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This document is a reporting form for pertussis cases, collecting patient information, clinical details, vaccination history, exposure, treatment, and public health actions.
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How to fill out pertussis - azdhs
How to fill out PERTUSSIS
01
Gather necessary personal and medical information.
02
Obtain the PERTUSSIS vaccination form from your healthcare provider or download it online.
03
Complete all required fields on the form, including name, date of birth, and medical history.
04
Indicate the date you are seeking the vaccination.
05
If applicable, have a parent or guardian sign the form for minors.
06
Submit the completed form to your healthcare provider or vaccination site.
Who needs PERTUSSIS?
01
Infants and young children, who are highly susceptible to pertussis.
02
Pregnant women, to protect their newborns.
03
Adolescents and adults, especially if they have close contact with infants.
04
Healthcare workers, to prevent the spread of pertussis.
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People Also Ask about
Is pertussis a serious illness?
Bordetella pertussis, the causative organism, was discovered in 1906, and a vaccine was developed in the 1940s. Before the pertussis vaccine was developed, pertussis was a major cause of infant morbidity and mortality. [1][2][3] Pertussis is a serious illness with very high morbidity and mortality.
What are the two signs and symptoms of pertussis?
Symptoms of whooping cough may include: Coughing, violently and rapidly, until all the air has left the lungs and a person is forced to inhale, causing a "whooping" sound. Sneezing. Nasal discharge. Fever. Sore, watery eyes. Lips, tongue, and nailbeds may turn blue during coughing spells.
What causes pertussis?
Early symptoms of pertussis (whooping cough) can look like a common cold. Whooping cough is known for the "whoop" noise when someone gasps for air after a coughing fit. Babies and young children may not cough but may have difficulty breathing instead.
What are the symptoms of pertussis in English?
A cold and whooping cough might seem alike in their initial stages. Both may start with a stuffy or runny nose, mild cough and sneezing. But while cold symptoms improve, whooping cough – also known as pertussis – usually gets worse with time. Whooping cough is a very contagious respiratory infection.
Does pertussis go away on its own?
Whooping cough is an illness that can spread easily. It's also called pertussis. An infection with bacteria causes it. Many people with the illness get a serious hacking cough.
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What is PERTUSSIS?
Pertussis, also known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis.
Who is required to file PERTUSSIS?
Healthcare providers are typically required to report cases of pertussis to health authorities, particularly in jurisdictions with mandatory reporting laws.
How to fill out PERTUSSIS?
To fill out a PERTUSSIS report, collect patient information including demographics, symptom details, onset date, and vaccination history, then submit it to the appropriate health authority according to their guidelines.
What is the purpose of PERTUSSIS?
The purpose of reporting pertussis cases is to monitor outbreaks, implement control measures, and protect public health by ensuring adequate vaccination and response strategies.
What information must be reported on PERTUSSIS?
Information that must be reported includes patient's name, date of birth, address, symptoms, date of onset, laboratory results, vaccination history, and any relevant exposure history.
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