Pertussis in Emergency Medicine Follow-up

  • Author: Joseph J Bocka, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: May 26, 2009
 

Deterrence/Prevention

Whole-cell vaccination

The vaccine, used from the 1940s until the mid-1990s in the United States and from the 1940s until the 1980s in Europe, consisted of a whole cell with endotoxin given in 4 doses. About 80% of recipients acquired effective protection with this regimen. Two doses provided some immunity, whereas 1 dose provided little protection.

About 50% of patients have a local reaction, 1 in 1750 have a seizure without fever, 10.5 per million have encephalitis, and permanent brain damage is rare. Concern about CNS adverse effects is a major reason why many individuals choose not to be vaccinated.

Acellular vaccination

Vaccination is now recommended with DTaP at the ages of 2, 4, 6, and 15-18 months, and 4-6 years of age. A booster with Tdap (DTaP is not recommended for children aged 7 years or older) is recommended instead of one Td booster from age 19 and up. Tdap is not recommended in pregnancy.

After immunization, fever is reported in 3-5% of patients, persistent crying in 12 per 100,000, febrile seizures in 5 per 100,000, afebrile seizure in 2 per 100,000, and hyporesponsive episodes in 5 per 100,000. Severe neurologic sequelae have not been reported. This is about the same as Td alone.

For the latest childhood and adolescent immunization recommendations, see the immunization schedules for 2009.[4]

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Complications

  • Pneumonia
  • Hypoxic encephalopathy
  • Otitis media
  • Tuberculosis activation
  • Epistaxis, hemoptysis
  • Hernia
  • Reinduction of paroxysmal coughing with upper respiratory infections
  • Seizures
  • Cerebral hemorrhage
  • Coma and death
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Prognosis

  • With treatment, complete recovery is expected.
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Patient Education

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Contributor Information and Disclosures
Author

Joseph J Bocka, MD  Director of Shelby Emergency Department, Attending Emergency Physician at Mansfield Hospital, Med Central Health System (Mansfield and Shelby, Ohio); Emergency Medical Service Medical Director for several services

Joseph J Bocka, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes  MBBS, FACEM, Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Centers for Disease Control and Prevention. Outbreaks of respiratory illness mistakenly attributed to pertussis--New Hampshire, Massachusetts, and Tennessee, 2004-2006. MMWR Morb Mortal Wkly Rep. Aug 24 2007;56(33):837-42. [Medline]. [Full Text].

  2. Glanz JM, McClure DL, Magid DJ, Daley MF, France EK, Salmon DA, et al. Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children. Pediatrics. June 2009;123(6):1446-51. [Medline]. [Full Text].

  3. Centers for Disease Control and Prevention. Immunization Schedules. Available at http://www.cdc.gov/vaccines/recs/schedules/default.htm. Accessed March 31, 2009.

  4. [Guideline] Recommended childhood and adolescent immunization schedules--United States, 2009. Pediatrics. Jan 2009;123(1):189-90. [Medline].

  5. [Guideline] Centers for Disease Control and Prevention. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Use of diphtheria toxoid-tetanus toxoid-acellular pertussis vaccine as a five-dose series. (Addendum). 1997 guideline with 2000-2003 supplements. [Full Text].

  6. [Guideline] American Academy of Pediatrics Commitee on Infectious Diseases. Prevention of pertussis among adolescents: recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Pediatrics. Mar 2006;117(3):965-78. [Medline].

  7. Aoyama T, Sunakawa K, Iwata S, et al. Efficacy of short-term treatment of pertussis with clarithromycin and azithromycin. J Pediatr. Nov 1996;129(5):761-4. [Medline].

  8. Bass JW, Stephenson SR. The return of pertussis. Pediatr Infect Dis J. Feb 1987;6(2):141-4. [Medline].

  9. Centers for Disease Control and Prevention. Recommended Adult Immunization Schedule-United States, October 2007-September 2008. MMWR Morb Mortal Wkly Rep. Oct 19 2007;56(41):Q1-Q4. [Full Text].

  10. Centers for Disease Control and Prevention. Recommended Immunization Schedules for Persons Aged 0--18 Years ---United States, 2008. MMWR. 2007;56(51&52):Q1-Q4.

  11. Centers for Disease Control and Prevention. Vaccine preventable deaths and the Global Immunization Vision and Strategy, 2006-2015. MMWR Morb Mortal Wkly Rep. May 12 2006;55(18):511-5. [Medline]. [Full Text].

  12. Geier DA, Geier MR. An evaluation of serious neurological disorders following immunization: a comparison of whole-cell pertussis and acellular pertussis vaccines. Brain Dev. Aug 2004;26(5):296-300. [Medline].

  13. He Q, Viljanen MK, Arvilommi H, et al. Whooping cough caused by Bordetella pertussis and Bordetella parapertussis in an immunized population. JAMA. Aug 19 1998;280(7):635-7. [Medline].

  14. Nennig ME, Shinefield HR, Edwards KM, et al. Prevalence and incidence of adult pertussis in an urban population. JAMA. Jun 5 1996;275(21):1672-4. [Medline].

  15. Roush SW, Murphy TV,. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA. Nov 14 2007;298(18):2155-63. [Medline].

  16. Tindberg Y, Blennow M, Granstrom M. A ten year follow-up after immunization with a two component acellular pertussis vaccine. Pediatr Infect Dis J. Apr 1999;18(4):361-5. [Medline].

  17. Ward JI, Cherry JD, Chang SJ, Partridge S, Lee H, Treanor J. Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med. Oct 13 2005;353(15):1555-63. [Medline].

  18. Wright SW, Edwards KM, Decker MD, Lamberth MM. Pertussis seroprevalence in emergency department staff. Ann Emerg Med. Sep 1994;24(3):413-7. [Medline].

  19. Wright SW, Edwards KM, Decker MD, Zeldin MH. Pertussis infection in adults with persistent cough. JAMA. Apr 5 1995;273(13):1044-6. [Medline].

 
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