Public Health Advisory: Macrolide-resistant Bordetella pertussis

Macrolide-resistant Bordetella pertussis (MRBP) has recently been detected by the Institute of Environmental Science and Research (ESR) and is an emerging issue in Aotearoa New Zealand. The NPHS is currently assessing the situation and gathering expert local and international opinion. Further advice will follow when available.

Key actions for healthcare professionals

• No change to antibiotic management is currently advised. Appropriate safety plans should be put in place, particularly for people at risk of severe outcomes.
• Pertussis culture could be considered in severe hospitalised cases to determine antibiotic susceptibilities, particularly if there is any concern about treatment failure, although this has been rarely documented. Discuss with your local clinical microbiologist.
• To prevent transmission of pertussis infection, staff, patients and visitors should follow basic respiratory infection prevention and control measures including mask wearing, where appropriate.
• Ensure all staff members are up to date with pertussis vaccination. Health New Zealand staff should contact their Occupational Health team if they are unsure when their last dose was given.

Further information

A macrolide antibiotic, azithromycin, is currently used as first-line treatment and chemoprophylaxis in the management of pertussis in Aotearoa and internationally. If given early in the course of illness, macrolide antibiotics can reduce the severity and duration of pertussis symptoms and reduce the period of infectivity, preventing onward spread. Macrolide antibiotics are also considered for chemoprophylaxis of high priority contacts to protect people, especially infants, who are at high risk of severe outcomes from pertussis infection.

MRBP has been detected internationally since 1994 and has recently been found in Aotearoa following local work undertaken by ESR.

China is currently reporting significant prevalence of MRBP, though other countries are reporting lower prevalence levels. There is no international consensus as to what level of macrolide resistance should prompt changes to treatment and chemoprophylaxis guidelines.

Guidelines for the management of pertussis in Aotearoa are being reviewed in light of this emerging issue. Publication of the full updated pertussis chapter of the Health NZ Communicable Disease Control Manual is pending until this review is complete.

Related links

• Pertussis chapter - Health NZ Communicable Disease Control Manual
• Pertussis - Info.Health
• Pertussis - Immunisation Advisory Centre
• Pertussis - KidsHealth