Abstract
BACKGROUND: DTaP was approved for use in the primary vaccine series for US children in 1996. Despite vaccine coverage rates estimated at 85%, as many as 10,000 cases of pertussis are reported annually in the US. In 2004, 79 children in Kansas City, MO had confirmed pertussis infection representing a 3 fold increase compared to 20 prior yrs, and doubling of the prior 4 yrs.
METHODS: Following IRB approval, all cases of pertussis reported by our infection control department were identified. Clinical and epidemiologic data was collected from visit records for infants and children diagnosed with pertussis 1/1/00–12/31/03 and was compared to data from 1/1/04–12/31/04.
RESULTS: The diagnosis of pertussis was confirmed in 79 children in 2004, compared to an average of 30/yr in 2000–03, and 20/yr in 1984–99. The % of children less than 6 mos was similar overall. There was an increase in children >10 yrs in the 2004 cohort (p<0.0001). Hispanic children represented 15% of cases in 2004 (locally 7% of pop), twice as many as the previous 4 yrs combined. The percentage of children receiving state supported health coverage increased from 50% to 68% (p= 0.013). More children were seen in the urgent care and ED setting (p=0.076).
Typical presentations were recorded for infected children, though omissions in the clinical description were common. 29% of the time, pertussis was not suspected at initial presentation. In those who received pertussis testing, correct treatment was prescribed in 62% of cases. Vaccine status was not recorded in 48% of patients >2 mos. Contact isolation was discussed in 8% of cases, and household chemoprophylaxis was provided in 51%.
CONCLUSION: Despite good vaccine coverage rates in the US, pertussis continues to be reported; 2004 represented the largest outbreak in the last 30 yrs. Disease was under diagnosed, vaccine status was often not recorded, and household prophylaxis delayed in most cases. The addition of vaccine for adolescents will have some impact, but strategies to improve control should also include increasing DTaP coverage rate for infants, consistent use of a clinical definition to diagnose pertussis, prompt treatment of the index case, and prophylaxis of household contacts.
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Myers, A., Jackson, M. & Simon, S. 19 Clinician's Approach to Pertussis During an Outbreak Year.. Pediatr Res 58, 819 (2005). https://doi.org/10.1203/00006450-200510000-00049
Issue Date:
DOI: https://doi.org/10.1203/00006450-200510000-00049