When is acute persistent cough in school-age children and adults whooping cough? A prospective case series study
Kathryn Philipson1, Felicity Goodyear-Smith, Cameron C Grant
1Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand.
Insights
Pertussis is a common cause of persistent cough in primary care. A new, less invasive oral fluid test can detect recent Bordetella pertussis infection, especially in children.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Pertussis (whooping cough) often presents subtly in vaccinated individuals.
- Current diagnostic methods for pertussis can be invasive.
Purpose of the Study:
- To assess the incidence of Bordetella pertussis infection in primary care patients aged 5-49 with acute persistent cough.
- To evaluate an oral fluid-based diagnostic test for pertussis.
Main Methods:
- Active surveillance for acute persistent cough (≥2 weeks) in Auckland, New Zealand.
- Oral fluid samples tested for IgG antibodies to pertussis toxin (PT); ≥70 arbitrary units indicated recent infection.
- Participants maintained cough diaries and reported symptoms.
Main Results:
- 226 participants enrolled; 10% (23/225) had recent B. pertussis infection.
- Children (17%) were more likely to have recent infection than adults (7%).
- Cough duration and specific symptoms did not differentiate pertussis cases.
Conclusions:
- Pertussis is a frequent cause of acute persistent cough in primary care.
- Clinical diagnosis of pertussis is challenging.
- The oral fluid test is a less invasive and acceptable diagnostic tool for pertussis.
Background:
Pertussis is a vaccine modified disease in most age groups and hence subtle in its presentation. Current diagnostic approaches require relatively invasive sampling.
Aim:
To determine the incidence of B. pertussis infection among people aged 5-49 years identified in primary care with acute persistent cough using an oral fluid based diagnostic test.
Design And Setting:
Active surveillance of acute persistent cough of 2 weeks duration or greater was established in Auckland, New Zealand from May to October 2011. The 15 participating primary care practices provided care for a socioeconomically diverse population.
Method:
Recent B. pertussis infection was determined by measurement of IgG antibodies to pertussis toxin (PT) in an oral fluid sample. An IgG antibody titre to PT of ≥70 arbitrary units defined recent infection. Participants reported symptoms at presentation and kept a cough diary.
Results:
A total of 226 participants were enrolled: 70 (31%) were children (5-16 years) and 156 (69%) were adults (17-49 years). Oral fluid samples were obtained from 225 participants. Ten per cent (23/225) had recent B. pertussis infection including a larger proportion of children than adults (17% versus 7%, P = 0.003). Neither cough duration nor any individual symptom discriminated between those with and without recent B. pertussis infection.
Conclusion:
Pertussis is a frequent cause of acute persistent cough presenting to primary care. Clinical differentiation of pertussis from other causes of acute persistent cough is difficult. An oral fluid based diagnostic test, which is less invasive than other diagnostic approaches, has high acceptability in primary care.
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