Pediatric Pertussis 

  • Author: Hazel Guinto-Ocampo, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Feb 27, 2012
 

Background

Pertussis, commonly known as whooping cough, is a respiratory tract infection characterized by a paroxysmal cough. It was first identified in the 16th century. In 1906, Bordet isolated the most common causative organism, Bordetella pertussis.Bordetella parapertussis has also been associated with whooping cough in humans. Before the advent of vaccinations, pertussis was a major cause of morbidity and mortality among infants and children. Reported cases of pertussis decreased by more than 99% after the introduction of pertussis vaccine combined with diphtheria and tetanus toxoids in the 1940s. However, despite considerable advances in the control of infectious diseases in children through global immunization programs, pertussis remains a disease of public health concern.

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Pathophysiology

Humans are the sole reservoir for B pertussis and B parapertussis. B pertussis is a gram-negative pleomorphic bacillus that spreads via aerosolized droplets from coughing of infected individuals. B pertussis attaches to and damages ciliated respiratory epithelium.

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Epidemiology

Frequency

United States

Since the early 1980s, pertussis incidence has cyclically increased, with peaks occurring every 2-5 years.[1] Most cases occur between June and September. Neither acquisition of the disease nor vaccination provides complete or lifelong immunity. Protection against typical disease wanes 3-5 years after vaccination and is not measurable after 12 years.

From 1980-2005, the reported incidence of pertussis in the United States dramatically increased across all age groups. Although the largest increase in pertussis cases has been among adolescents and adults, the annual reported incidence remained highest among infants younger than one year, at 55.2 cases per 100,000 population.[2, 3]

International

The worldwide incidence is estimated to include 48.5 million cases and nearly 295,000 deaths per year.[4] The case-fatality rate among infants in low-income countries may be as high as 4%.

Mortality/Morbidity

Infants born prematurely and patients with underlying cardiac, pulmonary, neuromuscular, or neurologic disease are at high risk for complications of pertussis (eg, pneumonia, seizures, encephalopathy, death). Older children, adolescents, and adults often have mild or atypical illness. Approximately one half of adolescents with pertussis cough for 10 weeks or longer. Complications among adolescents and adults include syncope, sleep disturbance, incontinence, rib fractures, and pneumonia.

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 B 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 substantially increased 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 aged 2-11 months. Pertussis has been reported as a cause of sudden infant deaths.

Race

Data on race were available for 75% of patients younger than 20 years from 1997-2000.[9] Of these patients, 88% were white, 8% were black, 2% were Asian/Pacific Islander, and 2% were American Indian/Alaska Native. In comparison, the national population estimates for persons younger than 20 years in 1998 were 79% white, 16% black, 4% Asian/Pacific Islander, and 1% American Indian/Alaska Native.

Sex

From 1997-2000, among pertussis cases in patients younger than 20 years, males and females were equally affected.[9]

Age

From 2001-2003, of patients with pertussis, 23% were younger than 1 year, 12% were aged 1-4 years, 9% were aged 5-9 years, 33% were aged 10-19 years, and 23% were older than 20 years.[5]

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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  Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

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: 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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