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Youngest populations most affected by pertussis outbreak
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BOSTON — Children aged 3 months and younger constituted most of the patients admitted to a California hospital for pertussis, data presented here at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy indicated.
The ongoing pertussis outbreak in California led to dramatic increases of patients admitted for this illness at the Children’s Hospital of Orange County, researchers reported. Using retrospective chart review, they gathered laboratory and clinical information on pertussis patients admitted to the hospital between 2009 and 2010. The researchers age-matched infants aged younger than 3 months who had pertussis with those who had respiratory syncytial virus or influenza.
Results revealed that 50 of 68 pertussis patients were admitted to the hospital. Ninety-two percent were aged 3 months and younger, 52% were aged 3 to 36 months and 25% were aged older than 10 years. The mean length of stay for all inpatients was 3.7 days, the researchers said.
Physicians confirmed diagnosis of pertussis via culture in 47% of patients, polymerase chain reaction only in 37% and direct fluorescent antibody alone in 3%. Thirteen percent were diagnosed clinically, according to the researchers.
Children aged 3 months and younger accounted for 72% of inpatients, and 33% required intensive care. Of these, three patients needed ventilator support. One patient required extracorporeal life support and exchange transfusion but did not survive. The mean length of hospital stay for patients in this age group was 13.2 days.
Fourteen percent of patients experienced coinfection, according to the researchers. Three had 2009 pandemic influenza A (H1N1) — one of whom also had bacteremia. Additionally, parainfluenza and respiratory syncytial virus each caused infection in one patient. Eleven percent of patients were readmitted to the hospital.
Seventy-eight percent of patients had cough contact, and in 43% of cases, mothers were the primary cough contacts.
The study findings indicate the importance of vaccination strategies for new mothers and other household contacts, the researchers said. – by Melissa Foster
Although pertussis vaccination has been available for decades, unlike most vaccine-preventable diseases, we are still struggling to develop truly effective vaccination strategies. The researchers argue for vaccination of new parents to build a protective cocoon around the infant. However, recognizing that young infants currently lack protection and are also at the highest risk of morbidity and mortality of pertussis makes revisiting the feasibility of both neonatal vaccination and the immunization of pregnant women seem appropriate.
– Steven B. Black, MD
University of Cincinnati Children's Hospital
Pediatrics and Global Health
Cincinnati, Ohio