Letter of Guidance for Parents and Clinicians during Outbreaks

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. 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.

Download the letter [2 pages] as a Word file.

View the front or back of the letter.

Front of Letter

Dear Parent or Guardian:

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

Recommendations:

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 pertussis.
If your child has a weakened immune system, ask your child’s doctor to prescribe antibiotics to your child as soon as possible to prevent pertussis. Doctors should give antibiotics to a child with a weakened immune system if they may have been exposed to pertussis, even if he or she is not coughing.
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 a weakened immune system
If your child has been diagnosed with pertussis by his or her doctor:
- Tell the school that a doctor diagnosed your child with pertussis.
- 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 antibiotics for five days to treat pertussis.
- Ask your child’s doctor for a note that states your child has pertussis.
If your child’s doctor says your child does NOT have pertussis:
- Ask for a note from the doctor telling the school that your child’s cough is NOT pertussis and that your child can return to school and other activities at any time.

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

If you bring your child to a doctor for pertussis, 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,

Top of Page

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:

As [insert public health entity] continues to work with the Centers for Disease Control and Prevention (CDC), we have developed the following guidelines for assessing and treating patients at this time:

For patients coughing <21 days:

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

For patients coughing ≥21 days:

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.
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.
The patient is no longer infectious and can return to school.

For all households: Administer Tdap to contacts 11 years or older who have not been previously vaccinated with Tdap, DTaP to contacts 2 months through 6 years who are not up-to-date, or refer for vaccination [insert contact].

You can find additional clinical and laboratory guidance on the CDC website: www.cdc.gov/pertussis.

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