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Query: UMLS:C0043167 (pertussis)
 19,595 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pertussis is an epidemic disease caused by Bordetella pertussis and also to a lesser extent by Bordetella parapertussis. Classical illness lasts 4-8 weeks and is characterized by paroxysms of coughing with posttussive vomiting and whooping; however, 47.4% of primary infections last 4 weeks or less. Whole cell pertussis vaccines are generally highly efficacious. All whole cell vaccines are reactogenic, causing fever and local reactions in many vaccinees. In the past, these vaccines were thought to cause infant deaths and brain damage. However, several large epidemiologic studies indicate that whole cell vaccines do not cause infant deaths or neurologic disease. Recent studies indicate that neither immunization nor infection give long-term immunity. As a result, B. pertussis infections are endemic in adult populations. The future control of B. pertussis will require immunization schedules with new acellular vaccines that include booster doses in older children and adults.
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PMID:Historical review of pertussis and the classical vaccine. 889 26

The rate of isolation of Bordetella parapertussis among children with cough during the follow-up of different clinical efficacy studies has been evaluated. In the Italian trial, a comparison of clinical characteristics between B. pertussis and B. parapertussis infections showed lower frequencies and shorter duration of typical symptoms of whooping cough such as paroxysmal coughing, whooping, and vomiting in the group of children affected with B. parapertussis infections. In about 70% of B. parapertussis infections, there was a two-fold increase of IgA or IgG anti-FHA from acute- and convalescent-phase serum specimens. The analysis of the distribution of B. parapertussis cases in children fully immunized with each pertussis vaccine suggested that vaccination is irrelevant in preventing B. parapertussis infection.
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PMID:Bordetella parapertussis infections. 927 58

We assessed the quality of evidence for the use of erythromycin in preventing secondary transmission of pertussis to close contacts of primary cases. A literature search was undertaken and identified papers were reviewed critically. Thirteen original papers and 1 manuscript met the inclusion criteria for review (3 randomized controlled trials, 4 analytical studies and 7 descriptive studies). Evidence from both experimental and analytical studies showed little effect of the use of erythromycin in preventing secondary transmission. Its effect is at best modest when compared with the protection conferred by use of good quality whole cell vaccine. Three studies reported adverse events with erythromycin prophylaxis; these were mainly nausea, vomiting and abdominal pain. In countries where effective pertussis vaccines are in use, erythromycin use should be confined to close contacts of cases, particularly unimmunized children or partially immunized infants who would be most susceptible to the complications of pertussis, or adults who come into close contact with vulnerable children.
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PMID:Review of the evidence for the use of erythromycin in the management of persons exposed to pertussis. 959 83

The primary aim of this study was to assess the tolerability and immunogenicity of a new Haemophilus influenzae type b (Hib)/AlPO4 (CHIRON, SpA) vaccine, in two-month-old healthy infants. Twenty-three subjects were enrolled and administered the new Hib vaccine containing AlPO4 adjuvant at two, three and four months of age concomitantly with diphtheria-pertussis-tetanus (DPT) and hepatitis B vaccines according to the local program. Children were observed for 30 minutes after each immunization for any immediate local and systemic reactions. An active surveillance for side effects was performed on the 2nd and 7th days following each immunization by telephone. Families also filled out diaries for the first seven days. From the 2nd day to the next immunization only data about adverse events necessitating a physician's visit or about serious adverse events were collected. Blood samples were obtained before the first immunization and one month after the third dose for evaluation of anti-polyribosylribitol phosphate (PRP) antibody response. Local reactions at the Hib site were mild and less frequent compared to those observed at the DPT site. Systemic reactions noted after the three immunizations were fever in 70 percent, irritability in 48 percent, persistent crying in 26 percent, change in eating habits in 22 percent, diarrhea in 17 percent, sleepiness in 17 percent, vomiting in 9 percent, and unusual crying in 4 percent of the cases. There was no serious adverse event. One hundred percent and 95 percent of children achieved an anti-PRP antibody response over 0.15 microg/ml and 1.0 microg/ml, respectively. The geometric mean titer was 15 microg/ml and the geometric mean ratio 84. It was concluded that the new (Hib)/AlPO4 vaccine is safe and well tolerated, and induced a good PRP antibody response in healthy two-month-old infants.
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PMID:Safety, tolerability and immunogenicity of a Haemophilus influenzae type b vaccine containing aluminum phosphate adjuvant administered at 2, 3 and 4 months of age. 1077 Jan 9

