Pertussis, the Pediatrician, and the Outbreak

BACKGROUND: A neonate presented with worsening gastrointestinal and respiratory distress. Pertussis isolation precautions were not initiated until 3 days after presentation. Although the initial Pertussis DFA was negative, the Pertussis culture was positive. METHODS: Surveillance for close contacts was begun. Exposed, asymptomatic healthcare workers (HCWs) were given azithromycin prophylaxis. The attending pediatrician developed a cough 9 days after the exposure and tested positive for Pertussis by PCR. Five other exposed, symptomatic HCWs met the confirmed case classification, despite negative laboratory findings. Surveillance and prophylaxis for cases exposed to the pediatrician and the five HCWs were begun. RESULTS: Two-hundred-thirty-one exposed patients and their family members were seen in the hospital setting and given prophylaxis; 51 of these individuals with a cough were tested for Pertussis by PCR and culture. The one positive contact was linked to an unrelated Pertussis case. The five exposed HCWs also spent clinical time in various outpatient settings. Ninety days after the index case presented, the pediatrician remains the only laboratory-confirmed secondary case. CONCLUSIONS: Pertussis should be part of the differential diagnosis in all patients < 6 months of age who present with an upper respiratory illness or distress. Droplet precautions should be initiated promptly in these patients. The current case definition when applied to individuals with negative laboratory findings can lead to expensive diagnostic testing, inappropriate antibiotic use, unneeded school/work furlough, and over-taxing of healthcare resources. Further investigation into the safety of immunizing adults with a Pertussis vaccine is needed.