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The prevention of severe pertussis and pertussis deaths in young infants

James D Cherry1

  • 1a Department of Pediatrics , David Geffen School of Medicine at UCLA , Los Angeles , CA , USA.

Expert Review of Vaccines
|February 10, 2019
PubMed

Insights

Preventing infant deaths from pertussis (whooping cough) requires maternal Tdap immunization and treating infected adults. Exchange blood transfusions can help infants if initiated before organ failure, addressing pertussis toxin-induced pulmonary hypertension.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Immunology

Background:

  • Pertussis (whooping cough) primarily causes infant mortality in developed nations.
  • Infant pertussis presents as afebrile cough, coryza, apnea, seizures, cyanosis, and emesis.
  • Severe cases involve high leukocyte/lymphocyte counts, rapid vitals, and pneumonia, with some intensive care treatments being detrimental.

Purpose of the Study:

  • To outline the characteristics and management of pertussis in young infants.
  • To discuss the pathophysiology of severe pertussis and its treatment.
  • To recommend preventative strategies for pertussis in neonates.

Main Methods:

  • Review of clinical presentation and outcomes of Bordetella pertussis in infants.
  • Analysis of the role of pertussis toxin in infant mortality.
  • Evaluation of current and proposed preventative measures, including maternal immunization and antimicrobial prophylaxis.

Main Results:

  • Infant deaths are attributed to pertussis toxin-induced pulmonary hypertension from leukocyte aggregates.
  • High leukocyte and lymphocyte counts are key indicators of severe pertussis.
  • Exchange blood transfusions are effective if started before shock or organ failure.

Conclusions:

  • Maternal Tdap immunization between 27-36 weeks gestation is crucial for preventing infant pertussis.
  • Diagnosing and treating pertussis in adolescents and adults is vital for infant protection.
  • Antimicrobial prophylaxis for infants and Tdap vaccination during all pregnancies are recommended preventative strategies.
Abstract

Keywords:
Pertussisexchange transfusioninfantsleukocyteslymphocytespertussis toxinpulmonary hypertension

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