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DOI: 10.1542/pir.33-9-4122012;33;412Pediatrics in Review
John Snyder and Donna FisherPertussis in Childhood
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Pertussis in ChildhoodJohn Snyder, MD,*
Donna Fisher, MD†
Author Disclosure
Drs Snyder and Fisher
have disclosed no
financial relationships
relevant to this article.
This commentary does
contain a discussion of
an unapproved/
investigative use of
a commercial product/
device.
Educational Gap
The incidence in the United States of pertussis, a potentially
fatal disease, has increased
during the past decade and new recommendations for vaccination
have been made in
recent years.
Objectives After reading this article, readers should be able
to:
1. Understand the pathophysiology of pertussis.
2. Describe the clinical presentation, natural history, and
potential complications of
pertussis infection.
3. Appreciate the changing epidemiology of pertussis.
4. Master the laboratory diagnosis and medical management of
pertussis infection.
5. Describe the vaccination strategies for the prevention of
pertussis infection.
IntroductionPertussis, commonly known as “whooping cough,” is a
respiratory illness caused by thebacterium Bordetella pertussis.
The classic clinical syndrome causes morbidity by affectingthe
upper respiratory tract in patients of all ages. The disease can be
modified greatly andprevented by primary vaccination. An ongoing
resurgence of clinical pertussis has been seenin the United States
over the past decade, with increasing numbers of young infants
affecteddespite the availability of effective vaccines. It is
important to understand the biologicalproperties of the bacterium,
the clinical presentation, and the factors contributing tothe
continuing burden of this disease.
The Organism and PathophysiologyB pertussis is a small
Gram-negative coccobacillus that infects only humans. It is aerobic
andgrows best at 35°C to 37°C. Bordetella species, including B
pertussis and B parapertussis, arefastidious and difficult to grow
on media usually used in the laboratory to grow
respiratorypathogens; B pertussis requires supplemental growth
factors including charcoal, blood, andstarch. Media such as
Bordet-Gengou, which contains potato starch, and
charcoal-basedRegan-Lowe media typically are used in microbiology
laboratories for culturing the
organism.B pertussis causes irritation and inflammation by
infecting
the ciliated respiratory tract epithelium. The ensuing
tissuenecrosis and epithelial cell damage recruits macrophages,and
reactive lymphoid hyperplasia of peribronchial and
tra-cheobronchial lymph nodes occurs.
The bacterium has several virulence factors and toxinsthat are
important in the pathogenesis of the disease and alsoplay a role in
inducing protective immune responses. Fila-mentous hemagglutinin
and fimbriae are adhesins requiredfor tracheal colonization. These
substances are highly immu-nogenic and are major components of
acellular vaccines.
Abbreviations
CDC: Centers for Disease Control and PreventionDTP: diphtheria,
tetanus, and whole cell pertussis vaccineDTaP: diphtheria, tetanus,
and acellular pertussis vaccinePCR: polymerase chain reactionPT:
pertussis toxinRSV: respiratory syncytial virusTdap: diphtheria,
tetanus, and acellular pertussis vaccine
(reduced diphtheria component)
*Assistant Professor of Pediatrics, Tufts University School of
Medicine, Boston, MA; Associate Director, Pediatric Residency
Program, Baystate Children’s Hospital, Springfield,
MA.†Assistant Professor of Pediatrics, Tufts University School of
Medicine, Boston, MA; Interim Chief, Division of Pediatric
Infectious
Diseases, Baystate Children’s Hospital, Springfield, MA.
Article infectious diseases
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Other virulence factors such as pertactin and pertussistoxin
(PT) can act as adhesins as well. PT can inactivateor suppress
signaling pathways of the immune system inthe lung, which delays
recruitment of neutrophils. Therole of pertussis toxin in the
pathogenesis of pertussis isnot fully understood. The toxin has
been shown to causeleukocytosis with lymphocytosis and possibly the
rare en-cephalopathy seen in the clinical disease. Other direct
sys-temic effects of PT include sensitization of the
beta-isletcells of the pancreas. This effect can lead to
hyperinsulinemiawith a resistant hypoglycemia, and sometimes
occursin young infants who have poor feeding, which exacer-bates
the symptoms. Adenylate cyclase toxin inhibitsmigration and
activation of phagocytes and T cells.
