Pediatric Pertussis Follow-up

  • Author: Hazel Guinto-Ocampo, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: May 26, 2011
 

Further Inpatient Care

Inpatient care is required for patients with pertussis who have intractable nausea and vomiting, failure to thrive, seizures, encephalopathy, or for patients with sustained hypoxemia during coughing paroxysms who require supplemental oxygen.

Therapy is largely supportive but should include macrolide administration and possible use of steroids, beta2-agonists, or both. Antibiotics are most effective if started when the patient is in the catarrhal stage and may abort infection or at least make the patient noncommunicable. Antibiotics may also prevent or alleviate secondary bacterial infection.

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Further Outpatient Care

Most patients older than 1 year can be treated on an outpatient basis if they do not fulfill the criteria for hospital admission (see Further Inpatient Care). Frequent outpatient reevaluations are required; frequency of observation should be individualized based on the patient's age, disease severity, and presence of comorbid conditions.

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Transfer

Transfer of patients is not usually indicated unless inpatient therapy and monitoring is warranted and such facilities are not available at the original institution. Need for transfer should be evaluated on an individual basis. Standard monitoring and transfer protocols should be followed.

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Deterrence/Prevention

Prevention through immunization remains the best defense in the fight against pertussis. Because nearly all of the fatal cases of pertussis occur in infants who were too young to have been immunized, novel strategies must be explored to protect these vulnerable young infants.

An option may be to immunize neonates with acellular pertussis vaccine. However, immunogenicity of the vaccine in newborns and possible induction of tolerance to B pertussis antigens need to be investigated.

Evidence is overwhelming that parents and older siblings are the primary source of infection in young infants. The incidence of pertussis in preadolescents, adolescents, and adults has increased, and may be responsible for the increasing number of cases observed in young infants in some countries. A study from the Netherlands concluded that 35-55% of infant cases of pertussis could be prevented if immunity to pertussis in parents is maintained or boosted.[17]

In December 2005, the American Academy of Pediatrics approved recommendations from the COID for universal vaccination of adolescents at the 11-year or 12-year visit to boost protection against pertussis.[15] The FDA has licensed 2 tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) products, for use in children aged 10-18 years (Boostrix; GlaxoSmithKline Biologicals, Rixensart, Belgium) and 11-64 years (Adacel; Sanofi pasteur, Toronto, Canada). Tdap will replace tetanus toxoids in the childhood immunization schedule. The effectiveness of this strategy has yet to be demonstrated.

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Complications

Complications of pertussis are usually minimal, and most patients make a gradual full recovery with supportive care and antibiotics.

Infants younger than 6 months with pertussis are more likely to have severe disease, to develop complications, and to require hospitalization. Major complications include pneumonia (20%), encephalopathy, seizures (1%), failure to thrive, and death (0.3%).

Minor complications during the illness include epistaxis, nausea and vomiting, subconjunctival hemorrhages, and ulcers of the frenulum.

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Prognosis

Prognosis for full recovery is excellent; however, patients with comorbid conditions as previously described have a higher risk of morbidity and mortality and should be evaluated on an individual basis.

Compared with older children and adults, infants younger than 6 months with pertussis are more likely to have severe disease, to develop complications, and to require hospitalization. From 2001-2003, 69% of infants younger than 6 months with pertussis required hospitalization.[2] Pneumonia, either from Bordetella pertussis infection or from secondary infection with other pathogens, is a relatively common complication, occurring in approximately 13% of infants with pertussis.[5] CNS complications such as seizures and encephalopathy are less common and are thought to result from severe paroxysm-induced cerebral hypoxia and apnea, metabolic disturbances such as hypoglycemia, and small intracranial hemorrhages. Reported deaths due to pertussis in young infants have increased substantially over the past 20 years.[6, 7, 8] From 1990-1999, the case fatality rate was approximately 1% in infants younger than 2 months and less than 0.5% in infants aged2-11 months.

Leukocytosis, particularly WBC counts of more than 100,000, has been associated with fatalities from pertussis. Another study showed that WBC counts of more than 55, 000 and pertussis complicated by pneumonia were independent predictors of fatal outcome in a multivariate model.

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Patient Education

When a diagnosis of pertussis is made, patient and parent education and individualized supportive treatment are the best options. All parents should receive information regarding the infectious and contagious potential of pertussis, as well as the risks derived from the vaccine.

Prevention of pertussis involves the use of vaccine approved by the FDA and standard infection control precautions.

For excellent patient education resources, visit eMedicine's Children's Health Center and Public Health Center. Also, see eMedicine's patient education articles Whooping Cough and Immunization Schedule, Children.

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Contributor Information and Disclosures
Author

Hazel Guinto-Ocampo, MD  Consulting Staff, Assistant Professor of Pediatrics, Department of Pediatrics, Division of Emergency Medicine, Nemours Children's Clinic, AI duPont Hospital for Children

Hazel Guinto-Ocampo, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Bryon K McNeil, MD  Medical Director, Bioterrorism and Emergency Preparedness, Clinical Assistant Professor, Departments of Internal Medicine and Emergency Medicine, Via Christ Regional Medical Center

Bryon K McNeil, MD is a member of the following medical societies: American Academy of Emergency Medicine and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Stephen C Aronoff, MD  Waldo E Nelson Chair and Professor, Department of Pediatrics, Temple University School of Medicine

Stephen C Aronoff, MD is a member of the following medical societies: Pediatric Infectious Diseases Society and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary J Noel, MD  Clinical Associate Professor, Department of Pediatrics, Weill Cornell Medical College

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

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.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

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A photomicrograph of Bordetella (Haemophilus) pertussis bacteria using Gram stain technique.
 
 
 
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