Pertussis Sullivan Nicolaides Pathology

Pertussis, commonly known as µwhooping cough¶is a highly contagious infection of the respiratory tract caused by the
bacterium Bordetella pertussis. Infants <6 months of age are at the greatest risk of severe disease and death. Pertussis is
included as part of the childhood immunisation schedule https://beta.health.gov.au/resources/publications/national-
immunisation-program-schedule-portrait.

Clinical
The clinical diagnosis of pertussis is based on a cough illness lasting •2 weeks with coughing paroxysms, inspiratory
³whoop´or post-tussive vomiting, without another apparent cause.

Laboratory Diagnosis
The laboratory diagnosis of pertussis is important for both individual patient management and public health responses.
Pertussis may be diagnosed by culture or nucleic acid amplification (PCR) of the pathogen in appropriate specimens,
and/or by the demonstration of a Bordetella pertussis toxin (BPT) specific antibody response.

Culture of B. pertussis from clinical specimens is no longer routinely performed.

Nucleic acid amplification techniques, principally by the polymerase chain reaction (PCR), is now the main method of
diagnosis for acute pertussis. PCR is significantly more sensitive and rapid than culture and has become the µgold
standard¶It is less affected by antibiotic therapy and remains positive for longer in the course of the illness. Although
nasopharygeal swabs are preferable, throat swabs are also acceptable for PCR; a significant advantage for testing older
children and adults. In our collection rooms both nasopharyngeal swabs and throat swabs are collected and the two
specimens combined for testing.

Serology is also used to diagnose pertussis utilizing the detection of a specific antibody response. The literature and our
own publications suggest elevated BPT IgG results •100 IU/mL correlate well with recent infection. Results are now reported
using international units referenced to the WHO International Standard. BPT IgG responses decline fairly rapidly and BPT IgG
is usually <100 IU/mL within one year post infection. Its presence in well and mostly vaccinated children is <3%. Many
variables can however affect these antibody levels including prior infection, and vaccination.

The choice of investigations is principally determined by the clinical stage of the illness.
Duration of Symptoms Recommended Test Recommended Specimens
(cough onset)

0-2 weeks PCR Combined nasopharyngeal flocked swab

and throat swab. Throat swab may be used
for PCR although the sensitivity is likely to
be slightly reduced
2-4 weeks PCR and Serology As above plus serum
>4 weeks Pertussis toxin IgG (BPT IgG) Serum
This report contains summary data for testing at Sullivan Nicolaides Pathology based on results of molecular testing (PCR)
and Serology (BPTIgG).

Pertussis PCR results

1. All pertussis PCR tests (reported as positive and negative) by week and current year.
2. All positive pertussis PCR results by age, sex and current year.
3. All pertussis and positive pertussis PCR testing by year from 2004 to current year.
4. All positive pertussis PCR tests by state for current year.
5. All positive pertussis PCR results by age and year.

Pertussis Serology results

6. All Bordetella pertussis Toxin (BPT) IgG results by week and current year.
(Positive - BPT IgG >100 IU/mL; Equivocal - BPT IgG 60 - 100 IU/mL; Negative - BPT IgG < 60 IU/mL)
7. All serologically diagnosed cases of acute pertussis; defined as the first episode of BPT IgG >100 IU/mL in the
previous 12 months.
8. All new serologically diagnosed pertussis PCR results by age, sex and current year.

Pertussis Combined PCR and Serological Diagnoses

9. All cases of serological + PCR diagnosed cases by week and current year.
10. All cases of serological + PCR diagnosed cases by year.

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4. All positive pertussis PCR tests by state for year 2020. This represents testing done by SNP only. A more
complete national picture can be found at http://www9.health.gov.au/cda/source/rpt_4.cfm.

5. All positive pertussis PCR results by age and year.

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References:
May ML, Doi S, King D, Evans J and Robson J A Prospective Evaluation of an Australian Pertussis Toxin IgG and IgA
Enzyme Immunoassay" Clinical Vaccine and Immunology 2012;19:190-7.
May ML, Evans J, Holgate T, Doi SA, Ross P, Robson JM. Pertussis toxin IgA testing over-diagnoses recent pertussis
infection. Pathology. 2017 Dec 1;49(7):770-5.

@Sullivan Nicolaides Pathology (2019). If you wish to use this report or any data or graphs contained in the report you must
seek the written permission of Sullivan Nicolaides Pathology. To request permission please send the following details and
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