EpidemiologyWorldwide, an estimated 50 million cases and
300,000deaths due to pertussis occur annually. (1) In the
UnitedStates, pertussis is an endemic disease, with periodic
epi-demics every 3 to 5 years and frequent outbreaks. The lastpeak
in the incidence of pertussis occurred in 2005,when w25,000 cases
were reported nationally. Increasingincidence has been noted in the
United States and othercountries despite widespread immunization.
In 2009,nearly 17,000 cases of pertussis were reported in theUnited
States, with many more going unreported. (2)
In the past year, 9,477 cases of pertussis (including10 infant
deaths) were reportedin California, the highest incidencein the
state since the cyclical peak in2005. (3) According to the
Centersfor Disease Control and Prevention(CDC), 50% of infants
under age 1year who are infected with pertussiswill require
hospitalization. Of these,50% will develop pneumonia and1% will die
of complications fromtheir infection. Pertussis morbidityand
mortality is most significant ininfants younger than age 3
months.Infants in this age group have thehighest incidence of
hospitalization,admission to intensive care units,and death from
pertussis.
In a review of a national pediatricinpatient database from 2000
to2003, 86% of all hospitalizationsfor pertussis were in infants
age
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also may be considered a true case, particularly inoutbreak
situations.
Clinical Presentation and Natural HistoryPertussis is spread by
aerosol droplets expelled whilecoughing or sneezing in proximity to
others. Many in-fants who get pertussis are infected by older
siblings,parents, or caregivers who may have only mild
symptoms.After an incubation period of 7 to 14 days, the
naturalhistory of pertussis tends to follow a relatively
predictableclinical course, although disease severity and
prognosisare quite variable. Because of this variability, a high
de-gree of suspicion is necessary to make a timely diagnosis.A
child suspected of having pertussis should be placed inappropriate
isolation until the infection is confirmed orruled out. A patient
suspected of having pertussis shouldbe masked in waiting rooms and
when sent for ancillarytesting.
Catarrhal PhaseThe catarrhal phase of pertussis lasts from 1 to
2 weeksand includes nonspecific complaints. The mild fever,cough,
and nasal signs and symptoms associated with thisearly phase of the
illness are similar to those seen in manyviral upper respiratory
tract infections, which often leadsto a delay in identifying
suspected cases. During thisphase of the illness, the cough worsens
as the patient pro-gresses to the paroxysmal phase.
Paroxysmal PhaseThe paroxysmal phase of the illness lasts from
weeks 2to 6. This phase is characterized byparoxysms of cough,
often describedas “rapid fire” or “staccato.” Clas-sically, as many
as 5 to 10 uninter-rupted coughs occur in succession,followed by a
“whoop” as the pa-tient rapidly draws in a breath. Anaudio file of
the cough and whoopcan be accessed online through thefollowing
link: http://www.pkids.org/diseases/pertussis.html. Thisclassic
whooping sound is heard lesscommonly in adolescents and adults.
The paroxysms may occur severaltimes per hour and can be
associatedwith cyanosis, salivation, lacrima-tion, and post-tussive
emesis. Theseparoxysms can be exhausting andoften interfere with
sleep and nutri-tional intake. Despite the severe
spells, patients often appear relatively well
betweenepisodes.
Infants younger than age 6 months often have a lesstypical
presentation. The classic “whoop” may be absent,and gasping,
gagging, and apnea can occur. Suddendeath has been reported. As the
cough gradually im-proves, the patient enters the convalescent
phase of theillness.
