How long should healthcare personnel with an active pertussis infection be restricted from work?

• A. From the beginning of catarrhal stage through the third week after onset of paroxysms, or until five days after the start of effective antimicrobial therapy
• B. For two days after starting antibiotics
• C. Only while fever is present
• D. Indefinitely

Answer: (A)

Pertussis is highly contagious and the contagious period starts with the early catarrhal stage and continues through the paroxysmal coughing period. To prevent transmission in healthcare settings, personnel with active pertussis should be restricted until the contagious period ends. That means they should not return to work until either the paroxysmal period has ended and it has been about three weeks from onset of paroxysms, or, if they start effective antibiotic therapy, after five days of that therapy. Antibiotics reduce contagiousness quickly, so returning after five days of therapy is appropriate even though the full 21 days since paroxysmal onset would otherwise apply. Fever is not a reliable indicator here, since many with pertussis do not have a fever.