Personal Health Division

Disease Specific Information

Pertussis (Whooping Cough)

Pertussis is an acute infectious disease caused by the bacterium Bordetella pertussis. Pertussis can cause serious illness in people of all ages. The most common complication, and the cause of most pertussis-related deaths, is secondary bacterial pneumonia. Young infants are at highest risk for developing pertussis-associated complications.

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THINK of pertussis in anyone with these symptoms, regardless of vaccination history

• A cough of any duration in a person who has been notified of a close exposure to pertussis,
• A paroxysmal cough of any duration, with whooping, post-tussive vomiting/gagging or apnea, or
• A persistent cough of unknown etiology, lasting more than seven days.
• Symptomatic contacts should be evaluated for pertussis.

TEST

• Whenever possible, obtain a nasopharyngeal swab or aspirate from everyone with suspected pertussis for laboratory testing.
• Although culture is highly specific for Bordetella, it may take 7 days for a result; PCR testing is rapid and has excellent sensitivity.

TREAT and REPORT suspected and confirmed cases

• Prescribe Erythromycin, Azithromycin, Clarithromycin, or Trimethoprim-Sulfamethoxazole for treatment
• Report suspected and confirmed cases to your local health department– call 269-373-5044 or fax 269-373-5060.

STOP TRANSMISSION

• Isolate patients with suspected pertussis until they have completed 5 days of appropriate antibiotic treatment.
• Prescribe antimicrobial prophylaxis to persons who are close contacts of pertussis cases.

PREVENT

• Vaccinate children routinely with Dtap and keep adults, including pregnant patients during the 27th through 36th weeks of pregnancy, up-to-date with Tdap.

Respiratory Illness Immunizations

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INFLUENZA

• Everyone 6 months and older, including people with an egg allergy, is recommended to get their annual influenza vaccination. Please remind patients that intramuscular influenza vaccination:
• Reduces outpatient medical visits, hospitalizations, and death in people of all ages
• Cannot cause influenza disease but can lead to sore/red arm at site of injection, headache, fever, muscle aches and fatigue – signs of an expected immune response
• Remains important even if the patient states they have never been infected with influenza
• Reduces disease severity if they get the flu – e.g. fewer intensive care and hospital stays
• Protects pregnant people during and after pregnancy and helps protect infants in their first few months of life

COVID-19

• Everyone 6 months and older is recommended to receive a 2024-2025 COVID-19 vaccine to target circulating SARS-CoV-2 strains and provide additional protection against severe COVID-19 associated illness and death. Updated clinical guidance on use of COVID-19 vaccines can be found here.

RSV

• Nirsevimab (Beyfortus) is a monoclonal antibody immunization that CDC has recommended to prevent severe RSV disease for infants aged less than 8 months born during or entering their first RSV season and for infants and children aged 8–19 months who are at increased risk of severe RSV disease entering their second RSV season. Unlike other immunizations which are typically age-based, nirsevimab is also weight-based but packaged in pre-filled syringes. Nirsevimab must be available as part of the VFC program and is covered by Medicaid and now most private insurances.
• RSVpreF (Abrysvo) is a vaccine for use in pregnant people at 32 weeks to 36 weeks and 7 days of pregnancy to prevent lower respiratory disease and severe disease due to RSV in infants from birth through 6 months of age. CDC recommends protecting all infants against severe RSV disease through use of either the maternal RSV vaccine or infant receipt of nirsevimab. Clinicians and health systems should consider maternal and infant RSV immunization implementation on hospital mother-baby units as well as family medicine, pediatric and OB/GYN outpatient locations.
• Three RSV vaccines (GSK’s Arexvy; Moderna’s mResvia; and Pfizer’s Abrysvo) are licensed by the FDA for use in adults ages 60 and older in the US to prevent severe RSV disease. Medicare Part D and Medicaid cover RSV vaccine without cost sharing. If not available in a primary care office, clinicians should consider prescribing the RSV vaccine for a patient at a pharmacy.

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Measles (Rubeola)

Measles is an acute viral respiratory illness. It is characterized by a prodrome of fever (as high as 105° F) and malaise, cough, coryza, and conjuctivitis - the three "C"s -, a pathognomonic enanthema (Koplik spots) followed by a maculopapular rash. The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities. Patients are considered to be contagious from 4 days before to 4 days after the rash appears. Community-wide vaccination is the most effective way to prevent measles. All children should be vaccinated against measles. The vaccine is safe, effective, and inexpensive. Children should receive two doses of the vaccine to ensure they are immune. For more information, visit Measles Fact Sheet for Providers.

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Syphilis

Syphilis is a systemic sexually transmitted bacterial infection caused by Treponema pallidum. There are four stages of Syphilis: Primary, Secondary, Latent, and Tertiary.

Primary Stage:

• One or more chancres (usually firm, round, small, and painless but can be atypical, subtle lesions) thought to appear at site of exposure (mainly genital area) about 3 weeks after infection (range 10-90 days)
• Chancres can heal on their own in a few days to weeks, even without treatment
• Patient is highly infectious, and in utero transmission is likely in pregant women

Secondary Stage

• Mucocutaneous lesions (most commonly rashes) can occur as chancre(s) fade roughly 6 weeks after infection (range 3 weeks to 6 months)
• Rashes may first appear on the palm of hands or the soles of feet, but typically appear on trunk and other areas of the body
• Lesions such as condyloma lata, a moist, wart-like lesion found in the genital area and mucous patches on the tongue occur in about 25% of patients
• Other common findings: lymphadenopathy and constitutional symptoms. Less common: patchy alopecia (about 10% of patients) and neurologic symptoms (1-2% of patients)
• Symptoms clear within 2 to 6 weeks, but may take up to 3 months, even without treatment
• In utero transmission is likely in pregnant women

Latent Stage

• Early Latent:
  • Patient has reactive nontreponemal and treponemal tests within 1 year of onset of infection, but no symptoms
  • Patient is potentially infectious, as signs of primary and secondary syphilis can reoccur and go unnoticed
• Late Latent or Latent of Unknown Duration:
  • Patient has reactive nontreponemal and treponemal tests ≥ 1 year of onset of infection or onset of infection cannot be determined, but no symptoms
  • Patient is not infectious in late latent stage but may be in latent of unknown duration if onset of infection within the past year

Tertiary Stage

• Manifestation in skin and bones (gummas), and cardiovascular system
• Patient is not infectious
• In utero transmission can occur during ANY latent stage of syphilis but is more likely in early latent stage

For more information and to find the full guide, click here.

CDC’s Sexually Transmitted Infections (STI) Treatment Guidelines, 2021 provides currentevidence-based prevention, diagnostic and treatment recommendations that replace the 2015 guidance. The recommendations are intended to be a source for clinical guidance. A mobile application is also available for accessible treatment guidance.

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