Convalescent PhaseFollowing the peak of the paroxysmal phase,
improve-ment in respiratory tract integrity and function
isassociated with decreasing frequency and severity ofthe coughing
episodes. The duration of this convalescentphase is highly
variable, lasting from weeks to months.
ComplicationsPertussis is most severe in infants under age 6
months, forwhom the mortality rate is w1%. Greater than 80%
ofdeaths related to pertussis infection occur in infants underage 1
year, with more than half of these deaths occurringin infants
age
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pneumomediastinum, subcutaneous emphysema, su-perficial
petechial hemorrhage, rib fracture, rectalprolapse, and even
intracranial hemorrhage.
Infants afflicted with pertussis often require hospitali-zation
for fluid, nutritional, and respiratory support. Dur-ing the years
1999–2003, the hospitalization rate forinfants age £6 months was
78%. (6) In a recent reviewthat used the Kids’ Inpatient Database,
86% of childrenunder age 1 year who were hospitalized with
pertussiswere age £3 months (Fig 2). (4)
Diagnosis by Laboratory StudiesIsolation of B pertussis from
nasopharyngeal swab or as-pirate cultured on specialized media used
to be the goldstandard for detecting the organism. Because the
organ-ism is variably present only in the early stage of the
illness,yield from cultures done later, when clinical symptomsare
more evident, is low. Specimens obtained 3 weeks af-ter the onset
of cough produces yields as low as 1% to 3%.Adolescents and adults
tend to present later in the courseof the illness, and the culture
rate in this population isvery low. Culture time generally is 2
weeks. In unimmu-nized infants with a high bacterial load who are
culturedearly in the illness, cultures may be positive in as little
as
72 hours. Culture also will identify cases that are causedby B
parapertussis.
Although culture remains the gold standard labora-tory test to
confirm the diagnosis of B pertussis, PCR isbeginning to replace
culture as the diagnostic test ofchoice for B pertussis in many
clinical settings. PCR forB pertussis is a rapid, specific, and
sensitive diagnostic testthat will remain positive late in the
course of the illness.Even in the presence of antibiotic treatment,
PCR oftenwill remain positive for as long as 7 days. Many
laborato-ries perform only PCR and do not use culture for
iden-tifying B pertussis, although most state public
healthlaboratories do maintain the ability to perform both cul-ture
and PCR testing.
The PCR test also has been adopted as an acceptablemethod for
diagnostic case surveillance in the UnitedStates. However, because
there are still no nationallystandardized assays, sensitivity and
specificity vary amonglaboratories. Since the advent of PCR testing
for identi-fying pertussis, the number of confirmed cases has
in-creased. Culturing for B pertussis still may have a rolein some
special circumstances, such as during an out-break. In several
instances, cases detected solely on thebasis of PCR in hospital
settings have proven to be“pseudo-outbreaks” due to false-positive
PCR results. (7)
Table 1. Laboratory Methods for Diagnosing Pertussis
Infection
TestSensitivity,%
Specificity,% Optimal Timing Advantages Disadvantages
Culture 12–60 100
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Because direct fluorescent antibody testing of naso-pharyngeal
secretions has been demonstrated in somestudies to have low
sensitivity and variable specificity,such testing should not be
relied upon as a criterionfor laboratory confirmation. Most
laboratories thereforehave discontinued use of the fluorescent
antibody testingof nasal secretions for pertussis.
Serological testing for pertussis is available in someareas, but
it is not standardized and, therefore, alsoshould not be relied
upon as a criterion for laboratoryconfirmation. Antibodies to PT
are the most commonserological test performed, generally utilizing
an en-zyme-linked immunosorbent assay.
Pertussis-specificimmunoglobulin M testing is not available
routinely.In a nonimmune child, a single positive immunoglobu-lin G
assay done during the second phase of the illness isconsidered
diagnostic. In the presence of pre-existingimmunity, a rise in
titer using paired specimens 2 to 3weeks after onset of clinical
illness is necessary and isconsidered the gold standard for
serologic diagnosis(Table 1).
