Prophylaxis," Centers for Disease Control and Prevention; a work of the United States government in the public domain. A stock photograph is left out.
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