COMMENTARY

CDC Commentary: Pertussis -- Recognition and Treatment

Thomas A. Clark, MD, MPH

Disclosures

January 25, 2010

Editorial Collaboration

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Hello, my name is Dr. Tom Clark. The topic: Pertussis.

Pertussis is a disease that does not just strike infants and young children. And it is a disease that's on the rise. Since the 1980s, there has been a dramatic increase in the number of reported cases of pertussis, especially among 10 to 19 year-olds and infants younger than 5 months of age. In 2008, more than 13,000 cases of pertussis were reported — and we know that there are many more cases that go unreported.

Several factors have likely contributed to the increase in reported cases, including increased awareness and improved recognition of pertussis among clinicians, greater access to and use of laboratory diagnostics, especially polymerase chain reaction testing, and increased surveillance and reporting of pertussis to public health departments. Even with these improvements, there is still a possibility that much of the disease goes unrecognized.

Pertussis has an insidious onset with catarrhal symptoms that are indistinguishable from those of minor respiratory tract infections. The cough, which is initially intermittent, becomes paroxysmal. In typical cases paroxysms terminate with inspiratory whoop and can be followed by posttussive vomiting.

Paroxysms of cough, which occur more at night, usually increase in frequency and severity as the illness progresses and usually persist for 2 to 6 weeks or more. The illness can be milder and the characteristic whoop absent in children, adolescents, and adults who were previously vaccinated. After paroxysms subside, a nonparoxysmal cough can continue for 2 to 6 weeks or longer.

Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death. Despite increasing awareness and recognition of pertussis as a disease that affects adolescents and adults, clinicians often overlook pertussis in the differential diagnosis of cough illness in this population. It's important to educate parents to consider pertussis when their child has a cough, letting them know that it can be a severe illness, especially for infants, and they should seek immediate treatment.

Pertussis vaccination is recommended for children, adolescents, and adults. The Advisory Committee on Immunization Practices recommends that children receive DTaP at 2, 4, and 6 months of age, between 15 and 18 months of age, and at 4 to 6 years of age.

Adolescents and adults need a booster, even if they were completely vaccinated as children. Regular check-ups for pre-teen patients should include a dose of Tdap. Adults who didn't get Tdap as a pre-teen or teen should get one dose of Tdap instead of one of the Td boosters, which are given every ten years. Getting vaccinated with Tdap is especially important for families with new infants.

The macrolide erythromycin has been the antimicrobial of choice for treatment or postexposure prophylaxis of pertussis. Guidelines were developed in 2005 to broaden the spectrum of macrolide agents available for pertussis treatment and postexposure prophylaxis.

Web Resources

Martin SW. CDC commentary: pertussis – with pertussis on the rise, who needs a Tdap vaccination? Public Information from the CDC and Medscape. © 2010. Available at: http://www.medscape.com/viewarticle/724242 Accessed August 31, 2010.

Pertussis Vaccines Website

Pertussis (Whooping Cough) Clinician Website

Pertussis (Whooping Cough) Sounds, Utah Department of Health - Sound Files

Pertussis Videos, Immunization Action Coalition - Video Files

Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices (ACIP), 2010

Use of Diphtheria Toxoid-Tetanus Toxoid-Acellular Pertussis Vaccine as a Five-Dose Series
Supplemental Recommendations of the Advisory Committee on Immunization Practices (ACIP

Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Prevention of Pertussis, Tetanus, and Diphtheria Among Pregnant and Postpartum Women and Their Infants: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis: 2005 CDC Guidelines

For Patients: Pertussis (Whooping Cough) – What You Need To Know

WebMD Pertussis Q&A With CDC Infectious Disease Expert (Patient Information)

Thomas A. Clark, MD, MPH , grew up in Spokane, Washington. He attended Tulane University in New Orleans, where he obtained both his Bachelors Degree and Medical Degree. After training as a pediatrician at Emory University in Atlanta, he completed training in preventive medicine and public health at Oregon Health Sciences University in Portland, Oregon. He has worked at the Centers for Disease Control and Prevention for eight years, including two years as an Epidemic Intelligence Service Officer. He currently serves as a medical epidemiologist and team leader in the Meningitis and Vaccine Preventable Diseases Branch, where he works on meningococcal disease, pertussis, and other bacterial vaccine-preventable diseases both domestically and internationally.

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