Leukocytosis, together with an absolute lymphocyto-sis on a
peripheral complete blood count, is another lab-oratory finding
supportive of B pertussis infection. Thisfinding often correlates
with disease severity, especiallyin very young infants. White blood
cell counts as highas 30 to 60 �103/mL can be seen. Monitoring of
fluidsand electrolytes is necessary in infants with severe
disease.Laboratory evaluation to rule out other respiratory
illnessmay be necessary.
Differential DiagnosisOther respiratory pathogens causing a
cough illness canmimic pertussis. Because very young infants can
presentonly with apnea episodes without the typical whoop orspasms
of cough, RSV infection should be considered.Rapid viral antigen
testing by various methods, includingdirect fluorescent antibody
panels, direct enzyme immu-noassays, and multiplex PCR panels, may
help differenti-ate among RSV, influenza, and adenoviruses.
Chlamydiatrachomatis can present as a cough illness in neonates,
butusually creates an interstitial pneumonitis pattern andlower
respiratory tract findings. Other causes of prolongedcough illness
in older children and adolescents includeChlamydia pneumoniae and
Mycoplasma pneumoniae.Specific serologies can be sent for these
atypical organisms.
ManagementIf left untreated, most individuals will clear B
pertussisspontaneously from the nasopharynx within 2 to 4 weeksof
infection. However, nasopharyngeal carriage can
persist for 6 weeks or more. During this period, individ-uals
remain contagious and can spread the illness toothers. When started
early in the course of the illness,during the catarrhal stage,
antibiotics can shorten thecourse and attenuate the severity of
pertussis. Once theparoxysmal phase has started, however,
antibiotics arenot effective in altering the course of the disease.
By thisstage, clinical manifestations of the illness are due
totoxin-mediated effects, and thus are not affected by
an-timicrobial therapy. Unfortunately, because the catarrhalphase
of pertussis is nonspecific, resembling many benignupper
respiratory tract infections, most cases are not yetdiagnosed by
this point in the illness.
Although the clinical course of pertussis is not readilyaffected
by treatment, the use of an appropriate antibi-otic is indicated,
even in the catarrhal phase, because thistherapy results in rapid
clearance of the organism fromthe nasopharynx (usually within 5
days of the start oftherapy) and thus can greatly shorten the
period ofcontagiousness.
For many years, the standard regimen for the treat-ment of
pertussis in children has been administration oforal erythromycin.
Recent studies have demonstratedequal efficacy and improved
tolerability of other macrolides,such as azithromycin. (8)
Azithromycin is associatedwith fewer adverse gastrointestinal
events, may be dosedonce daily, and does not inhibit the cytochrome
P450 sys-tem, and therefore may be preferable. In addition,
eryth-romycin has been associated with an increased risk ofpyloric
stenosis when administered to infants in the first2 weeks after
birth. (9)
The use of trimethoprim-sulfamethoxazole also hasbeen shown to
be effective in eliminating the nasopharyn-geal carriage of B
pertussis and may be an appropriate al-ternative for individuals
age >2 months who are unableto take a macrolide. A recent
Cochrane review of 13 clin-ical trials showed that a 7-day course
of therapy is equallyeffective as a 14-day course and is associated
with feweradverse effects (Table 2). (10)
ProphylaxisAntibiotics may prevent infection with B pertussis in
ex-posed individuals if given within 21 days of symptom on-set in
the index case. The CDC and the AmericanAcademy of Pediatrics
currently recommend prophylaxisof high-risk close contacts, as well
as close contacts whomay have contact with high-risk individuals.
The recom-mended antibiotics and dosing regimens for
pertussisprophylaxis are the same as for treatment. Because an
in-dividual’s previous vaccination status may not always re-liably
predict his susceptibility to infection, this status
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should not be a factor when determining the need forprophylaxis
(Table 3).
