Introduction 7 8 16 8 16 31 16 31 8 31 8 17 8 13 17 8 24 36 8 27 36 8 15 Epidemiology of pertussis 37 13 37 8 13 31 7 17 31 8 13 15 17 4 17 13 8 17 31 7 8 36 37 36 do 8 17 27 8 17 27 35 under 8 31 under 8 missed diagnosis 8 17 31 35 8 8 17 B pertussis 29 31 8 17 8 under reported 8 17 30 Laboratory diagnosis of pertussis 17 B. pertussis B. pertussis 8 24 Culture B. pertussis 17 24 24 17 24 16 PCR 8 17 32 35 17 17 35 B. pertussis 16 27 B. pertussis 8 28 1 17 Bordetella not  24 IS481, IS1001 8 24 16 35 Serology B. pertussis B. pertussis 24 B. pertussis H. influenzae M. pneumoniae of B. pertussis 24 B. pertussis 24 not 23 25 single or 17 24 35 10 8 Use of antibiotics in the treatment and prevention of pertussis 9 1 9 26 Table 1 9 Age Recommended drugs Alternative Azithromycin Erythromycin Clarithromycin TMP-SMX <1 mo a 40–50 mg/kg per day in 4 divided doses for 14 days Not recommended Contraindicated at <2 mo of age 1–5 mo See above See above 15 mg/kg per day in 2 divided doses for 7 days ≥2 mo of age: TMP, 8 mg/kg per day; SMX, 40 mg/kg per day in 2 doses for 14 days ≥6 mo and children 10 mg/kg as a single dose on day 1 (maximum 500 mg); then 5 mg/kg per day as a single dose on days 2–5 (maximum 250 mg/day) See above (maximum 2 g/day) See above (maximum 1 g/day) See above Adolescents and adults 500 mg as a single dose on day 1, then 250 mg as a single dose on days 2–5 2 g/day in 4 divided doses for 14 days 1 g/day in 2 divided doses for 7 days TMP, 300 mg/day; SMX, 1600 mg/day in 2 divided doses for 14 days Used with permission of the American Academy of Pediatrics. Red Book: 2006 Report of the Committee on Infectious Diseases Book, American Academy of Pediatrics, 2006 TMP SMX a Postexposure prophylaxis 9 11 33 11 12 Prevention of pertussis: vaccination strategies Pertussis vaccines licensed for use in infants, children, and adults vary across countries. These vaccines differ both in terms of their active ingredients and in terms of the other diseases for which coverage is provided (e.g., polio, diptheria). For example, Repevax (Sanofi Pasteur) contains diptheria, tetanus, pertussis (acellular, component) as well as inactivated polio, whereas ADACEL contains only tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. 2 15 16 Table 2 a 15 Strategy Primary objectives Secondary objectives 1. Universal adult immunization Reduce morbidity in adults Reduce transmission to young infants  Develop herd immunity Reduce morbidity in older children 2. Selective immunization of new mothers, family, and close contacts of newborns Reduce transmission to infants Reduce morbidity in adults, particularly young adults 3. Selective immunization of health care workers Reduce transmission to patients Reduce morbidity in health care workers 4. Selective immunization of child care workers Reduce transmission to infants Reduce morbidity in child care workers 5. Universal adolescent immunization Reduce morbidity in adolescents and young adults Reduce transmission to infants  Develop herd immunity  6. Preschool booster at 4 years of age Reduce morbidity in 4- to 6-year olds Reduce transmission to infants  Develop herd immunity  7. Reinforce and/or improve the current infant and toddler immunization strategy Reduce morbidity and mortality in infants, toddlers, and children Reduce overall circulation of pertussis Used with permission from Lippincott Williams & Wilkins a Immunization of adolescents 13 3 13 16 16 and 14 14 Immunization of adults 16 20 21 34 6 vaccines 16 B. pertussis Cocoon strategy 16 2 13 16 19 22 16 16 Maternal vaccination 16 18 Neonatal vaccination 5 16 19 Conclusion B. pertussis