ELWARD AM; Interscience Conference on Antimicrobial Agents and Chemotherapy (41st : 2001 : Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2001 Dec 16-19; 41: abstract no. 1095.

Washington Univ. Sch. of Med., St. Louis, MO

Bordetella pertussis is a gram-negative bacillus that causes prolonged, severe respiratory illness in unimmunized children and young infants, including whooping cough, and is an underrecognized cause of prolonged coughing illness in adults, with up to 18% of patients with cough for greater than seven days culture or PCR positive for the organism. The incidence of pertussis infection among healthcare workers has been estimated at 1.3-3.6% per year. Before vaccination became available, the attack rate was 157/100,000 population, with 265,000 cases per year and 7,000 deaths per year in the 1930s. Attack rates in households and schools range from 40% in adults to 80% in children age 6 months to four years. Attack rates among household contacts can be decreased by the administration of erythromycin for 14 days. Although there are no randomized controlled trials comparing the efficacy of clarithromycin or azithromycin against erythromycin for prophylaxis of household contacts of pertussis, in vitro data suggests that the MICs for azithromycin and clarithromycin against Bordetella pertussis and parapertussis are similar to that of erythromycin, and several small, prospective, uncontrolled studies of children with pertussis who received azithromycin for either 5 or 3 days revealed that seven days after the initiation of Azithromycin 94.3% of patients were culture-negative, and 14 days after antibiotics were initiated, all cultures were negative. Infection does not confer lifelong immunity, and vaccination provides protection against disease for 2-3 years, with little immunity remaining after 10-12 years. Vaccination of adults against pertussis is not currently recommended; however, in one randomized double-blind placebo controlled trial of three different concentrations of acellular pertussis vaccines (full strength, half strength, quarter strength) in 118 adult volunteers, using tetanus diptheria as a control, a statistically significant increase in antibody to pertussis toxin, filamentous hemagglutinin and the 69 kd outer membrane protein was shown in each group. The frequency of adverse reactions was low. Hospitalized patients with documented or suspected pertussis should be placed on droplet precautions in a private room until they have received five days of erythromycin. Household contacts should receive 14 days of erythromycin. clarithromycin and azithromycin may also be effective prophylaxis, based on in vitro data and limited uncontrolled studies in patients (36,37). Vaccination of healthcare workers to prevent nosocomial transmission of pertussis may be recommended after further studies are performed.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Anti-Bacterial Agents
• Azithromycin
• Bordetella pertussis
• Child
• Clarithromycin
• Cough
• Double-Blind Method
• Erythromycin
• Health Personnel
• Humans
• In Vitro
• Incidence
• Infant
• Microbial Sensitivity Tests
• Pertussis Toxin
• Pertussis Vaccine
• Prospective Studies
• Vaccination
• Whooping Cough

Other ID:

• GWAIDS0029876

UI: 102269508

From Meeting Abstracts