Individuals with confirmed or suspected pertussisshould be
excluded from school or child care settings pend-ing evaluation and
completion of 5 days of an appropriateantibiotic. If not
appropriately treated, individuals withpertussis should be kept
from school or child care settingsuntil 21 days have elapsed from
the onset of cough. (11)
PreventionInfection with B pertussis can be prevented through
ap-propriate immunization. Available vaccines are 80% to85%
effective at preventing disease after completion ofthe primary
series. Children who do become infectedwith B pertussis after
immunization are more likely tohave subclinical or less severe
illness. All currently avail-able pertussis vaccines are combined
with tetanus (T)
and diphtheria (D) toxoids, as either DTaP or Tdap(diphtheria,
tetanus, and acellular pertussis vaccine-reduced diphtheria and
pertussis components) (Table 4).
The pertussis component of the vaccine designated apor aP is
acellular, containing varying amounts of PT, fil-amentous
hemagglutinin, pertactin, and fimbriae anti-gens, depending on the
vaccine type. The AmericanAcademy of Pediatrics and the CDC’s
Advisory Commit-tee on Immunization Practices currently recommenda
primary series of 3 DTaP doses to be given at age 2, 4,and 6months,
followed by boosters at age 15 to 18monthsand 4 to 6 years. The
fifth dose is not recommended if thefourth dose is administered at
age ‡4 years. Children whohave confirmed cases of pertussis also
should completethe immunization series against pertussis.
Because immunity to pertussis from the DTaP serieswanes over
time, a booster dose is recommended at age
Table 2. Antibiotic Regimens for Treatment and Prophylaxis of
Pertussis
Agent Dose and Regimen
Azithromycin* • Infants age
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11 to 18 years, and preferably between age 11 and 12years. This
booster is administered by using the Tdap for-mulation of the
vaccine, which contains a reduced dose ofboth the diphtheria and
pertussis components to mini-mize local reactions.
Although it is not Food and Drug Administration-approved for
children age 7 through 9 years, the AdvisoryCommittee on
Immunization Practices recommends asingle dose of Tdap for children
age 7 through 9 yearswho are not fully immunized against pertussis.
This groupincludes children who have received fewer than 4 dosesof
DTaP, children who have received 4 doses of DTaPwith the last dose
given before age 4 years, and childrenwhose immunization status is
unknown. The booster isrecommended also for adults aged 19 and
older.
The incidence of pertussis in infants and children de-clined
dramatically following the introduction of wide-spread immunization
in this country. In the pastdecade, however, pertussis rates have
been climbing.There has been a shift also in the age distribution
of dis-ease. Although infants younger than age 6 months
stillaccount for the majority of reported cases of pertussis,older
children and adolescents represent an increasinglylarge proportion
of the clinical cases.
In addition, many cases of pertussis remain undiag-nosed in the
United States, because illness often goes un-recognized in
adolescents and adults who may not havetypical symptoms. In adults,
pertussis illness may not be
recognized because it is a subclinical disease at least 40%of
the time. (12)
Evaluation of pertussis-specific serological responsesafter
illness indicates that prolonged cough illness in ado-lescents and
adults often is diagnosed incorrectly as bron-chitis or a viral
upper respiratory tract infection.
Adults who have these clinical syndromes may be im-portant
reservoirs for spread of infection to infants. (13)Many studies
have shown that the rates of interfamilialand household
transmission to unimmunized infants arehigh. When the source can be
identified in these studiesof newborns with pertussis, family
members are the sourceof transmission in up to 83% of cases. In one
study, parentsaccounted for 55% of sources, siblings for 16%, and
otherfamily members and friends for another 18% when a sourcewas
identified. (14) Another study identified householdcontacts of
infants younger than age 6 months age withpertussis and attributed
the source to be mothers 38% ofthe time and siblings 41% of the
time. (15)
Although the explanation for the changing epidemiol-ogy of
pertussis infection is unclear, it is believed to bedue both to an
increased awareness and recognition ofcases and to waning vaccine
efficacy over time. Recent ev-idence suggests that at least some of
this waning vaccineefficacy may be due to antigenic divergence
between cir-culating and vaccine strains of B pertussis. (16)
With an adolescent Tdap vaccination rate of only 56%,and an
adult rate of
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this older population is an important step in breaking thecycle
of infection. Recent outbreaks of pertussis in infantsand young
children in populations with high vaccine re-fusal have raised the
concern that pockets of underimmu-nization alsomay be contributing
to the increase in pertussiscases. Recent evidence has confirmed
higher rates of per-tussis infection in populations of vaccine
refusers. (17)
Infants, particularly those under age 3 months, aremost
vulnerable to the serious complications of pertussisinfection.
