Whooping cough in school age children with persistent cough: prospective cohort study in primary care
Anthony Harnden1, Cameron Grant, Timothy Harrison
1Department of Primary Health Care, University of Oxford, Oxford OX3 7LF. anthony.harnden@dphpc.ox.ac.uk
Insights
A significant proportion of school-aged children with persistent cough have recent Bordetella pertussis infection, even if vaccinated. Consider whooping cough in immunised children with prolonged cough to avoid unnecessary tests and treatments.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Public Health
Background:
- Persistent cough in school-aged children is a common primary care presentation.
- Bordetella pertussis (whooping cough) can cause prolonged respiratory symptoms.
- The effectiveness of pertussis vaccination in preventing infection in this age group requires ongoing evaluation.
Purpose of the Study:
- To determine the prevalence of recent Bordetella pertussis infection among school-aged children presenting with a persistent cough.
- To identify clinical features associated with Bordetella pertussis infection in this population.
Main Methods:
- Prospective cohort study conducted in general practices in Oxfordshire, England.
- 172 children aged 5-16 years with cough lasting at least 14 days were enrolled.
- Serological testing was used to detect recent Bordetella pertussis infection; symptom data and cough characteristics were collected.
Main Results:
- 37.2% of children showed serological evidence of recent Bordetella pertussis infection.
- The majority (85.9%) of infected children had completed their pertussis immunisation schedule.
- Whooping cough was associated with specific symptoms like whooping, vomiting, sputum production, and prolonged cough with sleep disturbance.
Conclusions:
- Whooping cough should be considered in the differential diagnosis of school-aged children with persistent cough, irrespective of immunisation status.
- Accurate diagnosis of Bordetella pertussis infection can guide appropriate clinical management and prevent unnecessary investigations.
- Findings highlight the importance of considering pertussis even in vaccinated populations with prolonged respiratory symptoms.
Objective:
To estimate the proportion of school age children with a persistent cough who have evidence of a recent Bordetella pertussis infection.
Design:
Prospective cohort study (October 2001 to March 2005).
Setting:
General practices in Oxfordshire, England.
Participants:
172 children aged 5-16 years who presented to their general practitioner with a cough lasting 14 days or more who consented to have a blood test.
Main Outcome Measures:
Serological evidence of a recent Bordetella pertussis infection; symptoms at presentation; duration and severity of cough; sleep disturbance (parents and child).
Results:
64 (37.2%, 95% confidence interval 30.0% to 44.4%) children had serological evidence of a recent Bordetella pertussis infection; 55 (85.9%) of these children had been fully immunised. At presentation, children with whooping cough were more likely than others to have whooping (odds ratio 2.85, 95% confidence interval 1.39 to 5.82), vomiting (4.35, 2.04 to 9.25), and sputum production (2.39, 1.14 to 5.02). Children with whooping cough were also more likely to still be coughing two months after the start of their illness (85% v 48%; P = 0.001), continue to have more than five coughing episodes a day (P = 0.049), and cause sleep disturbance for their parents (P = 0.003).
Conclusions:
For school age children presenting to primary care with a cough lasting two weeks or more, a diagnosis of whooping cough should be considered even if the child has been immunised. Making a secure diagnosis of whooping cough may prevent inappropriate investigations and treatment.
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