Pertussis infection in adolescents and adults: Treatment and prevention
- Paul Cornia, MD
Paul Cornia, MD
- Associate Professor of Medicine
- University of Washington
- Benjamin A Lipsky, MD, FACP, FIDSA, FRCP
Benjamin A Lipsky, MD, FACP, FIDSA, FRCP
- Emeritus Professor of Medicine
- University of Washington
- Visiting Professor of Medicine
- Teaching Associate, Green Templeton College
- University of Oxford
Pertussis, also known as "whooping cough," is a highly contagious acute respiratory illness caused by Bordetella pertussis. In the pre-vaccine era, the disease predominantly affected children <10 years of age and usually manifested as a prolonged cough illness with one or more of the classical symptoms including inspiratory whoop, paroxysmal cough, and posttussive emesis .
Since the introduction of pertussis vaccines, the epidemiology of reported pertussis infections has changed; in the United States in the 1990s, more than one-half of cases occurred in adolescents and adults . Infected adolescents and adults can serve as a reservoir for infection of infants and children, who more often experience serious morbidity and mortality. Because symptoms and signs in adolescents and adults are often nonspecific, clinicians may not consider the diagnosis of pertussis.
Issues related to treatment and prevention of pertussis in adolescents and adults will be reviewed here. Issues related to treatment and prevention of pertussis in infants and children are discussed separately. (See "Pertussis infection in infants and children: Treatment and prevention".)
The pathogenesis, epidemiology, clinical manifestations, and diagnosis of this infection are discussed separately. (See "Pertussis infection: Epidemiology, microbiology, and pathogenesis" and "Pertussis infection in adolescents and adults: Clinical manifestations and diagnosis" and "Pertussis infection in infants and children: Clinical features and diagnosis".)
Based on limited data, most individuals appear to clear pertussis infection without antibiotic treatment within six weeks . Antibiotic treatment given during the early (catarrhal) phase may decrease the duration and severity of cough, but the diagnosis is rarely established during this phase among adolescents and adults. Antibiotic treatment later in the course of disease probably does not affect the course of symptoms but may be useful to reduce the spread of the infection to others.
- Güriş D, Strebel PM, Bardenheier B, et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 1990-1996. Clin Infect Dis 1999; 28:1230.
- Centers for Disease Control and Prevention (CDC). Pertussis--United States, 1997-2000. MMWR Morb Mortal Wkly Rep 2002; 51:73.
- Kwantes W, Joynson DH, Williams WO. Bordetella pertussis isolation in general practice: 1977-79 whooping cough epidemic in West Glamorgan. J Hyg (Lond) 1983; 90:149.
- Tiwari T, Murphy TV, Moran J, National Immunization Program, CDC. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. MMWR Recomm Rep 2005; 54:1.
- Centers for Disease Control and Prevention. Pertussis (Whooping Cough). Treatment. http://www.cdc.gov/pertussis/clinical/treatment.html (Accessed on January 14, 2016).
- Centers for Disease Control and Prevention. Pertussis (Whooping Cough): Treatment. http://www.cdc.gov/pertussis/clinical/treatment.html (Accessed on March 09, 2016).
- Bergquist SO, Bernander S, Dahnsjö H, Sundelöf B. Erythromycin in the treatment of pertussis: a study of bacteriologic and clinical effects. Pediatr Infect Dis J 1987; 6:458.
- Strle F, Maraspin V. Is azithromycin treatment associated with prolongation of the Q-Tc interval? Wien Klin Wochenschr 2002; 114:396.
- Ray WA, Murray KT, Meredith S, et al. Oral erythromycin and the risk of sudden death from cardiac causes. N Engl J Med 2004; 351:1089.
- Kerr JR, Preston NW. Current pharmacotherapy of pertussis. Expert Opin Pharmacother 2001; 2:1275.
- Hoppe JE, Dalhoff A, Pfründer D. In vitro susceptibilities of Bordetella pertussis and Bordetella parapertussis to BAY 12-8039, trovafloxacin, and ciprofloxacin. Antimicrob Agents Chemother 1998; 42:1868.
