Leave a Message

Website maintenance is scheduled for Saturday, January 18, and Sunday, January 19. Short disruptions will occur during these days.

brand logo

Pertussis: A Disease Affecting All Ages

Bordetella pertussis is a highly contagious bacterium known to cause pertussis (whooping cough) and is transmitted via airborne droplets. Although childhood vaccination has dramatically reduced reported pertussis cases, the incidence of the disease has increased over the past 20 years, most notably in previously immunized adolescents and adults. Pertussis should be suspected in patients of all ages with cough who meet the clinical criteria for the disease. Diagnostic tests currently approved by the U.S. Food and Drug Administration for pertussis infection have low sensitivity. Regardless of test results, physicians should treat clinically suspected pertussis with antimicrobials and report cases to their state health department. A 14-day erythromycin regimen has been the treatment of choice; however, shorter-course macrolide antibiotics (e.g., azithromycin, clarithromycin) may be as effective with fewer adverse effects and better adherence to therapy. The recently recommended tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine for adolescents and adults may decrease the incidence of pertussis in infants—the group at the greatest risk of pertussis complications.

Bordetella pertussis, a highly communicable gram-negative coccobacillus, causes pertussis (whooping cough). B. pertussis is an exclusively human pathogen that is transmitted via airborne droplets. The organism produces antigens that can cause local cell damage and may mediate systemic symptoms. B. pertussis is considered a difficult bacterium to grow in the laboratory.1

SORT: KEY RECOMMENDATIONS FOR PRACTICE

EnlargePrint
Clinical recommendationEvidence ratingComments
Patients with suspected early pertussis should be tested with nasopharyngeal culture and polymerase chain reaction assay.CConsensus-based guideline8
Antihistamines, steroids, beta agonists, and immunoglobulins are not routinely recommended for pertussis treatment.ASystematic review20
Erythromycin is a recommended therapy to effectively eradicate Bordetella pertussis and reduce transmission rates.ASystematic review21
Azithromycin (Zithromax) and clarithromycin (Biaxin) are recommended therapies for eradicating B. pertussis that are as effective as erythromycin but with better adherence to therapy.ASystematic review21 ; consistent findings from randomized-controlled trials2527
Close household contacts of patients with pertussis should be treated with antibiotics to prevent disease.BConsensus guidelines8,22,28 ; limited studies show that secondary cases were prevented29,30 ; a systematic review showed insufficient evidence to determine benefit21
Adolescents should receive Tdap vaccination instead of a Td booster to reduce the incidence of pertussis.CExpert opinion34 ; disease-oriented evidence3538 ; no outcome validation studies exist on preventing infantile pertussis
Adults should receive a one-time Tdap booster instead of a Td booster to reduce the incidence of pertussis.CExpert opinion34 ; disease-oriented evidence3538 ; no outcome validation studies exist on preventing infantile pertussis

Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis; Td = tetanus-diphtheria.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 363 orhttps://www.aafp.org/afpsort.xml.

Before the introduction of pertussis vaccinations, the average yearly rate of reported pertussis in the United States was 157 per 100,000 persons, with cyclic peaks occurring every two to five years,2,3 although underreporting may mean that the actual rates were much higher.1 After vaccinations were introduced in the 1940s, incidence of pertussis fell dramatically to less than one per 100,000 persons by 19704; however, rates have increased modestly since 1980,2,3 with significant increases in adolescent and adult populations.25

Vaccination Limitations

In the prevaccine era, more than 93 percent of reported pertussis cases occurred in children younger than 10 years.1 In 2003, most cases occurred in persons 10 years or older (Figure 1).5 As a result, previously vaccinated adolescents and adults whose immunity has decreased have become reservoirs for pertussis infection.1

Figure 1.

EnlargePrint

Number of reported pertussis cases by age group in the United States in 2003.

Adapted from Hopkins RS, Jajosky RA, Hall PA, Adams DA, Connor FJ, Sharp P, et al. Centers for Disease Control and Prevention. Summary of notifiable diseases—United States, 2003. MMWR Morb Mortal Wkly Rep 2005;52:55.

