Pertussis - East Central Health District
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Transcript Pertussis - East Central Health District
Pertussis
Whooping cough is back
Adapted for BugLine from presentation by:
Cassandra D. Youmans, MD, MPH, MS-HCM, FAAP
District Health Director
East Central Health District VI
Objectives
Enhance East Central Public Health District VI’s ability to recognize
and respond appropriately to pertussis
Refresh University Hospital healthcare personnel to allow
appropriate treatment and reporting of pertussis
Give Tdap* vaccine to healthcare personnel to protect our:
Highest risk patients by surrounding them immunity
A circle of immunity made up of vaccinated caregivers
Healthcare personnel from “catching” pertussis
* Tdap, Tetanus, diphtheria and pertussis
Two Pupils Treated for Pertussis
Saturday, April 15, 2006
Columbia County School officials confirmed
that at least one pupil tested positive for
whooping cough, and the two siblings are
being treated. One attended Evans High
School, and the other Evans Middle
School…highly contagious, spread through
the air by cough and begins with cold
symptoms and a cough…
The case was not properly reported to the
public health department, allowing for the
above
And the article included a warning to parents
Augusta Chronicle
Resurgence of Pertussis
Mutation
Waning vaccine-induced immunity
5 to 7 years after vaccination,
leaving adolescents and adults
unprotected
Waning disease-induced immunity
doesn’t last much longer than that of
vaccination
Enhanced identification: Public
health awareness, surveillance,
diagnostic programs
Bordetella pertussis, the germ
Gram-negative rod
Humans are the only host
Incubation period 6-to-21 days (usually
7-to-10 days)
Duration of illness 6-to-10 weeks
(usually 6 weeks)
Expected occurrence 3-to-5 year cycles
of increased disease
Pertussis is under reported, 40-160 fold
less than actual illness
Asymptomatic infections are 4–22 times
more common than symptomatic
infections
Spread
Close person to person contact via
aerosolized droplets from
respiratory secretions of patients
with disease
90% of nonimmune household
contacts acquire the disease
Adolescents and adults (27% of
reported cases in 2004) are the
major source of infection in
unvaccinated children
Infants and young children are
infected by older siblings who
have mild to asymptomatic
disease (43% of reported cases)
Clinical Symptoms
Initially mild upper respiratory tract
symptoms (catarrhal stage,1-2wks),
most contagious period progressive
paroxysms of cough (paroxysmal
stage 2-4 wks)
Inspiratory whoop, followed by
vomiting
Fever minimal to absent
Symptoms subside gradually over
months (convalescent stage1-2 wks)
Clinical Symptoms in Infants
Most severe in infants <6
months
Atypical presentation
Apnea most common symptom
Whoop is absent
Hospitalization often needed
Lymphocyte predominant,
increased white count can
match severity of the cough
Infant Complications
Seizures (3%)
Pneumonia (22%)
Encephalopathy (1%)
Death
Case fatality rate:
1.3% in infants <1 month
0.3% in infants 2-11 months
Diagnosis
Increase of pertussis antibody
IgA antibody titer to pertussis is becoming the method of choice
IgG antibody to pertussis toxin indicative of recent infection
Single serum test for significantly high pertussis specific antibody can
confirm the diagnosis
Adolescents and adults with B. pertussis cough illness don’t seek
care until the week 3-4 of illness
Organism most frequently recovered in catarrhal or early paroxysmal
stage
PCR on nasopharyngeal secretions obtained with Dacron swab, put
on special media, with 10 to 14 day incubation
Alert the Lab when pertussis is suspected - the culture media is not
readily available
Negative cultures are common
Treatment
Aim is to eradicate nasopharyngeal carriage
Treatment duration usually 14 days with erythromycin sulfate
(EES), newer Macrolides 5-7 days
Macrolides-erythromycin, azithromycin, and clarithromycin
Azithromycin eradicates naso-pharyngeal carriage the fastest
Hypertrophic pyloric stenosis has been reported with oral EES in
infants younger than 6 weeks
Trimethoprim-sulfamethoxazole is an alternative to
erythromycin-resistant strain, or for intolerance to macrolides
Penicillins, first and second generation cephalosporins are not
effective
Supportive Care
Hospitalized patients need to be on Droplet Isolation for 5 days
after therapy
Monitor exposed children for respiratory symptoms for 20 days
Laboratory confirmation is difficult, so diagnosis often based on
characteristic clinical manifestations
Children may return to school after 5 days of appropriate antibiotic
therapy
Prevention - Terms
Tetanus Diphtheria (Td)
Tetanus Toxoid, Reduced
Diphtheria Toxoid and Acellular
Pertussis Vaccine, Adsorbed
(Tdap)
Prevention = Immunization
Universal immunization of all children <7
years of age is recommended by the AAP
U.S. pertussis is an acellular vaccine in
combination with diphtheria and tetanus
toxoids
Acellular vaccines contain one or more
immunogens from B pertussis
Acellular vaccines are absorbed on
aluminum salt and must be given
intramuscularly
3 DTaP, and 1 combined vaccine that
includes DTaP and Haemophilus
influenzae type b conjugate vaccine is
given at 15-18 months
Recommendations of the Advisory Committee
on Adult Immunization Practices (ACIP)
One dose of Tdap for adults 19– 64 years
of age to replace the next booster does of
tetanus and diphtheria toxoids vaccine (Td)
Tdap for adults who have close contact
with infants <12 months of age
May give Tdap within 2 year intervals to
protect against pertussis
Tdap is not licensed for adults >65 years
Contraindications and Precautions
Contraindications to Tdap
History of serious allergic reaction
(anaphylaxis) to vaccine components
History of encephalopathy not attributable
to an identifiable cause within 7 days of vaccination
with pertussis vaccine
Precautions to Tdap
Guillain-Barre Syndrome, 6 weeks
after a dose of tetanus toxoid
Moderate to severe acute illness
Unstable neurological condition
References
ACIP Votes to Recommend Use of
Combined Tetanus Diphtheria and
Pertussis (Tdap) Vaccine for Adults.
Advisory Committee on
Immunization Practices. 2006
Cherry, JD. MD, MSc. The
epidemiology of pertussis, Pediatric
Infectious Disease Journal. 2006;
25:4:361-362
Pickering, LK. Pertussis.The Red
Book. 2003; 26:472-486
Gilbert, D.N. The Sanford Guide to
Antimicrobial Therapy. 2005; 35:24
Questions?