- Mortensen JE, Rodgers GL. In vitro activity of gemifloxacin and other antimicrobial agents against isolates of Bordetella pertussis and Bordetella parapertussis. J Antimicrob Chemother 2000; 45 Suppl 1:47.
- Felmingham D, Farrell DJ. In vitro activity of telithromycin against Gram-negative bacterial pathogens. J Infect 2006; 52:178.
- Horiba K, Nishimura N, Gotoh K, et al. Clinical manifestations of children with microbiologically confirmed pertussis infection and antimicrobial susceptibility of isolated strains in a regional hospital in Japan, 2008-2012. Jpn J Infect Dis 2014; 67:345.
- Trollfors B. Effect of erythromycin and amoxycillin on Bordetella pertussis in the nasopharynx. Infection 1978; 6:228.
- Hoppe JE. Susceptibility testing of Bordetella pertussis. J Clin Microbiol 1998; 36:1465.
- Wang K, Bettiol S, Thompson MJ, et al. Symptomatic treatment of the cough in whooping cough. Cochrane Database Syst Rev 2014; :CD003257.
- Witt MA, Arias L, Katz PH, et al. Reduced risk of pertussis among persons ever vaccinated with whole cell pertussis vaccine compared to recipients of acellular pertussis vaccines in a large US cohort. Clin Infect Dis 2013; 56:1248.
- Klein NP, Bartlett J, Fireman B, et al. Comparative effectiveness of acellular versus whole-cell pertussis vaccines in teenagers. Pediatrics 2013; 131:e1716.
- Acosta AM, DeBolt C, Tasslimi A, et al. Tdap vaccine effectiveness in adolescents during the 2012 Washington State pertussis epidemic. Pediatrics 2015; 135:981.
- Mattoo S, Cherry JD. Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies. Clin Microbiol Rev 2005; 18:326.
- Centers for Disease Control and Prevention. Vaccines and Immunizations. Pertussis. Epidemiology and Prevention of Vaccine-Preventable Diseases, The Pink Book: Course Textbooks, 12th ed, 2011. http://www.cdc.gov/vaccines/pubs/pinkbook/pert.html.
- Singh M, Lingappan K. Whooping cough: the current scene. Chest 2006; 130:1547.
- Pertussis vaccination: acellular pertussis vaccine for the fourth and fifth doses of the DTP series update to supplementary ACIP statement. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1992; 41:1.
- Pertussis vaccination: acellular pertussis vaccine for reinforcing and booster use--supplementary ACIP statement. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep 1992; 41:1.
- Keitel WA, Muenz LR, Decker MD, et al. A randomized clinical trial of acellular pertussis vaccines in healthy adults: dose-response comparisons of 5 vaccines and implications for booster immunization. J Infect Dis 1999; 180:397.
- Halperin SA, Smith B, Russell M, et al. An adult formulation of a five-component acellular pertussis vaccine combined with diphtheria and tetanus toxoids is safe and immunogenic in adolescents and adults. Vaccine 2000; 18:1312.
- Rothstein EP, Anderson EL, Decker MD, et al. An acellular pertussis vaccine in healthy adults: safety and immunogenicity. Pennridge Pediatric Associates. Vaccine 1999; 17:2999.
- Van der Wielen M, Van Damme P, Joossens E, et al. A randomised controlled trial with a diphtheria-tetanus-acellular pertussis (dTpa) vaccine in adults. Vaccine 2000; 18:2075.
- Tran Minh NN, He Q, Edelman K, et al. Immune responses to pertussis antigens eight years after booster immunization with acellular vaccines in adults. Vaccine 2000; 18:1971.
- Turnbull FM, Heath TC, Jalaludin BB, et al. A randomized trial of two acellular pertussis vaccines (dTpa and pa) and a licensed diphtheria-tetanus vaccine (Td) in adults. Vaccine 2000; 19:628.
- Pichichero ME, Rennels MB, Edwards KM, et al. Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults. JAMA 2005; 293:3003.
- Ward JI, Cherry JD, Chang SJ, et al. Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med 2005; 353:1555.
