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Medicine
Volume 42, Issue 1, January 2014, Pages 8-10

Bacterial infections

Pertussis
Alison Kent, Paul T. Heath

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Abstract

Pertussis is an infectious disease of the respiratory tract caused by the Gram-negative bacterium Bordetella pertussis.
Pertussis vaccines have led to a significant reduction in the incidence and severity of pertussis in infants worldwide.
Despite this decrease in incidence, pertussis remains one of the principal causes of vaccine-preventable deaths; in
2008 the World Health Organization reported an estimated 16 million cases per year and 195,000 paediatric deaths.

In the last 20 years there has been an increase in the number of adolescent and adult cases reported in developed
countries. These cases represent a potential source of infection to unimmunized infants, who typically have a more
severe course with higher mortality.

Pertussis infection in previously immunized adults, the elderly or young infants frequently presents with atypical
symptoms and can easily be overlooked as a diagnosis.

This review will provide a summary of B. pertussis and discuss diagnostic tests, treatment and prevention.

Section snippets

Aetiology

Pertussis is an infectious disease of the respiratory tract caused by Bordetella pertussis or, less commonly, Bordetella
parapertussis. Bordetella spp. are strictly aerobic, Gram-negative coccobacilli.…

Epidemiology

In the pre-vaccine era, pertussis was an endemic disease with epidemic peaks occurring approximately every 3 years.
Most cases occurred in young children and mortality was high.

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Since their introduction in the 1940s, whole-cell pertussis vaccines have led to a significant reduction in pertussis
globally. It is estimated that more than 80% of infants worldwide routinely receive three doses of pertussis vaccine in
the first year of life (as part of the diphtheria/tetanus/pertussis combination1).…

Pathogenesis

The disease process in pertussis is multifactorial and dependent on several B. pertussis virulence factors. The principal
factors are those that have been included in the new acellular pertussis vaccines – pertussis toxin, filamentous
haemagglutinin, pertactin and agglutinogens. Other factors (e.g. tracheal cytotoxin, tracheal colonization factor,
adenylate cyclase factor) may also be implicated. These factors, singly or in combination, enable the organism to attach
to and damage the…

Transmission

B. pertussis is a human-specific pathogen and unable to survive outside its host. Transmission is by aerosolized droplets.
Pertussis is highly infectious with an attack rate of 15–17 (i.e. the initial case infects 17 susceptible people) and a
secondary attack rate for household contacts of 80–100%, even in mild disease. The incubation period is typically 7–10
days with untreated cases remaining infectious for 3 weeks following symptom onset. Antibiotics can limit this period
of infectivity to 5 …

Clinical features

Typical: the three stages of pertussis are as follows.

Catarrhal – nonspecific symptoms include rhinorrhoea, sore throat, conjunctivitis and non-productive cough. This
stage typically lasts 2 weeks. Fever is present in less than 20% of cases.

Spasmodic – the cough becomes paroxysmal, and episodes of coughing can cause cyanosis or facial discolouration as a
result of venous congestion. Episodes typically end with a deep inspiration (whoop) and vomiting. Paroxysms can
occur more than 30 times per…

Diagnosis

Diagnosis of pertussis is largely clinical. Confirmation or corroborative evidence can be gained from a history of contact
with a case and/or laboratory investigations.

Culture of secretions is highly specific but poorly sensitive. Sensitivity decreases with illness duration, antibiotic
therapy and increasing age of the patient. Culture is unlikely to be positive after 2 weeks of symptoms and serology is
recommended in this case. Secretions are collected via a pernasal swab (posterior…

Management

Supportive – oxygen therapy and gentle suction of pharyngeal secretions are sometimes required during paroxysms.
Specific treatments for the cough, including corticosteroids, salbutamol and pertussis-specific immunoglobulin have
been proposed, but a Cochrane review indicated that there was insufficient evidence to draw any conclusions about the
benefits of these interventions.9

Medication – antibiotics have not been shown to influence the clinical course once the disease has commenced but
should …

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Prevention

Routine infant vaccination with whole-cell or acellular pertussis vaccines is the mainstay of pertussis prevention.
Acellular pertussis vaccines are generally preferred to whole cell vaccines due to their improved adverse effect profile.

Post-exposure prophylaxis with macrolide antibiotics is recommended for families/close contacts of infants.10

Waning immunity following vaccination (4–10 years) is clearly documented and has led many countries to consider,
and some to employ, booster vaccinations …

Special issue articles Recommended articles

References (14)

I. Ridda et al.
The importance of pertussis in older adults: a growing case for reviewing vaccination strategy in the
elderly
Vaccine (2012)

F. Zepp et al.
Rationale for pertussis booster vaccination throughout life in Europe
Lancet Infect Dis (2011)

A. Gil et al.
Hospital admissions for pertussis in Spain, 1995–1998
Vaccine (2001)

F.R. Mooi et al.

K.E. Wiley et al.

B. Ivanoff et al.
Pertussis: a worldwide problem
Dev Biol Stand (1997)

Immunization surveillance, assessment and monitoring [Internet]. Available from:...

There are more references available in the full text version of this article.

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