Immunity from the vaccine is not yet complete in the first year of life. Childhood pertussis vaccination has not created the herd immunity that might protect incompletely immunized infants. Despite vaccination, the incidence of pertussis infection in children younger than one year has increased to more than one half of all childhood pertussis cases (Figure 15).3,5 Pertussis is the only vaccine-preventable disease associated with increasing deaths in the United States, climbing from 4 deaths in 1996 to 17 in 20015 and occurring almost exclusively in infants younger than one year.2,4

Complications

Pertussis can lead to hospitalization, pneumonia, dehydration, weight loss, sleep disturbance, seizures, and, rarely, encephalopathy or death.1 These complications vary depending on patient age (Figure 26). Most pertussis related hospitalizations occur in the first year of life.4 Young infants are at the greatest risk of secondary bacterial pneumonia, the most common cause of pertussis-related deaths.4,7 Acute dehydration and malnutrition occur in patients with cough that limits food and fluid intake. Cerebral hypoxia from severe paroxysms1 can cause seizures and encephalopathy. Refractory pulmonary hypertension can be a late sequela in infants with pertussis.1,7

Figure 2.

EnlargePrint

Reported pertussis complications by age group in the United States from 1997 to 2000 (n = 28,187).

Adapted from Centers for Disease Control and Prevention. National Immunization Program. Pertussis and pertussis vaccine. Epidemiology and prevention of vaccine-preventable diseases. Accessed August 30, 2005, at:http://www.cdc.gov/nip/ed/slides/pertussis8p.ppt.

Clinical Presentation

Pertussis symptoms are described in three stages: catarrhal, paroxysmal, and convalescent (Table 11,8). Many factors can alter the usual course of pertussis, causing an atypical presentation.

TABLE 1

Stages of Pertussis Infection

EnlargePrint
StageDuration(weeks)SymptomsComment
CatarrhalOne to twoLacrimation, low-grade fever, malaise, mild conjunctival inflammation, rhinorrhea, late-phase nonproductive cough
  • Insidious onset

  • Gradually worsening symptoms

ParoxysmalOne to sixParoxysms (bursts of coughing during a single exhalation) followed by an inspiratory “whooping” sound, post-tussive cyanosis, and emesis
  • Peaks after two weeks

  • Weight loss, leukocytosis, and lymphocytosis are common

In infants younger than six months (especially those younger than four weeks): apnea, bradycardia, prolonged cough, poor feeding, no paroxysms
ConvalescentTwo to 12Paroxysms gradually improve but recur with respiratory infections
  • White blood cell count normalizes

Information from references 1 and 8.

STAGES OF PERTUSSIS

The catarrhal stage consists of nonspecific cold-like symptoms. After one to two weeks, patients develop coughing (i.e., bursts of coughing during a single exhalation) followed by an inspiratory “whooping” sound.1,8 An audio recording of pertussis-associated coughing is available athttp://www.immunizationed.org. Paroxysms can be associated with post-tussive cyanosis and emesis. Infants younger than six months may present with severe cough of any duration, poor feeding, apnea, or bradycardia without coughing paroxysms. The convalescent stage includes slow resolution of paroxysms, although coughing may persist for several months.1,8

The cold-like symptoms common in the catarrhal stage often are initially misdiagnosed as viral upper respiratory tract infection. When coughing persists or paroxysms accompany these symptoms, the differential diagnosis includes infection with pathogens associated with community-acquired pneumonia (e.g., Chlamydia pneumoniae, Mycoplasma pneumoniae) and pertussis. Pertussis is most contagious in the catarrhal and early paroxysmal stages.

ATYPICAL PRESENTATION

Previously vaccinated adolescents and adults may have less severe paroxysmal symptoms.9,10 Children who are completely vaccinated have shorter courses of illness than incompletely vaccinated children.9,11 Girls older than three years may have more severe paroxysms than boys of the same age.11 The younger the child, the more severe paroxysms tend to be11; however, infants may not have paroxysms at all.1

An atypical presentation can cause a misdiagnosis during the early, most contagious stages of pertussis.12 If adolescents and adults (who often have minimal symptoms) are not treated, they may unknowingly expose susceptible infants to the disease.13 Despite atypical presentations, when carefully questioned, most adolescents and adults with pertussis report paroxysmal symptoms.14 Current public health initiatives focus on reducing the risk of infantile pertussis through education about early symptom recognition and vaccination of adolescents and adults.