- Broder KR, Cortese MM, Iskander JK, et al. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006; 55:1.
- Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm?s_cid=mm6001a4_w.
- Centers for Disease Control and Prevention (CDC). Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Adults Aged 65 Years and Older - Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 2012; 61:468.
- Suryadevara M, Bonville CA, Cibula DA, et al. Pertussis vaccine for adults: Knowledge, attitudes, and vaccine receipt among adults with children in the household. Vaccine 2014; 32:7000.
- Liu BC, McIntyre P, Kaldor JM, et al. Pertussis in older adults: prospective study of risk factors and morbidity. Clin Infect Dis 2012; 55:1450.
- France EK, Glanz J, Xu S, et al. Risk of immune thrombocytopenic purpura after measles-mumps-rubella immunization in children. Pediatrics 2008; 121:e687.
- US Food and Drug Administration: Approved Products--Adacel http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm172481.htm (Accessed on April 09, 2014).
- Mertsola J, Van Der Meeren O, He Q, et al. Decennial administration of a reduced antigen content diphtheria and tetanus toxoids and acellular pertussis vaccine in young adults. Clin Infect Dis 2010; 51:656.
- Kroger AT, Duchin J, Vázquez M. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html (Accessed on April 27, 2017).
- Kretsinger K, Broder KR, Cortese MM, et al. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. MMWR Recomm Rep 2006; 55:1.
- Calugar A, Ortega-Sánchez IR, Tiwari T, et al. Nosocomial pertussis: costs of an outbreak and benefits of vaccinating health care workers. Clin Infect Dis 2006; 42:981.
- Baggett HC, Duchin JS, Shelton W, et al. Two nosocomial pertussis outbreaks and their associated costs - King County, Washington, 2004. Infect Control Hosp Epidemiol 2007; 28:537.
- Flanagan MP. How to manage a pertussis outbreak in your practice. Fam Pract Manag 2005; 12:31.
- ACIP Provisional Recommendations for Health Care Personnel on use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) and use of Postexposure Antimicrobial Prophylaxis. http://www.cdph.ca.gov/HealthInfo/discond/Documents/ACIPRecommendationsOnTdapAndPEP.pdf (Accessed on March 23, 2012).
- Forsyth KD, Campins-Marti M, Caro J, et al. New pertussis vaccination strategies beyond infancy: recommendations by the global pertussis initiative. Clin Infect Dis 2004; 39:1802.
- Forsyth KD, Wirsing von Konig CH, Tan T, et al. Prevention of pertussis: recommendations derived from the second Global Pertussis Initiative roundtable meeting. Vaccine 2007; 25:2634.
- Ulloa-Gutierrez R, Hozbor D, Avila-Aguero ML, et al. The global pertussis initiative: Meeting report from the Regional Latin America Meeting, Costa Rica, 5-6 December, 2008. Hum Vaccin 2010; 6:876.
- Guiso N, Liese J, Plotkin S. The Global Pertussis Initiative: meeting report from the fourth regional roundtable meeting, France, April 14-15, 2010. Hum Vaccin 2011; 7:481.
- Guiso N, Wirsing von König CH, Forsyth K, et al. The Global Pertussis Initiative: report from a round table meeting to discuss the epidemiology and detection of pertussis, Paris, France, 11-12 January 2010. Vaccine 2011; 29:1115.
- Cherry JD, Tan T, Wirsing von König CH, et al. Clinical definitions of pertussis: Summary of a Global Pertussis Initiative roundtable meeting, February 2011. Clin Infect Dis 2012; 54:1756.
- Forsyth K, Plotkin S, Tan T, Wirsing von König CH. Strategies to decrease pertussis transmission to infants. Pediatrics 2015; 135:e1475.
- Pertussis, Parapertussis (Whooping cough). In: Control of Communicable Diseases Manual, 17th ed, Chin J. (Ed), American Public Health Association, Washington, DC 2000. p.34.
- Antimicrobial therapy
- Cough management
- - Tdap booster
- General use
- - Pregnant women
- Healthcare personnel
- - International strategies
- Postexposure prophylaxis
- Other control measures
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