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close this bookWHO Recommended Surveillance Standards (WHO; 1999; 157 pages)
View the documentAcknowledgements
View the documentAcronyms
View the documentIntroduction
View the documentNational Coordination of Communicable Disease Surveillance
View the documentExplanatory notes
View the documentSurveillance activities: criteria and WHO Department
View the documentCommunicable disease contacts in Regional Offices
close this folderDiseases
View the documentB20-B21-B22-B23-B24 AIDS
View the documentA22 Anthrax
View the documentA23 Brucellosis
View the documentA00 Cholera
View the documentA81.0 Creutzfeldt-Jakob disease
View the documentA90, A91 Dengue fever (A90) including Dengue haemorrhagic fever (DHF) & Dengue shock syndrome (DSS, A91)
View the documentA36 Diphtheria
View the documentB72 Dracunculiasis (Guinea worm disease)
View the documentA98.3, A98.4 Ebola-Marburg viral diseases
View the documentA83.0 Japanese encephalitis
View the documentB74 Lymphatic filariasis
View the documentB96.3 Haemophilus influenzae type b
View the documentB15-B17 Acute viral hepatitis
View the documentB20-B24 HIV infection
View the documentJ10, J11 Influenza
View the documentA96.2 Lassa fever
View the documentA48.1 Legionellosis
View the documentB55.1, B55.2 Cutaneous leishmaniasis
View the documentLeishmania / HIV co-infections
View the documentB55.0 Visceral leishmaniasis
View the documentA30 Leprosy
View the documentA27 Leptospirosis
View the documentB50-54 Malaria
View the documentB05 Measles
View the documentA39 Meningococcal disease
View the documentA87 Viral meningitis
View the documentB73 Onchocerciasis
View the documentA37.0 Pertussis
View the documentA20 Plague
View the documentA36 Poliomyelitis
View the documentA82 Rabies
View the documentA02.0 Salmonellosis
View the documentB65 Schistosomiasis
View the documentA50-52 Syphilis
View the documentA33 Tetanus, neonatal
View the documentB56-0, B56-1 African trypanosomiasis
View the documentB57 American trypanosomiasis
View the documentA15-A19 Tuberculosis
View the documentA75.3 Scrub typhus
View the documentA95.9 Yellow fever
open this folder and view contentsSyndromes
View the documentAnnex 1 Software free and in the public domain
View the documentAnnex 2 Proposed surveillance definitions
View the documentAnnex 3 Role and use of Geographic Information Systems (GIS) and mapping for epidemiological surveillance

A37.0 Pertussis

(Whooping cough)


Pertussis is a major cause of childhood morbidity and mortality. An estimated 45 million cases and 400 000 deaths occur every year; case-fatality rates in developing countries can reach 15%. High routine coverage with effective vaccine is the mainstay of prevention. Surveillance data on the disease can monitor the impact of vaccination on disease incidence, identify high risk areas and identify outbreaks.


Clinical case definition

A person with a cough lasting at least 2 weeks with at least one of the following:


• paroxysms (i.e. fits) of coughing
• inspiratory "whooping"
• post-tussive vomiting (i.e. vomiting immediately after coughing)
• without other apparent cause

Laboratory criteria for diagnosis


• Isolation of Bordetella pertussis, or
• Detection of genomic sequences by polymerase chain reaction (PCR)

Case classification


Suspected: A case that meets the clinical case definition.
Confirmed: A person with a cough that is laboratory-confirmed.


Routine monthly reporting of aggregated data of suspected and confirmed cases from peripheral level to intermediate and central level. Zero reporting required at all levels.

All outbreaks should be investigated immediately and laboratory-confirmed. During an outbreak, case-based data should be collected.

To describe the changing pertussis epidemiology in countries with low pertussis incidence (where DTP3 coverage is usually >80%), additional information of age group and immunization status should be collected. As an alternative, case-based surveillance, active surveillance, sentinel surveillance and/or occasional surveys and/or laboratory confirmation for suspected cases should be considered.

International: Aggregated data of clinical (suspected) and confirmed cases in routine surveillance reports of countries to WHO Regional Offices according to regional specifications.


Aggregated data for reporting


• Number of cases
• Number of 3d doses of diphteria-pertussis-tetanus vaccine (DTP3) given to infants
• Completeness/timeliness of monthly reports



• Unique identifier
• Geographical information (e.g., district and province)
• Date of birth
• Date of onset
• Total number of pertussis vaccine doses; 99 = unknown
• Date of latest pertussis vaccine dose; 99 = unknown
• Classification: 1 = confirmed: 2 = suspected; 3 = discarded


Aggregated data


• Incidence rate by month, year, and geographic area
• DTP3 coverage by year and geographic area
• Completeness/timeliness of monthly reporting
• Proportional morbidity (compared to other diseases of public health importance)

Case-based data same as aggregated data plus the following


• Age-specific incidence rate
• Immunization status of cases
• Case-fatality rate
• Proportional mortality (compared to other diseases of public health importance)



• Investigate outbreaks to understand epidemiology of pertussis in the country, why the outbreak occurred (e.g., failure to immunize, vaccine failure, accumulation of susceptibles, waning immunity), and to ensure proper case management

• Monitor case-fatality rate; if high, determine cause (e.g., poor case management, lack of antibiotics/supportive care, patients not seeking treatment in time)

• Determine age-specific incidence rate, and incidence rate by geographical area to know risk groups/areas

• Monitor incidence rate to assess impact of control efforts


Regional Offices

See Regional Communicable Disease contacts on section "Communicable disease contacts in Regional Offices".

Headquarters: 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

Vaccines and Other Biologicals (VAB)/Expanded Programme on Immunization (EPI)


E-mail: duclosp@who.ch / Surveillancekit@who.ch
Tel: (41 22) 791 4527/2111
Fax: 791 4193 attn EPI
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