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How should we approach adolescent and adult pertussis?
William A Agger1, Rajiv M Naik
1Gundersen Lutheran Medical Center, La Crosse, Wisconsin 54601, USA. waagger@gundluth.org
Insights
Pertussis (whooping cough) affects adolescents and adults, but diagnosis is challenging. New vaccines for these age groups offer a promising strategy to control rising pertussis incidence.
Area of Science:
- Infectious Diseases
- Immunology
- Public Health
Background:
- Pertussis (whooping cough) is increasingly recognized as a significant health issue in adolescents and adults.
- Diagnosis of pertussis is complicated by nonspecific symptoms and limitations in current diagnostic tests.
- Early treatment is crucial but often delayed due to diagnostic challenges.
Purpose of the Study:
- To address the diagnostic and therapeutic challenges of pertussis in adolescents and adults.
- To evaluate the role of new vaccines in controlling pertussis outbreaks.
- To discuss the controversies surrounding antibiotic use for pertussis prevention.
Main Methods:
- Review of diagnostic challenges and therapeutic controversies for pertussis.
- Evaluation of newly approved vaccines for adolescent and adult pertussis.
- Analysis of vaccine safety and immunogenicity data.
Main Results:
- New Food and Drug Administration-approved vaccines for adolescents and adults are safe and elicit protective antibody responses.
- These vaccines present a viable strategy for reducing pertussis incidence.
- Antibiotic therapy for prevention is controversial due to resistance and diagnostic difficulties.
Conclusions:
- Expanding vaccination programs for adolescents and adults can help curb the rising incidence of pertussis.
- New vaccines offer a safe and effective means to control pertussis in older populations.
- Addressing diagnostic limitations remains important for timely pertussis management.
Abstract:
Previously considered a disease of childhood, pertussis is now also recognized as a significant problem for adolescents and adults; however, diagnosing pertussis remains problematic due to its nonspecific clinical presentation and the time delay, sensitivity/specificity, and expense of testing. To be effective, therapy is best started very early in the illness, when the illness is seldom recognized. Other than chemoprophylaxis in families with a non-immune infant, antibiotic therapy is controversial due to the ubiquitous nature of pertussis, its similarity to other respiratory infections, increased prevalence, prolonged outbreaks, and difficulties in determining true exposures in the general community. If antimicrobial therapy is used extensively for whooping cough prevention, drug reactions and increased bacterial resistance are expected. Likewise, without laboratory confirmation of infection, isolation of individuals is difficult and expensive. Fortunately, 2 new Food and Drug Administration-approved vaccines, 1 for adolescents and 1 for adolescents/adults, are now available. Both have been shown to be safe and to produce protective antibody responses. As vaccination of adolescent and adult groups is expanded, the rising incidence of pertussis in all age groups can be curtailed.
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