Challenges of Adult Pertussis

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Challenges of Adult Pertussis
National Immunization Conference
March 18, 2003 Charles E. Jennings Illinois
Immunization Program
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• Reported Pertussis Cases -- U.S., 1922-2000

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Pertussis Incidence-United States

• 1,730 cases in 1980
• 8,296 cases in 2002 (provisional data)
• Rates of pertussis up 400 during 1990-2001

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Reported Pertussis Cases by Age Group, U.S.,
1983-2000
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• Reported Pertussis Incidence by
• Age Group (Yrs), U.S., 1983-2000

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Relationship of Source-case to 174 Infants with
Pertussis GA, IL, MA, MN, 1999-2000
Bisgard KM et al, 2001
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Analysis of Pertussis CasesBy Age At Date of
OnsetIllinois, 1997-2001
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Adult Pertussis Incidence Illinois

• 42 of 191 (24) cases occurred in adults in 2001
• 68 of 205 (33) cases occurred in adults in 2002

• Persons aged 10-19 years comprised 18 of all
  cases, 2001
• Persons aged 10-19 years comprised 13 of all
  cases, 2002

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Clinical Case Definition

• A cough illness lasting greater than two weeks
  with one of the following
• Paroxysms of coughing,
• inspiratory whoop,
• Post-tussive vomiting, without other apparent
  cause.

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Case Classification

• Confirmed
• A case that is laboratory confirmed or one that
  meets the clinical case definition and is either
  laboratory confirmed or epidemiologically linked
  to a laboratory-confirmed case.
• Probable
• A case that meets the clinical case definition,
  is not laboratory confirmed, and is not
  epidemiologically linked to a laboratory-confirmed
  case.

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Laboratory Criteria for Diagnosis

• Isolation of Bordetella pertussis from clinical
  specimen or
• Positive Polymerase Chain Reaction (PCR) for B.
  pertussis

Colonization of tracheal epithelial cells by
Bordetella pertussis
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Summary of Adult PertussisCrawford County,
IllinoisAugust October 2002

• Confirmed Cases 4
• Probable Cases 20
• Oil Refinery Cases 17
• Community Cases 7

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Adults With Pertussis Oil Refinery
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Important Characteristics of Adult Pertussis

• Can have mild symptoms
• Clinicians might not consider pertussis as the
  cause of illness
• Isolation of B. pertussis in adults is difficult
• No serological assay for a single convalescent
  sera is available
• Adults may not seek medical care till very late
  in the illness

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Analysis of Coles County Area Pertussis
Cases Illinois, 2001-2002
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Important Characteristics of Adult Pertussis

• Can have mild symptoms
• Clinicians might not consider pertussis as the
  cause of illness
• Isolation of B. pertussis in adults is difficult
• No serological assay for a single convalescent
  sera is available
• Adults may not seek medical care till very late
  in the illness

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Analysis of Coles County Area Pertussis CasesBy
Days Between Date of Onset and ER VisitIllinois,
2001-2002
Does not include those 17 cases not seen at ER
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Analysis of Coles County Area Pertussis CasesBy
Number of Days Between Date of Onset and
TreatmentIllinois, 2001-2002
Number Of Days
Does not include those 9 cases not provided
antibiotic treatment as o1/127/02
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Use of Macrolide Antibiotics

• Azithromycin was used in this outbreak
• Use is not well documented
• Erythromycin is the recommended antimicrobial
• Treatment is most effective when given within 3
  weeks of onset
• During outbreaks, repeated courses may be
  necessary

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Proportion of Pertussis Cases by First Antibiotic
Prescribed, U.S., 1997-2000
N28,537
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summary

• Adults might be a reservoir for B. pertussis is
  the community
• A public health response was delayed till disease
  was recognized late in the course of the initial
  cases
• The single isolate in this outbreak was PFGE type
  13 the most frequently identified pattern

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PFGE (CDC Type 13) McHenry County, Illinois 1998
2001
Jan March 1999
March 2000
May June 1999
Jan 1998
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conclusion

• A standardized and valid serologic test is needed
  to diagnose recent B. pertussis in adults
• Acellular pertussis vaccines might have a future
  role in control of outbreaks in older age groups
• More study is needed for use of alternative
  antibiotics
• Health care providers need increased knowledge of
  pertussis disease in adults

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Acknowlegements

• Kae Hunt
• Kathy McFadden
• Greg Huhn M.D.
• Illinois Department of Public Health
• Pam Skaggs
• Crawford County Health Departments

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