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    Pertussis Whooping Cough Is Back

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    Bahaa Ahmad Assoud
    Pertussis, or whooping cough, is making a resurgence in the United States. The objectives of the presentation were to refresh healthcare workers on recognizing and appropriately treating and reporting cases of pertussis. It also aimed to provide Tdap vaccines to healthcare workers to protect the highest risk patients through a "circle of immunity". Pertussis is caused by the Bordetella pertussis bacterium and spreads through respiratory droplets. It causes a cough that starts mild but progresses to severe coughing fits. Infants are most at risk for severe complications. Diagnosis involves antibody tests or culturing the bacteria. Treatment involves antibiotics and isolation. Immunization through DTaP and Tdap vaccines is recommended to

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    Pertussis Whooping Cough Is Back

    Uploaded by

    Bahaa Ahmad Assoud
    10 views17 pages
    Pertussis, or whooping cough, is making a resurgence in the United States. The objectives of the presentation were to refresh healthcare workers on recognizing and appropriately treating and reporting cases of pertussis. It also aimed to provide Tdap vaccines to healthcare workers to protect the highest risk patients through a "circle of immunity". Pertussis is caused by the Bordetella pertussis bacterium and spreads through respiratory droplets. It causes a cough that starts mild but progresses to severe coughing fits. Infants are most at risk for severe complications. Diagnosis involves antibody tests or culturing the bacteria. Treatment involves antibiotics and isolation. Immunization through DTaP and Tdap vaccines is recommended to

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    Pertussis, or whooping cough, is making a resurgence in the United States. The objectives of the presentation were to refresh healthcare workers on recognizing and appropriately treating and reporting cases of pertussis. It also aimed to provide Tdap vaccines to healthcare workers to protect the highest risk patients through a "circle of immunity". Pertussis is caused by the Bordetella pertussis bacterium and spreads through respiratory droplets. It causes a cough that starts mild but progresses to severe coughing fits. Infants are most at risk for severe complications. Diagnosis involves antibody tests or culturing the bacteria. Treatment involves antibiotics and isolation. Immunization through DTaP and Tdap vaccines is recommended to

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    10 views17 pages

    Pertussis Whooping Cough Is Back

    Uploaded by

    Bahaa Ahmad Assoud
    Pertussis, or whooping cough, is making a resurgence in the United States. The objectives of the presentation were to refresh healthcare workers on recognizing and appropriately treating and reporting cases of pertussis. It also aimed to provide Tdap vaccines to healthcare workers to protect the highest risk patients through a "circle of immunity". Pertussis is caused by the Bordetella pertussis bacterium and spreads through respiratory droplets. It causes a cough that starts mild but progresses to severe coughing fits. Infants are most at risk for severe complications. Diagnosis involves antibody tests or culturing the bacteria. Treatment involves antibiotics and isolation. Immunization through DTaP and Tdap vaccines is recommended to

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 17

    Pertussis

    Whooping cough is back

    Adapted for BugLine from presentation by:


    Cassandra D. Youmans, MD, MPH, MS-HCM, FAAP
    District Health Director
    East Central Health District VI
    Objectives
     Enhance East Central Public Health District VI’s ability to recognize
    and respond appropriately to pertussis
     Refresh University Hospital healthcare personnel to allow
    appropriate treatment and reporting of pertussis

     Give Tdap* vaccine to healthcare personnel to protect our:


     Highest risk patients by surrounding them immunity
     A circle of immunity made up of vaccinated caregivers
     Healthcare personnel from “catching” pertussis

    * Tdap, Tetanus, diphtheria and pertussis


    Two Pupils Treated for Pertussis
    Saturday, April 15, 2006

     Columbia County School officials confirmed


    that at least one pupil tested positive for
    whooping cough, and the two siblings are
    being treated. One attended Evans High
    School, and the other Evans Middle School…
    highly contagious, spread through the air by
    cough and begins with cold symptoms and a
    cough…

     The case was not properly reported to the


    public health department, allowing for the
    above Augusta Chronicle
     And the article included a warning to parents
    Resurgence of Pertussis
     Mutation
     Waning vaccine-induced immunity
    5 to 7 years after vaccination,
    leaving adolescents and adults
    unprotected
     Waning disease-induced immunity
    doesn’t last much longer than that of
    vaccination
     Enhanced identification: Public
    health awareness, surveillance,
    diagnostic programs
    Bordetella pertussis, the germ
     Gram-negative rod
     Humans are the only host
     Incubation period 6-to-21 days (usually
    7-to-10 days)
     Duration of illness 6-to-10 weeks
    (usually 6 weeks)
     Expected occurrence 3-to-5 year cycles
    of increased disease
     Pertussis is under reported, 40-160 fold
    less than actual illness
     Asymptomatic infections are 4–22 times
    more common than symptomatic
    infections
    Spread
     Close person to person contact via
    aerosolized droplets from
    respiratory secretions of patients
    with disease
     90% of nonimmune household
    contacts acquire the disease
     Adolescents and adults (27% of
    reported cases in 2004) are the
    major source of infection in
    unvaccinated children
     Infants and young children are
    infected by older siblings who
    have mild to asymptomatic
    disease (43% of reported cases)
    Clinical Symptoms

