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Understanding Pertussis: Clinical Description and Epidemiology

Learn about the clinical description, diagnosis, and epidemiology of pertussis, also known as whooping cough. Understand case and outbreak investigation, review surveillance data, and comprehend complications and laboratory testing.

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Understanding Pertussis: Clinical Description and Epidemiology

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  1. Pertussis (Whooping Cough or Hundred Day Cough) Thein Shwe, MPH, MS, MBBS VPD & IBD Epidemiologist DIDE 4th Quarter Training 11/18/2009

  2. Objectives • To describe clinical description, diagnosis and epidemiology of pertussis • To understand • Investigation of a case of pertussis and outbreak of pertussis • To review U. S. and West Virginia pertussis surveillance data

  3. Disease Description • Pertussis, a cough illness commonly known as whooping cough (100 Day Cough), is caused by the bacterium Bordetella pertussis. • Prolonged paroxysmal cough often accompanied by an inspiratory whoop. • Varies with age and history of previous exposure or vaccination. • Neither infection nor immunization provides lifelong immunity

  4. Other Bordetella species • Three other Bordetella species: • B. parapertussis, • B. holmesii, and • B. bronchiseptica. • B. pertussis and B. parapertussis coinfection is not unusual. • Disease with Bordetella species other than B. pertussis is not reportable.

  5. Clinical Description of Pertussis

  6. SOUND OF PERTUSSIS http://www.soundsofpertussis.com/sound_of_pertussis.cfm

  7. Epidemiology of Pertussis Mode of transmission • Person to person via • Aerosolized droplets from cough or sneeze • Direct contact with secretions from respiratory tract of infectious person • 80% - secondary attack rate • Older children and adults are important sources of disease for infants and young children • Infants <12 months of age greatest risk for complications and death

  8. Epidemiology of Pertussis cont. • Reservoir - Humans • Incubation period – 7-10 days (5-21 days). • Infectious period – Most contagious during the catarrhal stage and the first 2 weeks after cough onset • Duration of illness: • Children: 6-10 wks. • ~ ½ of Adolescents: 10 wks or longer

  9. Pertussis Complications • Syncope (temporary loss of consciousness/faint) • Sleep disturbance • Incontinence • Rib fractures • Complications among infants • Pneumonia (22%) • Seizures (2%) • Encephalopathy (<0.5%) • Death • Infants, particularly those who have not received a primary vaccination series, are at risk for complications and mortality.

  10. Pertussis Laboratory Diagnosis

  11. Pertussis Laboratory Testing

  12. Proper Technique for Obtaining a Nasopharyngeal Specimen for Isolation of B pertussis

  13. Nasopharyngeal Swab Collection Procedure http://content.nejm.org/cgi/content/full/NEJMe0903992/DC1

  14. Why do We do Pertussis Surveillance? • To assess burden of disease and guide policy and control strategies • e.g., vaccination of postpartum mothers and adult and adolescent contacts of infants • To monitor disease trends and identify populations at risk • To identify clusters of related cases that might indicate an outbreak • To monitor changes in the B. pertussis organism

  15. Pertussis Case Investigation & Outbreak Investigation

  16. CDC/CSTE PERTUSSIS CASE DEFINITION

  17. Pertussis Clinical Case Definition • A Cough illness lasting at least 2 weeks • With one of the following: - paroxysms of coughing, or - inspiratory “whoop,” or - posttussive vomiting; And without other apparent cause (as reported by a healthcare professional)

  18. Laboratory Criteria for Diagnosis • Isolation of Bordetella pertussis from a clinical specimen (Culture) • Positive polymerase chain reaction (PCR) assay for B. pertussis DNA

  19. Case Classification • Probable: • Meets the clinical case definition, • Not laboratory confirmed, and • Not epidemiologically linked to a laboratory-confirmed case • Confirmed: • A case of acute cough illness of any duration with a positive culture for B. pertussis • A case that meets the clinical case definition and is confirmed by PCR • A case that meets the clinical definition and is epidemiologically linked directly to a case confirmed by either culture or PCR

  20. Pertussis Case Investigation EXERCISEs

  21. What would you do with this pertussis laboratory report? Exercise 1 - Submitter: Patient Name: Smith, James Office of Lab Services Address: 234 A St 167 11th Ave. Charleston, WV 25311 S. Charleston, WV25303 DOB: 06/12/2005 Attention To: Dr Bloom Age: 4 yrs Sex: Male ______________________________________________________ Specimen source: Nasopharyngeal Collection date: 11/7/09 Culture: Bordetella pertussis isolated Reported date: 11/14/09

