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A pertussis outbreak among daycare children in Northern Israel: who gets sick?
Ori Hochwald1, Ellen S Bamberger, Lisa Rubin
1Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.
Insights
Pertussis vaccination is highly effective, with 92.5% efficacy observed in a daycare outbreak. Unvaccinated children were significantly more likely to contract pertussis, highlighting the importance of immunization.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Epidemiology
Background:
- A pertussis outbreak occurred in a daycare despite 87.5% vaccination coverage.
- This study investigated pertussis transmission dynamics in a childcare setting.
Purpose of the Study:
- To evaluate the effectiveness of the acellular pertussis vaccine.
- To assess the role of azithromycin chemoprophylaxis in preventing pertussis spread.
Main Methods:
- Studied 31 daycare children (aged 3-5.5 years) exposed to pertussis.
- Collected nasopharyngeal swabs for Bordetella pertussis culture and PCR.
- Monitored participants for symptoms and performed laboratory testing at baseline, day 21, and day 60.
Main Results:
- 6 out of 31 children (19%) tested positive for B. pertussis via PCR.
- 4 of the positive cases were unvaccinated, while 2 were vaccinated (one with milder symptoms, one asymptomatic).
- Vaccine efficacy was calculated at 92.5%; incidence was significantly lower in vaccinated children (P = 0.000).
Conclusions:
- Pertussis vaccination is crucial, as evidenced by all unvaccinated children contracting the infection.
- The study supports the importance of maintaining high pertussis vaccination rates in childcare settings.
- Azithromycin chemoprophylaxis showed no further cases by day 21, but its role requires further investigation due to low uptake.
Background:
An outbreak of pertussis occurred in a daycare center with 87.5% vaccination coverage.
Objectives:
To assess the effectiveness of the acellular pertussis vaccine and prevention of pertussis after chemoprophylaxis with azithromycin.
Methods:
We studied 31 daycare children aged 3-5.5 years exposed to a child with pertussis. Nasopharyngeal swabs were obtained for Bordetella pertussis culture and polymerase chain reaction initially, and at days 21 and 60 of follow-up, in cases exhibiting symptoms.
Results:
Of the 31 daycare children 6 (19%) tested positive for 8. pertussis by PCR, 4 of whom had not been vaccinated against the disease. Of the two vaccinated children who contracted pertussis, one had milder symptoms and the other was asymptomatic. The incidence of pertussis was significantly lower in the vaccinated group (2/27) than in the unvaccinated group (4/4) (P = 0.000), with efficacy of the vaccine calculated to be 92.5%. Azithromycin chemoprophylaxis was taken only by 14 of the 25 exposed children (56%). On day 21 follow-up, there was no further laboratory-diagnosed B. pertussis cases in any of the exposed children, regardless of whether or not chemoprophylaxis was taken.
Conclusions:
Based o the children's clinical manifestations and PCR findings a pertussis outbreak had occurred in the daycare center studied. Our findings support the importance of pertussis vaccination since all the unvaccinated children in the daycare center contracted the infection.
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