How to manage a pertussis outbreak in your practice.

Dr. Flanagan practices in State College, Pa., and is an associate professor of family and community medicine with the Penn State College of Medicine’s Milton S. Hershey Medical Center. Kathleen Julian, MD, who recently finished a fellowship in infectious diseases at the Milton S. Hershey Medical Center, was consulted in this article’s preparation. Conflicts of interest: Dr. Flanagan serves in the men’s health division of the Pfizer Speaker’s Bureau. V accines for measles and polio have effectively reduced those diseases to rarities almost never encountered by today’s family physician. In addition, the disease burden of pertussis, like tetanus and diphtheria, has been dramatically reduced in the United States through relatively high immunization rates with efficacious vaccines. Contrary to the perception of many physicians, however, waning pertussis immunity in adults and adolescents means that whooping cough is not a relic of the past. Our practice was reminded of this recently when I became the index case in a community-wide pertussis outbreak. In the time before I started antibiotics and was diagnosed, I continued to fulfill my duties, as most mildly ill but committed physicians would have done. I saw patients at the office, rounded at the hospital and taught medical students, despite an increasingly intrusive cough. Although I had a polymerase chain reaction (PCR) for pertussis sent off, it wasn’t until I found myself coughing one night and heard a single, questionable “whoop” that I began to seriously suspect pertussis. Even then, I didn’t fully comprehend the implications of this, nor did my partners. I began to mask before examining children and awaited my PCR results. The test returned positive, and our medical director contacted the state health department, which recommended that I stop seeing patients until I had been on five Michael P. Flanagan, MD, FAAFP