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A Case of Pertussis: What Emergency Health Care Providers Need to Know
Kathleen S Jordan1, Peggy Mackay
1School of Nursing, The University of North Carolina at Charlotte (Dr Jordan and Ms Mackay); Mid-Atlantic Emergency Medicine Associates, Charlotte, North Carolina (Dr Jordan); and Carolinas Healthcare System, Charlotte, North Carolina (Ms Mackay).
Insights
Pertussis, a contagious respiratory illness, saw reduced incidence after vaccination but is rising again. Early identification and prevention are crucial due to risks, especially in vulnerable, unimmunized populations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Pertussis (whooping cough) was a leading cause of childhood illness and death before the 1940s whole-cell vaccine.
- Vaccination significantly reduced pertussis cases, but incidence has climbed since the 1990s.
Observation:
- Clinical pertussis presentation varies by age and vaccination status.
- The classic symptoms include severe coughing fits, inspiratory whoop, and post-cough vomiting.
- Non-classic symptoms in unimmunized individuals and those who transmit the disease can delay diagnosis.
Findings:
- Increasing pertussis incidence highlights challenges in sustained disease control.
- Vulnerable populations, including infants and the unvaccinated, remain at high risk.
- Atypical presentations complicate early identification and treatment efforts.
Implications:
- Emphasizes the need for robust pertussis prevention strategies and timely diagnosis.
- Highlights the importance of recognizing varied clinical presentations for effective public health interventions.
- Underscores the ongoing threat of pertussis despite widespread vaccination programs.
Abstract:
Pertussis is a highly contagious acute respiratory illness. Prior to the availability of the whole-cell pertussis vaccine in the late 1940s, pertussis was one of the most common infectious diseases of childhood in the United States and a major cause of infant morbidity and mortality. Although pertussis vaccination has resulted in a substantial reduction in the disease, the incidence has been steadily increasing since the 1990s. The clinical presentation of pertussis may be variable depending on the age and immunization status of the patient. The classic presentation includes a triad of symptoms: paroxysms of coughing; an inspiratory whoop following cough; and posttussive vomiting. Those most vulnerable are the ones not yet immunized and the ones most likely to transmit the illness who may not exhibit "classic" pertussis symptoms, delaying or preventing identification and treatment. Because pertussis carries known morbidity and mortality risks, prevention and early identification are paramount.
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