FROM : THE SDCMS GERM COMMISSION
TO : PHYSICIANS
GHASTLY GERM GAZETTE JANUARY 2007
Whoop! There It Is … Pertussis in Adolescents and Adults ✔ Persistent cough for 2–3 weeks in an adolescent or adult? ✔ Post-tussive emesis? ✔ Other family members coughing?
Think Pertussis! here is now ample evidence that adolescents and adults get pertussis and that physicians often miss the diagnosis. Among the problems that this creates is that unsuspecting adults are transmitting pertussis to high-risk contacts such as infants.
T
Consider These Facts: There were 371 cases of pertussis reported in San Diego in 2005. That is more than triple the number of cases reported in 2004. Many more cases occurred in 2006. More than 43% of those cases were in adults over the age of 19 years. So What, Who Cares? Adults with pertussis are sick for a long time. 61% of adults with pertussis can still be coughing 100 days later. 80% have cough for more than 21 days. Workers lose an average of six (6) workdays when their children got pertussis. Nursing home outbreaks with 49% attack rates have occurred. Most importantly, adults with pertussis spread the disease. An adult family member (parent or grandparent) was the source of pertussis in 55% of 264 infant cases in one study. Pertussis in infants can be fatal! What Does Pertussis in Adults Look Like? Persistent Cough Paroxysmal Cough Post-tussive Emesis Apnea
100% 87% 41% 37%
How Can I Diagnose Pertussis? Many labs in San Diego offer pertussis culture. Pertussis PCR is also available in some. Sensitivity of these tests can be low, particularly if the illness has already been prolonged. No reliable serologic testing is routinely available. If pertussis is diagnosed on one family member, look hard for it in the rest of the family. What Should I Do If I Suspect Pertussis? Try to confirm the diagnosis with culture and/or PCR testing. Treat with a macrolide antibiotic. Azithromycin for five (5) days, Erythromycin for 14 days. Report suspected cases to the health department at (619) 515-6620. What Can I Do to Prevent Pertussis? CDC recommends that all adolescents (11 years of age and older) and adults up to age 64 years of age should receive the new tetanus-diphtheria-acellular pertussis (Tdap) vaccines in place of Td vaccine. The standard interval for administration of Tdap vaccine is ten (10) years from the last Td. However for adolescents and adults who will have close contact with children less than 12 months of age (e.g., women prior to pregnancy or immediately post-partum, young parents, siblings of young infants, and healthcare workers who see children), Tdap vaccine should be offered at an interval as short as two (2) years from the last Td [MMWR, 2006;55 (RR17):1-36]. Post-exposure prophylaxis with a macrolide antibiotic, if given within three (3) weeks of exposure, may be of some value particularly for household and high-risk contacts (immunosuppressed patients, infants less than 12 months of age).
TO BE REMOVED FROM OUR FAX LIST, CHECK HERE ❑ AND FAX THIS SHEET BACK WITH YOUR NAME AND FAX NUMBER TO (858) 569-1334.