Elsevier

The Journal of Pediatrics

Volume 164, Issue 6, June 2014, Pages 1489-1492.e1
The Journal of Pediatrics

Clinical and Laboratory Observations
Pertussis: A Persistent Cause of Morbidity and Mortality in Young Infants

Portions of this report were presented at the annual meeting of the Infectious Disease Society of America, October 17-21, 2012, San Diego, CA.
https://doi.org/10.1016/j.jpeds.2014.01.023Get rights and content

In 2012, a pertussis outbreak in Dallas County resulted in the deaths of 4 children (3, unvaccinated; 2, <60 days of age). Despite recommendations that include immunization of women preferably during the third trimester of pregnancy or postpartum, household contacts (“cocooning”), and infants as early as 42 days of age, challenges in pertussis prevention remain.

Section snippets

Methods

From January 1, 2012, to December 31, 2012, all positive nasopharyngeal polymerase chain reaction (PCR) tests for B pertussis (Analyte Specific Reagent for identification and differentiation of B pertussis and parapertussis; Cepheid, Sunnyvale, California) were identified by prospective surveillance of the Children's Medical Center Dallas (CMC) microbiology laboratory results by infection prevention and control staff members (J.T., J.S.). Pertussis cases were considered “confirmed” if the

Results

In 2012, Dallas County experienced an increased incidence of pertussis for the first time since 2008, with 220 cases (183 [83%] <18 years of age) that met surveillance definitions (Figure 1; available at www.jpeds.com). Of the 183 children, 131 (72%) were cared for at CMC; 33 (25%) children were hospitalized, with 10 (8%) requiring ICU admission. Infants ≤3 months of age (n = 38) accounted for 79% (n = 26) and 70% (n = 7) of the hospital and ICU admissions, respectively. There were 4

Discussion

Increased pertussis in Dallas County in 2012 resulted in serious disease and death in 2 infants ≤3 months of age and 2 young children with underlying medical conditions. For infants ≤3 months of age, fewer than one-half of their mothers were vaccinated with Tdap postpartum according to the 2011 ACIP guidelines for cocooning, including both mothers of the infants who died.5 Three mothers had onset of cough before delivery, suggesting that postpartum vaccination would not have prevented

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The authors declare no conflicts of interest.

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