     Initially mild upper respiratory tract


    symptoms (catarrhal stage,1-2wks),
    most contagious period progressive
    paroxysms of cough (paroxysmal
    stage 2-4 wks)
     Inspiratory whoop, followed by
    vomiting
     Fever minimal to absent
     Symptoms subside gradually over
    months (convalescent stage1-2 wks)
    Clinical Symptoms in Infants

     Most severe in infants <6 Infant Complications


    months  Seizures (3%)
     Atypical presentation  Pneumonia (22%)
     Apnea most common symptom  Encephalopathy (1%)
     Whoop is absent  Death
     Hospitalization often needed  Case fatality rate:
     Lymphocyte predominant,
    1.3% in infants <1 month
    increased white count can 0.3% in infants 2-11 months
    match severity of the cough
    Diagnosis
     Increase of pertussis antibody
     IgA antibody titer to pertussis is becoming the method of choice
     IgG antibody to pertussis toxin indicative of recent infection
     Single serum test for significantly high pertussis specific antibody can
    confirm the diagnosis

     Adolescents and adults with B. pertussis cough illness don’t seek


    care until the week 3-4 of illness
     Organism most frequently recovered in catarrhal or early paroxysmal
    stage
     PCR on nasopharyngeal secretions obtained with Dacron swab, put
    on special media, with 10 to 14 day incubation
     Alert the Lab when pertussis is suspected - the culture media is not
    readily available
     Negative cultures are common
    Treatment
     Aim is to eradicate nasopharyngeal carriage
     Treatment duration usually 14 days with erythromycin sulfate
    (EES), newer Macrolides 5-7 days
     Macrolides-erythromycin, azithromycin, and clarithromycin
     Azithromycin eradicates naso-pharyngeal carriage the fastest
     Hypertrophic pyloric stenosis has been reported with oral EES in
    infants younger than 6 weeks
     Trimethoprim-sulfamethoxazole is an alternative to
    erythromycin-resistant strain, or for intolerance to macrolides
     Penicillins, first and second generation cephalosporins are not
    effective
    Supportive Care
     Hospitalized patients need to be on Droplet Isolation for 5 days
    after therapy
     Monitor exposed children for respiratory symptoms for 20 days
     Laboratory confirmation is difficult, so diagnosis often based on
    characteristic clinical manifestations
     Children may return to school after 5 days of appropriate antibiotic
    therapy
    Prevention - Terms

     Tetanus Diphtheria (Td)

     Tetanus Toxoid, Reduced


    Diphtheria Toxoid and Acellular
    Pertussis Vaccine, Adsorbed
    (Tdap)
    Prevention = Immunization
     Universal immunization of all children <7
    years of age is recommended by the AAP
     U.S. pertussis is an acellular vaccine in
    combination with diphtheria and tetanus
    toxoids
     Acellular vaccines contain one or more
    immunogens from B pertussis
     Acellular vaccines are absorbed on
    aluminum salt and must be given
    intramuscularly
     3 DTaP, and 1 combined vaccine that
    includes DTaP and Haemophilus
    influenzae type b conjugate vaccine is
    given at 15-18 months
    Recommendations of the Advisory
    Committee on Adult Immunization Practices
    (ACIP)

     One dose of Tdap for adults 19– 64 years


    of age to replace the next booster does of
    tetanus and diphtheria toxoids vaccine (Td)
     Tdap for adults who have close contact
    with infants <12 months of age
     May give Tdap within 2 year intervals to
    protect against pertussis
     Tdap is not licensed for adults >65 years
    Contraindications and Precautions
    Contraindications to Tdap
     History of serious allergic reaction
    (anaphylaxis) to vaccine components
     History of encephalopathy not attributable
    to an identifiable cause within 7 days of vaccination
    with pertussis vaccine

    Precautions to Tdap
     Guillain-Barre Syndrome, 6 weeks
    after a dose of tetanus toxoid
     Moderate to severe acute illness
     Unstable neurological condition
    References
     ACIP Votes to Recommend Use of
    Combined Tetanus Diphtheria and
    Pertussis (Tdap) Vaccine for Adults.
    Advisory Committee on Immunization
    Practices. 2006
     Cherry, JD. MD, MSc. The
    epidemiology of pertussis, Pediatric
    Infectious Disease Journal. 2006;
    25:4:361-362
     Pickering, LK. Pertussis.The Red
    Book. 2003; 26:472-486
     Gilbert, D.N. The Sanford Guide to
    Antimicrobial Therapy. 2005; 35:24
    Questions?

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