Suspect pertussis report form

Who should be reported

All people with suspected pertussis should be reported to public health.

Suspect case of pertussis: An illness consistent or compatible with pertussis and without other apparent cause such as:

Any acute cough illness with uncontrollable coughing fits (paroxysmal cough), a whoop, or vomiting after coughing
Any acute cough illness in a person who is a close contact to someone who tested positive for pertussis

All individuals tested for pertussis should be immediately treated and isolated for 5 days.

Please submit one form for each suspect case of pertussis. A PDF version of this reporting form is available online and can be faxed to 608-266-4858, Attn: Communicable Disease Team.