Managing Rising Pertussis Risks in the Dental Operatory

Print & Go GuidanceBy Genni Burkhart

Pertussis, commonly known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Recent data indicate a concerning resurgence of pertussis cases in the United States. In 2024, reported cases increased more than five times compared to the previous year, with many affected individuals having received the recommended vaccinations. This resurgence underscores the importance of heightened awareness and vigilance, particularly in settings such as the dental operatory, where close patient contact is a daily routine.

As such, this presents unique challenges in infection control due to the nature of procedures, which involve the generation of aerosols and close patient proximity. These factors increase the risk of transmitting respiratory infections, including pertussis. Moreover, healthcare personnel are at increased risk of acquiring pertussis infection due to contact with infected patients and waning protection from prior vaccinations.

Let's put this into perspective. From the 1960s to the 1990s, cases of pertussis dropped sharply due to the introduction of the DTaP vaccine. Following the increased prevalence of vaccine misinformation in the early 2000s, a sharp rise in cases occurred until the COVID-19 pandemic in 2020. As of early September this year, the Centers for Disease Control (CDC) has reported more than 20,000 cases across the U.S., a slight increase from the same period last year. In an environment where we now find ourselves, with herd immunity disintegrating, the effectiveness of old vaccines (DTP vs. DTaP) can wane over time.

This means, in addition to COVID-19, measles, and the seasonal flu (virus), your practice should also put whooping cough on the radar. A proactive approach with infection control steps embedded in your entire dental team's daily routine can go a long way in protecting both patients and staff.

Oops! Accidental Exposure

Unfortunately, it's not that hard to become inadvertently part of a pertussis transmission chain. Staff with waning immunity or mild, asymptomatic infection can unknowingly spread the disease. Because dentistry involves close facial proximity and can provoke coughing or gagging, strict respiratory and droplet precautions are essential, especially during flu season and now, with an increase in cases of whooping cough. Furthermore, team members experiencing a "prolonged cough" should avoid patient care until cleared by their doctor.

Prevention Strategies for Dental Offices

• Vaccination and Boosters: Vaccination remains the most effective way to reduce disease severity and prevent the transmission of diseases. Dental teams should encourage staff to stay up to date with the TDaP vaccine. Boosters may be recommended in outbreak areas or for staff with uncertain vaccination history. Maintaining current vaccinations also reduces the likelihood of operational disruptions.
• Postexposure Prophylaxis: Staff exposed to pertussis but without symptoms may receive postexposure antimicrobial treatment within 21 days of exposure. Symptomatic staff should refrain from patient care for 21 days from the onset of cough or until completing five days of effective antibiotic therapy. Following these guidelines minimizes the risk of transmission and ensures the practice can continue to function smoothly.
• Monitoring and Exclusion Policies: Clear policies for staff monitoring, symptom reporting, and exclusion are essential. Asymptomatic staff under postexposure prophylaxis may continue working while being monitored. However, staff showing symptoms should remain excluded until they are cleared to return. Consistency in enforcing these policies protects both patients and staff and reduces the likelihood of an office-wide outbreak.

Practical Steps

Thankfully, practices can easily integrate infection prevention into everyday routines.

• Staff should be trained to recognize early pertussis symptoms, including prolonged coughing.
• Patients should be routinely screened for recent cough illnesses before appointments and rescheduled for non-urgent care when necessary.
• Post signage about respiratory hygiene and cough etiquette in waiting and treatment areas.
• Maintain protocols for postexposure prophylaxis and treatment in consultation with public health authorities.
• Develop or update workflows for reporting exposures and return-to-work procedures.
• Apply strict hand hygiene, surface disinfection, and respiratory protection at all times, particularly heading into flu (virus) season.

As pertussis cases rise, dental offices can benefit from a proactive and organized approach to infection control, similar to the approach taken during flu season in the U.S. Science continues to demonstrate that vaccination, early detection, timely post-exposure treatment, and consistent droplet precautions protect both patients and staff. These steps also go a long way in helping to maintain dental practice efficiency and strengthen patient confidence in the care they receive.

References

Centers for Disease Control and Prevention. (2025, January 31). Pertussis | Infection control. U.S. Department of Health & Human Services. https://www.cdc.gov/infection-control/hcp/healthcare-personnel-epidemiology-control/pertussis.html

Russell, R. (2025, September 17). Whooping cough surges in US: How to protect yourself and others. RDH Magazine. https://www.rdhmag.com/infection-control/article/55317400/whooping-cough-surges-in-us-how-to-protect-yourself-and-others

American Dental Association. (2025, March 15). Whooping cough spreading throughout nation. ADA News. https://adanews.ada.org/huddles/whooping-cough-spreading-throughout-nation/

UNICEF. (2023, April 20). Increases in vaccine-preventable disease outbreaks threaten years of progress, warn WHO. UNICEF Press. https://www.unicef.org/press-releases/increases-vaccine-preventable-disease-outbreaks-threaten-years-progress-warn-who

Author: With over 15 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.