Pertussis cluster points to need for Tdap vaccine
Vaccinate HCWs to prevent risk to infants
When the nurse went to work with a persistent cough, she undoubtedly thought she just had a lingering cold, or perhaps a seasonal allergy. But she actually suffered from pertussis, and inadvertently spread a serious illness to at least 11 infants in the newborn nursery of a Texas hospital.
None of the babies died. But this outbreak of pertussis, which occurred in 2004, demonstrates why health care workers should receive pertussis boosters, now available as Tdap, or a combined tetanus, diphtheria and pertussis vaccine. The Advisory Committee on Immunization Practice (ACIP) recommends Tdap for health care workers who have direct patient contact.
Doctors also need to consider pertussis as a possible diagnosis when adults have an ongoing respiratory illness, says Joyce Hood, MPH, RN, COHN-S, director of occupational health services at Cook Children's Healthcare System in Fort Worth, TX, who was the lead author of a recent report on the Texas outbreak in the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention.
"We're seeing doctors look at [pertussis] as one of the top three [possible diagnoses] when someone has a cough illness lasting more than three weeks," she says.
Pertussis is a disease that once seemed virtually eliminated by childhood vaccination. But the incidence of pertussis gradually rose. From 2001 to 2004, the number of reported cases almost tripled. The 2004 case total was higher than any year since 1959. Infants were most vulnerable to pertussis. In the 1980s, 61 infants died of pertussis; in the 1990s, that rose to 93 infant deaths.1
In 2004, a staff nurse noticed a cluster of six pertussis cases among very young infants who had been born within days of each other at the same hospital. She notified an infectious disease physician, who contacted the public health department.
Charts were audited and both infants and health care workers at the neonatal nursery received PCR testing. Ultimately, 11 cases were linked through PCR tests to a single health care worker, who had cared for 113 infants. She was furloughed for five days and treated with erythromycin.
All but one of the infants identified had symptoms serious enough to require hospital treatment.
"Many of them wound up in pediatric intensive care, many of them on ventilators," says Hood. "Infants are very vulnerable. They're totally unprotected."
The health care worker had been vaccinated as a child, according to the CDC report. Many people don't realize that they could get pertussis as an adult because they have diminished immunity from their childhood vaccine, says Hood.
"We have a lot of undetected pertussis out there. It gets mixed up with flu season, allergy season, and cold season," she says.
The Tdap booster became available in 2005. Cook Children's Hospital began offering the vaccine at employees' annual health screening or respiratory fit testing, says Hood.
The vaccine is voluntary, but it's not hard to convince employees to get the Tdap to protect their young patients, Hood says. The Tdap vaccination rate is about 70%, she says.
Reference
1. Hood JL, Murphey DK, and Dunn JJ. Hospital-acquired pertussis among newborns Texas, 2004. MMWR 2008; 57:600-603.
When the nurse went to work with a persistent cough, she undoubtedly thought she just had a lingering cold, or perhaps a seasonal allergy. But she actually suffered from pertussis, and inadvertently spread a serious illness to at least 11 infants in the newborn nursery of a Texas hospital.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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