Pertussis and persistent cough: practical, clinical and epidemiologic issues.
نویسنده
چکیده
BACKGROUND Epidemiologic issues of testing, treatment, prevention, immunization, mandated reporting, and post-exposure prophylaxis do not often intrude on the Emergency Department management of the well-appearing adolescent or adult with a couple of weeks of cough. OBJECTIVES Considering that waning immunity to pertussis, the only vaccine-preventable disease with increasing cases and deaths in the United States, is responsible for 12-35% of such illness, such issues need to be considered. DISCUSSION Mostly self-limited in adults, transmission of pertussis to infants places them at risk for hospitalization and death. Pertussis is highly contagious (80% transmission), and atypical presentations are the rule in adults (cough alone) and infants (apnea, bradycardia, poor feeding). Treatment in the first few weeks can impact the clinical course, and later treatment can still prevent transmission. Clinical features like paroxysmal cough, inspiratory "whoop," and post-tussive emesis have mildly increased predictive values and may be absent in adults. Testing is unreliable after 3 weeks of cough. Treatment reduces communicability within 5 days and is suggested without regard to test results within 3 weeks of cough onset for those aged > 1 year (within 6 weeks of cough for < 1 year). Reporting requirements are based on the clinical case definition: ([Cough ≥2 weeks] + [paroxysms OR whoop OR post-tussive emesis]). Lower reporting thresholds are appropriate during an outbreak or when vulnerable populations are at risk. Post-exposure prophylaxis is recommended for at-risk contacts. Tdap is encouraged for all adults. CONCLUSION Practical recommendations consistent with the most current guidelines are offered.
منابع مشابه
Impact of vaccination on epidemiology of diphtheria and pertussis
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بررسی تظاهرات بالینی سیاه سرفه در کودکان بستری شده در بیمارستان بوعلی سینا ساری در سال‌های 1391-1387
Background and purpose: Pertussis is one of the communicable reasons of prolonged cough that children are being vaccinated in our country for prophylaxis. Despite high vaccine coverage the incidence of pertussis is still increasing. This study was done to investigate the prevalence of pertussis in children and its clinical manifestations before and after the beginning of vaccination age. Mater...
متن کاملWhen is acute persistent cough in school-age children and adults whooping cough? A prospective case series study.
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متن کاملPertussis Prevalence in Korean Adolescents and Adults with Persistent Cough
We investigated the prevalence of pertussis in Korean adolescents and adults with persistent cough. Study population was adolescents (aged 11-20 yr) and adults (≥ 21 yr old) who showed persistent cough of 1-8 weeks' duration. Pertussis was diagnosed by culture, polymerase chain reaction (PCR), and serology. A total of 310 subjects participated in this study, and 76 cases (24.5%) met the criteri...
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ورودعنوان ژورنال:
- The Journal of emergency medicine
دوره 44 4 شماره
صفحات -
تاریخ انتشار 2013