Pertussis

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Basics

  • Highly contagious
  • Synonym: whooping cough, “100 day” 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
  • Worldwide: 24.1 million cases (1)
  • 160,700 deaths in children <5 years old (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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