Special Settings

Patients who are experiencing rapid clinical progression with a severe cough during the second week of illness should be considered particularly infectious. Procedures that might generate aerosols (e.g. nebulized medications, BiPAP, or HFOV) should be avoided if possible. When intubation is necessary, measures should be taken to reduce unnecessary exposure to health care workers, including reducing the number of health care workers present and adequately sedating or paralyzing the patient to reduce the cough (MMWR; 52: 433-6).

All high-risk procedures should be performed only by highly experienced staff.