These infants typically become infected fromadolescents and adults
whose immunity has waned overtime, making the Tdap booster an
extremely importantelement of the overall pertussis prevention
strategy. Be-cause immunization with Tdap during pregnancy
confersprotection to the newborn as a result of
transplacentalantibodies, the CDC also recommends Tdap for
preg-nant women after 20 weeks’ gestation who have not al-ready
received it, or whose vaccination status is unknown.If Tdap is not
given during pregnancy, it should be givenin the immediate
postpartum period.
DTaP or Tdap (depending on age) is also recommendedby the CDC
for all family members and caregivers ofthe infant, including
adults age ‡65 years, for whomTdap is not US Food and Drug
Administration-approved.This “cocooning” strategy can effectively
shield the sus-ceptible newborn from exposure to pertussis
infection.Recent evidence suggests that newborns themselvesmay be
able to mount an adequate antibody responseto pertussis vaccine.
Further research on infant immuni-zation against pertussis may lead
the way to improvedprotection for this most vulnerable population.
(18)(19)
Vaccine SafetyAn effective pertussis vaccine has been in use in
theUnited States since the introduction of the original wholecell
pertussis vaccine in the mid-1940s. This vaccine wascombined with
diphtheria and tetanus toxoids as thediphtheria, tetanus, and whole
cell pertussis vaccine(DTP) vaccine in 1947. Although this vaccine
was effec-tive, it was associated with a high frequency of
significantbut nonlife-threatening adverse events, ranging fromhigh
fever to hypotonic-hyporesponsive episodes. Thesereactions were a
consequence of the large number of pro-teins present in this whole
cell preparation.
Fear of these sometimes frightening reactions ledsome parents
and clinicians to link the vaccine to braindamage and other
conditions that were seen followingvaccination with DTP.
Antivaccine groups and negativemedia coverage surrounding this
alleged linkage createda backlash against the vaccine, resulting in
a wave of
successful litigation against the manufacturers of DTP.In the
United States, pharmaceutical companies stoppedproducing the
vaccine, requiring action from the federalgovernment to safeguard
the nation’s supply by enactingthe National Childhood Vaccine
Injury Act of 1986. Thisact included the Vaccine Injury
Compensation Program,which established a fund supported by an
excise tax oneach vaccine component to compensate parents of
chil-dren who developed any condition listed on its compen-sable
injury table.
Despite the long history of concern over the DTP vac-cine,
multiple well-designed studies have repeatedly failedto link the
vaccine to brain injury. (20)(21)(22)(23)(24)(25)In 1990, the
acellular pertussis vaccine (DTaP) was in-troduced, which is
associated with a significantly re-duced incidence of adverse
events. Local reactions stillare relatively common, with 20% to 40%
of children ex-periencing some combination of local redness,
swelling,and pain. Systemic reactions are uncommon, with 3%to 5%
experiencing a fever (‡101°F). These reactionsare seen most often
following the fourth and fifth doses.
Summary
• Pertussis is a serious and potentially fatal diseasecaused by
the bacterium Bordetella pertussis. Ininfants under age 6 months,
who are too young to beadequately protected by the vaccine,
pertussis isassociated with a hospitalization rate of almost 80%and
a mortality rate of nearly 1%.
