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Pertussis (Whooping Cough or Hundred Day Cough)

Pertussis (Whooping Cough or Hundred Day Cough). Thein Shwe, MPH, MS, MBBS VPD & IBD Epidemiologist DIDE 4 th Quarter Training 11/18/2009. Objectives. To describe clinical description, diagnosis and epidemiology of pertussis To understand

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Pertussis (Whooping Cough or Hundred Day Cough)

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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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