Fever Among Pertussis Cases Reported Through Enhanced Pertussis Surveillance, 2015–2022
By
Michelle M Hughes
Amy Rubis
Anna M Acosta
Vanessa Aden
Patricia Firmender
Kate Horn
Emma Stanislawski
Rachel Wester
Erin Youngkin
Victor Cruz
Tami H Skoff
January 30, 2025
Clinical Scorecard: Fever Incidence in Pertussis Cases Documented by Enhanced Surveillance from 2015 to 2022
At a Glance
Category Detail
Condition Pertussis (whooping cough), a contagious respiratory disease caused by Bordetella pertussis Key Mechanisms Infection leads to severe coughing fits; fever is not typical but occurs in about 10% of cases Target Population Individuals of all ages, with particular risk to infants and young children not fully vaccinated Care Setting Public health surveillance and clinical settings diagnosing and managing pertussis
Key Highlights
Approximately 10% of pertussis cases reported documented fever (≥38°C) from 2015 to 2022. Fever onset mostly coincides with or follows cough onset; median fever temperature was 38.7°C. Fever presence should not exclude pertussis diagnosis despite not being part of classical presentation. Guideline-Based Recommendations
Diagnosis
Consider pertussis diagnosis even if fever is present, as fever occurs in about 10% of cases. Use PCR testing and epidemiologic linkage for confirmed diagnosis per updated 2020 case definition. Recognize atypical presentations especially in adolescents and adults. Management
Vaccination remains the best prevention and reduces infection severity. Monitor clinical symptoms including whooping, posttussive vomiting, apnea, and cyanosis. Monitoring & Follow-up
Document fever presence and timing relative to cough onset during case investigation. Surveillance should include fever status to better characterize clinical presentations. Risks
Infants under 2 months are less likely to have fever but remain at high risk for severe disease. Probable cases and vaccinated individuals showed higher likelihood of fever, indicating variable clinical presentations. Patient & Prescribing Data
7840 pertussis cases with known fever status from US Enhanced Pertussis Surveillance (2015–2022)
Vaccinated individuals were twice as likely to have fever, suggesting vaccination modifies clinical presentation.
Clinical Best Practices
Do not exclude pertussis diagnosis solely based on presence of fever. Collect detailed vaccination history and clinical symptomatology to guide diagnosis. Be aware of seasonal and demographic variations in fever prevalence among pertussis cases. Use standardized case report forms for consistent data collection in surveillance. References