• Complications of pertussis include encephalopathy,pneumonia,
apnea, seizures, and death. The course ofthe illness is more severe
in young children, withinfants under age 6 months most at risk
forhospitalization and severe complications.
• A high degree of suspicion is important. Treatmentusually is
initiated too late in the illness to alter thecourse, but can
prevent transmission of the disease toothers.
• An effective vaccine is available and recommended forall
children. Because of waning vaccine immunity overtime, an
additional dose of vaccine is recommendedfor older children and
adults.
• Women whose pregnancy has passed 20 weeks or whoare in the
postpartum period who were not vaccinatedpreviously or whose
vaccination status is unknown,and other individuals who may come in
contact witha newborn, should be vaccinated as part of a strategyto
“cocoon” the newborn from infection.
• Enlarging pockets of underimmunization may bea contributing
factor to the current upswing inpertussis cases, reminding us of
the importance ofmaintaining high vaccination rates for the
preventionof disease outbreaks.
infectious diseases pertussis
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References1. World Health Organization. WHO –Recommended
standardsfor surveillance of selected vaccine-preventable diseases.
2003.WHO/V&B/02.01, 28–302. Centers for Disease Control and
Prevention. In: Roush S,McIntyre L, Baldy L, eds. 5th ed. Atlanta,
GA: Manual for theSurveillance of Vaccine-Preventable Diseases;
20113. Centers for Disease Control and Prevention. Pertussis.
(Whoop-ing Cough) Outbreaks. Available at:
http://www.cdc.gov/pertussis/outbreaks.html. Accessed January 4,
20124. Cortese MM, Baughman AL, Zhang R, Srivastava PU, WallaceGS.
Pertussis hospitalizations among infants in the United States,1993
to 2004. Pediatrics. 2008;121(3):484–4925. Haberling DL, Holman RC,
Paddock CD, Murphy TV. Infantand maternal risk factors for
pertussis-related infant mortality in theUnited States, 1999 to
2004. Pediatr Infect Dis J. 2009;28(3):194–1986. Centers for
Disease Control and Prevention. QuickStats: rate ofhospitalizations
for pertussis among infants aged
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1. An obstetrical resident asks you when to administer the
pertussis vaccine to a 25-year-old pregnant womanwhose immunization
status is unknown. You tell the resident that, among the following,
the soonestrecommended time would be after
A. 16 weeksB. 20 weeksC. 24 weeksD. 28 weeksE. 32 weeks
2. The woman delivers before the vaccine is administered. You
recommend that the following people who live inthe household be
vaccinated:
A. Both parentsB. MotherC. Parents and siblings over 10 yearsD.
Parents, siblings over 10 years, and grandparentsE. Parents,
siblings over 10 years, grandparents, and nanny
3. A 4-month-old infant boy has had a fever (100.6˚F), a
persistent cough, and nasal discharge for the past week.You are
considering a diagnosis of pertussis. The most practical and rapid
laboratory study to confirm thediagnosis is
A. Complete blood count with differentialB. Culture on
Regan-Lowe mediumC. Fluorescent antibody testingD. Polymerase chain
reaction testingE. Serum antibody titer
4. The diagnosis of pertussis is confirmed. The antibiotic of
choice for an infant this age is
A. AzithromycinB. ErythromycinC. PenicillinD.
Trimethoprim-sulfamethoxazoleE. Vancomycin
5. The infant is begun on appropriate treatment. The parents ask
when he can return to child care. You tell themthat their son will
no longer be contagious after receiving antibiotic therapy for
A. 24 hoursB. 48 hoursC. 72 hoursD. 5 daysE. 10 days
infectious diseases pertussis
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DOI: 10.1542/pir.33-9-4122012;33;412Pediatrics in Review
John Snyder and Donna FisherPertussis in Childhood
ServicesUpdated Information &
http://pedsinreview.aappublications.org/content/33/9/412including
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References
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