Pertussis (Whooping Cough) Exposure in Pediatric Healthcare Workers

ISSUE: Brookdale University Medical Center (BUMC) is a 530-bed teaching facility with a 52-bed pediatric unit and 6-bed ICU. On March 7, 2003, a foreign-born pediatric resident developed a sore throat, fever, and cough while working in one of the hospitalʹs pediatric clinics. She stayed home and took antibiotic therapy for 2 days. After a week, her son was admitted to the pediatric ward for 1 day with excess coughing. Despite taking cough medicine, the childʹs coughing increased over a 2-week period, and he was readmitted on March 19, 2003, for 4 days with severe cough and vomiting. Diagnosis with viral syndrome was made. On March 21, 2003, the child was tested for Pertussis, started on erythromycin, and discharged. The resident was also tested for Pertussis and started on erythromycin. Her son become cyanotic and was readmitted the next day to the pediatric intensive care unit (PICU). She stayed with her son in PICU for 3 days. Twenty-three days after initial onset of symptoms, the Employee Health Service of BUMC was notified by the New York City Department of Health of a positive Pertussis test result on the pediatric resident. PROJECT: To prevent exposure of Pertussis in healthcare settings. RESULTS: Immunization status of 71 patients in the pediatric clinic exposed to the resident was reviewed. Of the 18 patient cases with less than 2 doses of DPT vaccination, 16 were given prophylactic medicine. Two of five PICU patients required prophylaxis due to age. There were a total of 98 exposed healthcare workers (to both the child and the resident). 90 received prophylactic medication. No additional cases of Pertussis were identified. LESSON LEARNED: Infection control practitioners should be aware of the potential for adult cases of Pertussis, particularly in healthcare workers who have direct care for patients. Early diagnosis and notification of infection control could prevent exposure of susceptible individuals.