From 1989 to 1998, the incidence of pertussis increased in Massachusetts adolescents and adults, reaching 71 and 5 per 100,000, respectively, by 1998, whereas the incidence in children remained stable. By 1998, 92% of cases occurred in adolescents and adults. Nationally, in contrast, adolescents and adults had incidences of only 5 and 0.8 per 100,000, respectively, and accounted for 47% of cases. The availability of a specific serologic test and active surveillance by public health personnel in Massachusetts are at least partial explanations. The rise in incidence may be real, however, because, as diagnostic efforts increased, the percentage of patients with a positive serologic test result also increased. Cases identified in adolescents and adults were quite severe: 83% and 87%, respectively, experienced paroxysmal cough, 45% and 41% experienced vomiting, and 41% and 52% experienced a cough lasting >4 weeks. Administration of acellular pertussis vaccine in these age groups could prevent this substantial morbidity.
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PMID:The increasing incidence of pertussis in Massachusetts adolescents and adults, 1989-1998. 1102 64

Although pertussis is increasingly recognized as a cause of prolonged cough illness in adolescents and adults, its prevalence is not well established. We evaluated pertussis infection in 442 adolescents and adults > or = 12 years old (mean age, 41.3 years) who had a cough-related illness of 7--56 days' duration. For 4 patients (0.9%), results of nasopharyngeal culture or PCR were positive for Bordetella pertussis; for 10 patients (2.3%), either results of culture or PCR were positive or pertussis antibody titers increased 4-fold. Eighty-eight patients (19.9%) had either laboratory-confirmed pertussis or laboratory evidence of pertussis. These patients had significantly longer duration of cough than did patients without laboratory evidence of pertussis (56 days vs. 46 days), and more of them had vomiting with cough (45.5% vs. 28.5%, respectively). Pertussis is a common cause of prolonged cough illness in adolescents and adults and is frequently associated with other symptoms of whooping cough.
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PMID:Pertussis is a frequent cause of prolonged cough illness in adults and adolescents. 1136 Feb 9

In non-smokers the underlying causes for chronic persistent cough (CPC) e.g. chronic cough without diagnostic chest X-ray or pulmonary function test--are usually as follows: several common upper airways diseases, bronchial (cough type) asthma, gastrooesophageal reflux or treatment with an ACE (angiotensin converting enzyme)--inhibitor. In 10% of CPC however the cause remains uncertain. We report a 30 year old non-smoker with severe coughing and repeated vomiting for two months. No laboratory or technical data could be collected suggestive of a common cause of CPC: Upper airways disease, bronchial flow limitation or hyperresponsiveness, ACE inhibitor medication, B. pertussis infection, gastrooesophageal reflux disease (by 24 hours pH-probe) were ruled out. Fiberbronchoscopic findings remained unremarkable, except for the bronchial biopsy specimen, which showed moderate eosinophilic inflammation of the mucosa and marked thickening of the subepithelial layer. Since the cough was non-productive, sputum induction with 3 ml nebulised 3% NaCl solution was performed. 28% of the granulocytes were eosinophil stained. A low quality morning sputum (< 1 ml) showed 21% eosinophilia. Thus, the diagnosis of eosinophilic bronchitis was established. 400 micrograms budesonide dry powder inhalations b.i.d. for one week resolved the cough, treatment was stopped after three weeks. No recurrence was seen two months later. Both the cough type asthma and the eosinophilic bronchitis could represent a form fruste of classical bronchial asthma beyond wheezing or dyspnoea, but with the common main symptom: cough. Since hyperresponsiveness and cough are phenotypic hallmarks of cough variant asthma, in eosinophilic bronchitis--beside cough--another two features of asthma are present: eosinophilic inflammation of the mucosa along with sputum eosinophilia and subepithelial layer thickening. Not surprisingly, eosinophilic bronchial inflammation could be shown in patients with cough variant asthma as well, who--up to 56% during a four year-period--develop classic asthma. The long-term outcome of eosinophilic bronchitis is not known, however. Thus, asthma, cough variant asthma and cough due to eosinophilic bronchitis can mirror different phenotypes or phases of the same entity. CPC due to either the cough type asthma or the eosinophilic bronchitis is like asthma fast responding to inhalative steroids. (Induced) sputum staining should be added to the diagnostic armamentarium of CPC.
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PMID:[Eosinophilic bronchitis without asthma--an additional rare cause for chronic persistent cough (CPC)? A 30-year old patient with severe CPC due to eosinophilic bronchitis without asthma or hyperreactivity]. 1144 11

