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Pertussis

Pertussis is a topic covered in the 5-Minute Clinical Consult.

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Basics

  • Highly contagious
  • Synonym: Whooping cough

Description

  • Host: humans
  • Most common reservoir: adults
  • Ages: all
  • Distribution: worldwide
  • Pattern: endemic or epidemic with outbreaks every 3 to 5 years
  • Seasonality: can occur year-round; peaks late summer–autumn
  • Transmission: person to person via aerosolized respiratory droplets
  • Effective vaccine: available
  • Immunity: neither 100% nor lifelong immunity with either infection or vaccine
  • System(s) affected: respiratory

Epidemiology

Incidence
  • United States: most recent peak in 2012 reported 48,277 (1)
  • Worldwide: estimated 16 million cases/year (1)

Etiology and Pathophysiology

  • Toxin mediated
  • Infectious process with predilection for ciliated respiratory epithelium
  • Common organisms:
    • Bordetella pertussis (accounts for ~95% of cases)
    • Bordetella parapertussis

Risk Factors

  • Exposure to a confirmed case
  • Non- or underimmunized infants and children
  • Premature birth
  • Chronic lung disease
  • Immunodeficiency (e.g., AIDS)
  • Age <6 months (accounts for ~90% pediatric pertussis hospitalizations) (2)

General Prevention

  • Public health measures
    • Surveillance
    • Outbreak management
    • Care of exposed persons
  • Prevention programs
  • Immunization
    • Primary childhood immunization series against pertussis followed by boosters (3)
    • Maternal immunization during each pregnancy (4,5,6)
    • Adults, including health care providers in close contact with infants <1 year of age should be immunized.
Pediatric Considerations
Strategies to reduce neonatal pertussis:
  • Tdap with each pregnancy, preferably between 27 and 36 weeks gestation (4,5,6)
  • Cocooning (6)
  • Tdap recommended for all persons in close contact with infants <1 year of age

Geriatric Considerations
The incidence of pertussis in individuals age 50 years and older has increased between 2006 and 2010.

Commonly Associated Conditions

  • Apnea in infants
  • Secondary bacterial pneumonia
  • Sinusitis
  • Seizures
  • Encephalopathy
  • Urinary incontinence

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Citation

Stephens, Mark B., et al., editors. "Pertussis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116449/all/Pertussis.
Pertussis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116449/all/Pertussis. Accessed April 26, 2019.
Pertussis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116449/all/Pertussis
Pertussis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116449/all/Pertussis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pertussis ID - 116449 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116449/all/Pertussis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -