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HCWs have significant role in prevention of health care-associated pertussis
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Health care professionals should take advantage of their significant role in the prevention of health care-associated pertussis, as the country experiences the largest pertussis epidemic in the past 50 years, according to study findings in The Journal of the Pediatric Infectious Diseases Society.
Tirza Calderón, a masters of public health student at the Perelman School of Medicine of the University of Pennsylvania, and colleagues reviewed 65 relevant studies about pertussis transmission in pediatric health care settings, pertussis prevention and control measures, or health care worker (HCW) vaccination strategies.
Patients, HCWs, and visitors in pediatric health care facilities have an increased risk for pertussis transmission for several reasons: 1) there is a concentration of susceptible patients in pediatric health care facilities; 2) workers in these facilities are mostly adults, whose pertussis immunity decreases over time, increasing their risk for infection and becoming a source of transmission; and 3) behavioral activities of infants and children, such as sharing toys in communal playrooms, can facilitate transmission to visiting family members.
Health care professionals have a 1.7-fold greater risk for acquiring pertussis compared with the general population, according to researchers. They have been a source of infection to patients, colleagues and community members. A review of occupational exposure to pertussis in a large pediatric health care setting indicated an average of five HCWs’ exposures per case patient.
To prevent secondary transmission, early recognition of pertussis is vital to implement appropriate control measures. Despite this, a common feature of health care-associated pertussis is a significant delay in the diagnosis of source cases.
Challenges associated with diagnostic testing have been cited as barriers to adequate infection prevention and control. Because sensitive and specific laboratory tests are lacking, pertussis is difficult to diagnose. As a result, outbreaks are difficult to identify and control in a timely manner, according to Calderón and colleagues.
As soon as pertussis is suspected and a specimen is collected, antimicrobial treatment should be initiated, according to researchers. Treatment helps to limit transmission, even though severity and duration of symptoms may not be affected. Treatment is recommended up to 3 weeks after cough onset among children older than 1 year of age, but can be administered up to 6 weeks after cough onset among children aged younger than 1 year, women in the third trimester of pregnancy, and those in close contact with infants. Patients remain contagious until 5 days after they begin treatment. All individuals confirmed to have pertussis should be isolated, the researchers recommend.
In addition to isolation, limiting physical contact in pediatric health care facilities can prevent transmission of pertussis.
The CDC’s Prevention Health Care Infection Control Practices Advisory Committee suggests HCWs adhere to droplet precautions when caring for symptomatic patients. Adherence to respiratory hygiene can prevent pertussis exposures by identifying symptomatic individuals with undiagnosed respiratory illness upon entry to a health care facility.
Education can be used as a tool to prevent pertussis transmission in health care settings, but more evidence on the impact of educational programs is needed. HCWs benefit from repeat education on the implications of waning immunity after vaccination or natural infection, spectrum of symptoms, modes of transmission, and the importance of post-exposure prophylaxis compliance. Education of the public may also help reduce the risk of health care-associated transmission.
According to the National Health Interview Survey, vaccination coverage of HCWs was 37% in 2011, indicating a need for staff education on the importance of up-to-date immunization to prevent pertussis.
“Prevention and control of pertussis is vital for pediatric health care facilities. Personnel in these settings need to assess new challenges associated with pertussis, urge timely recognition, enhance understanding of adolescent and adult roles in transmission, and establish comprehensive prevention and control frameworks. Amidst the largest national epidemic of pertussis in over 50 years, heightened risk of nosocomial transmission should drive efforts to develop interventions that more successfully manage this disease in health care settings,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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