Pertussis (i.e., whooping cough) is associated typically with an inspiratory "whoop," prolonged paroxysmal cough, and posttussive vomiting; however, persons infected with Bordetella pertussis sometimes experience atypical symptoms, making prompt recognition difficult and probably increasing infection transmission. All infants aged <6 months and any infants who have not yet received 3 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine are especially vulnerable to B. pertussis infection. This report summarizes the investigations of two pertussis deaths that occurred in 2000. Clinicians should consider pertussis as a cause of illness, especially among vulnerable infants who present with cough illness, respiratory distress, or apnea. Timely diagnosis of pertussis in caregivers and other contacts of infants could prevent infant pertussis fatalities.
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PMID:Pertussis deaths--United States, 2000. 1223 2

Pertussis is the 3rd highest vaccine preventable cause of death among children 5 years old. It is most frequent in children 2 years old and is fatal for 12 month old infants. People tend to confuse it with other respiratory infections. Despite its importance and the fact that it is a reportable disease, health systems in the Americas do not have an adequate surveillance system for pertussis. The number of reported cases in the Americas fell 67% between 1980-1990 which corresponded with increased coverage of DPT3 vaccine (36.6-75.5%). Further the number of deaths decreased form 5016-1398 between 1978-1986, but only 17 countries reported deaths and none of them sent reports each year. Some countries reported a fall in cases with a parallel increase in immunization coverage while others reported no link between the 2. Thus the system in inadequate. A major constraint to establishing a surveillance system is determining a clinical case definition since symptoms vary from slight to fatal spastic coughing and vomiting. Further 3 doses of DPT are only 80% effective and the other 20% display atypical symptoms. Moreover a special medium is needed to isolate Bordetella pertussis and timing of the sample is crucial. PAHO suggests any cough lasting =or 14 days be a suspected case. A suspected case with 1 of the following should be a confirmed case: isolation of B. pertussis, positive serology, cough followed by vomiting, cough with inspiratory whoop, or contact with another confirmed case. Any pertussis reporting should be integrated with other reporting systems and all health facilities and private physicians should report cases. Health workers should regularly investigate cases in the community. Epidemiologists need to study data to determine trends. Besides once the system is operating, it should be evaluated regularly by comparing data from major hospitals and clinics with those from the Ministry of Health. PAHO will help counties to set up a surveillance system.
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PMID:A call for a pertussis surveillance system. 1228 25

Seven cases of pertussis in patients aged between 1 and 6 months detected over 3 months were reported. Paroxysmal cough (six cases), post-tussive vomiting (three cases) and poor feeding (three cases) were the most common presenting symptoms. Bordetella pertussis was isolated from six patients. The total leucocyte counts were mildly increased (10.8-15.6x10(9)/L). The lymphocyte counts were markly raised (59-73%) and appear to be useful indicators of pertussis. It appears that herd immunity does not offer adequate protection to the vulnerable group even in well-vaccinated populations. High vaccination coverage should be maintained, and vaccination should be given as early an age as possible. Aggressive efforts to identify cases and contacts are essential. Health care workers should have a high index of suspicion for pertussis, in particular for those with paroxysmal cough and high lymphocyte counts so as to give timely diagnosis and treatment.
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PMID:Pertussis--a re-emerging infection? 1472 Apr 90


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