5. PERTUSSIS
• Bordetella pertussis – bacterium
• Pertussis - toxin-mediated disease that paralyzes the cilia, which
interferes with the clearing of pulmonary secretions
• Incidence – 1930s - 200,000 (mortality 10,000 - usually infants)
• Incidence - 2014 – 32,971
• 2014 – MAYO Rochester two infants on life support
• Treatment - macrolide or trimethoprim/sulfamethoxazole prevent
contagion but not help cough
6. PERTUSSIS VACCINATION
• Vaccine 1940s – DPT – fever, seizures
• Vaccine 1990s - Dtap kids or Tdap adults - less immunogenic
• Dtap – 2, 4 and 6 months, 18 months and 4-6 years
• Tdap – 11-12 years – this is considered the final ADULT dose
• Duration of protection 3-5 years
• Pregnant 2010 – third trimester – passive immunity for infant
• Consider – new fathers, grandparents, infant daycare, pediatric
medical staff, only use Dtap not Td vaccine every 10 years
7. NO BIG WHOOP
• Cough and coughing spasms – 100 day cough
• Cough to vomit or syncope
• No whoop
• Coryza
• Not toxic – minimal fever, minimal phlegm
• Gradual onset over 1-2 weeks
8. • MYTH
• Pertussis is a childhood disease
• Pregnant women should not be
vaccinated
• Adults can only have one Tdap
vaccination
TRUTH
Adults are susceptible as vaccine
protection is not durable. Typical
adult has 2.5 episodes.
Pregnant women should receive
Tdap at 28 – 32 weeks.
CDC – guidelines are minimal for
population
9.
10. 45 yo female – cough, cough and cough
• C/O cough 2 weeks, no fever, no phlegm, no myalgia – TX
symptomatic
• Return 2 weeks – cough – RX azithromycin
• Return 2 weeks – cough – CXR – neg, RX Amoxicillin
• Return 2 weeks – cough – prednisone
• Doctor reads CDC Morbidity and Mortality Weekly Report (MMWR)
• Doctor test Pertussis +, no further treatment.
11. 47 yo kindergarten teacher
• C/O cough and cold 3 weeks, exam – neg, HX asthma
• TX continue Advair, RX azithromycin
• 2 weeks later, C/O cough worse, coughing SPELLS,
• note Jose in class has been coughing head off for months,
• Pertussis test +, TX – prednisone – no help
12. 50 yo plumber (male of course)
• C/O cough 4 weeks, wife is the kindergarten teacher,
• Pertussis +, TX azithromycin, codeine cough med.
• History – never vaccinated as child mother felt breast feeding was
adequate protection.
• Plumber – still coughing – had cough syncope and
• 1 -fell off bleachers at go cart track
• 2- LOC driving motorhome & son age 10 took the wheel to safety.
13. 42 yo machinist
• C/O cough and loss of concentration at job
• Multiple doctor visits, multiple meds – no improvement
• Referral to elderly ENT – diagnosis Pertussis (had seen a few)
• Disability paperwork for 100 days.
14. 18 yo female varsity hockey player
• Mother C/O daughter cough all night even during sleep
• Father (physician) is supposed to fix it, exam – neg, Pertussis test +
• Close door on bedroom
15. 2 month male – “listen doctor”
• Mom note cough several days
• Exam – negative
• Doctor – reassures Mom – “nothing serious, just a cold”
• Mom – “listen doctor – you don’t get it – he turns black – not blue –
during these coughing spells”
• Doctor – sat up straighter and listened, RX – Zithromax, Pertussis +
• Fortunately – never got sicker and had rapid recovery
• Doctor – more grey hair
