Information and guidance on pertussis (whooping cough)

Pertussis is an acute, highly contagious infectious respiratory infection caused by Bordetella pertussis (Gram-negative bacterium) that can spread from person-to-person through contact with contaminated airborne droplets. It can affect people of all ages, but most cases occur in infants under three months old who are too young to be protected by direct immunisation and are also most at risk of developing severe complications. Most practice staff will have been vaccinated against pertussis during childhood as part of the routine immunisation program. This means they are at a significantly lower risk of transmission and serious illness. 

While the numbers are relatively low, there has been a 10-fold increase compared to the past three years. Should this continue to rise, it could impact the delivery of primary care services. The UK Health Security Agency (UKHSA) has provided guidance to local Health Protection Teams (HPTs) to manage the recent increase, prevent hospitalisation and mortality among vulnerable groups. The guidance also highlights the importance of available immunisation programs.

We have set out below key information to ensure the appropriate identification of cases, and provide guidance on managing circumstances that are relevant to optometry practices.

In the first instance, patients who contact the practice with symptoms of respiratory infection, including pertussis (whooping cough), should postpone their eye care unless it is urgent or an emergency.

If patients have suspected, confirmed or epidemiology linked pertussis infection you should defer routine care until they have completed 48 hours of appropriate antibiotic treatment, or after 21 days from onset of symptoms if not treated.

In the unlikely event these patients require face-to-face eye care that cannot be postponed, you should apply the relevant transmission based precautions (TBPs) according to the National Infection Prevention and Control Manual (NIPCM). You are not considered exposed to pertussis infection if appropriate personal protective equipment (PPE) and respiratory protective equipment (RPE) is worn.

If you are unable to implement the relevant TBPs, they should be referred to an appropriate local service that is able to apply these measures or contact your local hospital eye department for advice.

As pertussis is a legally notifiable condition, if the patient has not already contacted their GP you must report suspected cases (including those you have deferred on this basis) to your local HPT urgently by telephone and advise the patient to contact their GP.

The local HPT should identify all household contacts and provide relevant advice on preventing spread of infection. It is important to explain that you are a healthcare worker. All healthcare workers, including optometrists and patient-facing practice staff, who work with infants or pregnant women are considered at increased risk of transmitting severe or complicated infection to these groups if they have pertussis.

  • If you work with infants or pregnant women: The HPT will make a determination of the level and duration of exposure. Depending on your vaccination status you may be offered post-exposure prophylactic antibiotic treatment. You should notify your employer if you are identified as a contact, follow HPT advice on returning to work and seek urgent medical advice if you develop pertussis symptoms.
  • If you do not work with infants and pregnant women: You may continue to attend work following an individual risk assessment undertaken by your employer or occupational health team. You should seek urgent medical advice if you develop pertussis symptoms.

You are considered infectious from the onset of symptoms. If you have either suspected, confirmed or epidemiologically linked pertussis infection, you should not attend work:

  • until 48 hours of appropriate antibiotic treatment has been completed, or
  • for 21 days from the onset of symptoms if not treated, or until you feel well, whichever is later.

You may then return to work following an individual risk assessment undertaken by your employer or occupational health team.

Further information