  22. Does it meet the lab criteria? - Check lab criteria for diagnosis

  23. Exercise 2 Patient Name: Bond, James WVU Hospital Address: Peace Ave. Morgantown, WV Star City, WV 26503 DOB: 03/1/1985 Attention To: Age: 24 yrs Dr Moody Sex: Male _____________________________________________ Specimen source: Nasopharyngeal Specimen date: 11/10/09 Bordetella by Rapid PCR Result - Bordetella pertussis DNA detected Reported date: 11/12/09

  24. Does it meet the lab criteria? - Check lab criteria for diagnosis

  25. Exercise 3 • Patient Name: A Pullman Lab Corp of America • DOB: 10/7/1998 Dublin, Ohio • Address: Clarksburg, WV • ____________________________________________ • Test Name – B pertussis IgM Ab, Quantitative • Comment: Positive = >1.1, Negative = <1.0, Borderline = 1.0 -1.1 • B pertussis IgM result = 1.7

  26. Does it meet the lab criteria? - Check lab criteria for diagnosis

  27. PERTUSSIS CASE INVESTIGATION Regardless of Type of Test and Result,All PERTUSSIS REPORTS SHOULD BE INVESTIGATED Immediately

  28. Importance of Rapid Case Identification • Early diagnosis and treatment to limit disease spread • Identify and provide prophylaxis to close contacts pending laboratory confirmation • When suspicion of pertussis is low, investigation can be delayed pending laboratory confirmation • Exception: prophylaxis of infants and their household contacts should NOT be delayed

  29. What is the next step in a case investigation? • Refer to Pertussis Protocol • Use Pertussis WVEDSS form • Begin your case ascertainment

  30. Pertussis Surveillance Protocolhttp://www.wvidep.org/Portals/31/PDFs/IDEP/Pertussis/PERTUSSIS%20Protocol%20Sept2007.pdf

  31. Pertussis WVEDSS Form

  32. How do you ascertain a case? • Three pieces of information needed to determine if you have a pertussis case • Clinical information • Additional laboratory report(s) • Epidemiological information

  33. What information would you obtain from a provider?

  34. What information would you obtain from a provider? cont’d

  35. What would you obtain from the patient/parent?

  36. What Epidemiological information do you need to obtain?

  37. Contact Tracing of a Pertussis Case

  38. Management for Exposed persons

  39. Postexposure Prophylaxis for Pertussis in Infants, Children, Adolescents, and AdultsSource: Red Book 2009 AAP – pg. 507

  40. Once the investigation is completed: • Document public health action • Check case classification • Print the report for your files or per your LHD policy & procedure • Send lab report(s) to DIDE • Submit completed WVEDSS report electronically to your regional epidemiologist and DIDE

  41. Pertussis Outbreak Case Definition • Outbreak is defined as: • Two or more cases • Involving two or more households • Clustered in time & spaceAND • One case must be confirmed by positive culture

  42. Pertussis Outbreak Line List Formhttp://www.wvidep.org/Portals/31/PDFs/IDEP/Pertussis/Pertussis%20Outbreak%20Linelisting%20Form.pdf

  43. Outbreak Notification and Control • Notify your regional epidemiologist & DIDE immediately • Evaluate case status & manage close contacts • Obtain nasopharyngeal swabs for culture (confirmation) and PCR

  44. Outbreak Control in Any Settings • Treat/Prophylax with recommended antibiotic • Isolate 5 days after starting antibiotic treatment or 21 days from cough onset if no treatment • Bring immunizations up-to-date • Accelerated vaccination if cases are occurring young infants

  45. Alert your providers and notify the parents… • Healthcare Providers • Send Health alert letter • Provider information sheet • Parent/Guardian • Send notification letter • Public information sheet

  46. Exposures in Child Care • Exposed Children (especially incompletely immunized) and childcare providers should be • Observed for respiratory tract symptoms for 21 days after contact with an infectious person has been terminated • Administer vaccine and antibiotics • Exclude: • Symptomatic or confirmed pertussis until completion of 5 days of the recommended course of antimicrobial therapy or 21 days if untreated

  47. Follow up & Reporting • Check for the status of the outbreak control • Document and update your regional epidemiologist and DIDE when the outbreak is controlled completely • Forward report with lab results to DIDE

  48. PERTUSSIS SURVEILLANCE DATA WEST VIRGINIA & U.S.A

  49. Number of Reported Pertussis Cases, by Year, United States, 1922-2005Source: MMWR December 15, 2006 / 55(RR17);1-33

  50. Number of Reported Pertussis Cases, by Year, United States, 1922-2006Source: MMWR May 30, 2008 / 57 (04);1-47,51

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