Diagnostic testing

Tests used to confirm B. pertussis are listed in Table 2.15 Although each test has advantages and disadvantages, proper technique is important. A polyester swab of the nasopharynx is more effective than a swab of the throat or anterior nostril. The polyester swab should be inserted into the base of a nostril and left in the posterior pharynx for 10 seconds before withdrawing. Nasopharyngeal aspirates have higher bacterial recovery than swabs, and specimens can be split for multiple tests8; however, the equipment required for aspirates is not widely available.

TABLE 2

Accuracy of Diagnostic Tests for Pertussis Infection

EnlargePrint
TestSensitivity (%)Specificity (%)PPVNPVComments
Bordetella pertussis culture1510010088Requires special culture media; takes seven to 12 days to receive results; up to 80 percent sensitive only in early disease; sensitivity is affected by antibiotics; CDC recommends using with polymerase chain reaction assay to confirm a pertussis diagnosis
Polymerase chain reaction assay94978499Can confirm diagnosis quickly (one to two days); expensive; not affected by antibiotics; no single test is universally accepted; not widely available; CDC recommends using with culture to confirm the diagnosis
Direct fluorescent antibody test52988392Requires specially trained personnel; can confirm diagnosis quickly; high false-positive rates; can be used when cultures are negative; not recommended by the CDC
SerologyVariableVariableNo single test is universally accepted; not standardized nationally; not recommended by the CDC

PPV = positive predictive value; NPV = negative predictive value; CDC = Centers for Disease Control and Prevention.

Adapted with permission from Loeffelholz MJ, Thompson CJ, Long KS, Gilchrist MJ. Comparison of PCR, culture, and direct fluorescent-antibody testing for detection of Bordetella pertussis. J Clin Microbiol 1999;37:2874.

CULTURES

B. pertussis is difficult to grow in cultures. Direct agar inoculation or careful transport in special media before inoculation is required.8 Cultures can take seven to 12 days to confirm growth and are less sensitive after antimicrobial therapy is initiated.1 Because of its high false-negative rate, this technique is a poor confirmatory test when used alone late in the disease course.

POLYMERASE CHAIN REACTION ASSAY

A polymerase chain reaction (PCR) assay to detect B. pertussis is more sensitive than culture later in the disease course and is similar in specificity.15,16 A PCR assay can confirm pertussis infection quickly (within one or two days) and is not affected by antimicrobial therapy.17 Because false-positive results may occur with PCR assay, the Centers for Disease Control and Prevention (CDC) recommends testing patients with suspected pertussis using PCR assay and cultures.8

DIRECT FLUORESCENT ANTIBODY TEST

Direct fluorescent antibody (DFA) testing has been the traditional technique for detecting B. pertussis. Although DFA testing has high specificity and provides results quickly, its sensitivity is lower than PCR assay, and specially trained laboratory technicians are required to perform the test. The CDC does not recommend DFA testing.8

SEROLOGY

The role of serology for detecting pertussis has not been defined. Serologic tests are used most often in epidemiologic studies1,8 and can detect immune responses to various antigens and toxins produced by B. pertussis. The CDC does not recommend this test because it is not standardized nationally.8

Case Reporting

Physicians in the United States, Guam, and Puerto Rico are legally required to report pertussis cases to state health departments.18 The CDC classifies pertussis cases as clinical, confirmed, or probable (Table 38). Physicians should report pertussis when it is clinically suspected and should not await laboratory confirmation.18 The CDC recommends testing and treating patients with clinical or probable pertussis regardless of test results.8 Testing, treatment, and reporting should be considered in patients of all ages presenting with a cough lasting more than two weeks that develops a paroxysmal quality, inspiratory whooping, or post-tussive emesis; and in infants with severe cough, apnea, or bradycardia for any length of time.19

TABLE 3

CDC Definitions for Pertussis Cases

EnlargePrint
CaseDefinition
ClinicalAcute cough for 14 days plus one of the following: paroxysmal cough, post-tussive emesis, inspiratory “whooping,” and no other apparent cause
or
In an outbreak setting: acute cough for 14 days
ConfirmedPatient's illness meets criteria for “clinical case” plus one of the following: positive PCR assay, epidemiologic linkage to a laboratory- confirmed (PCR assay or culture) case
or
Acute cough illness of any duration and positive Bordetella pertussis culture
ProbablePatient's illness meets criteria for “clinical case” plus all of the following: negative PCR assay, negative B. pertussis culture, no epidemiologic linkage to a laboratory-confirmed (PCR assay or culture) case

CDC = Centers for Disease Control and Prevention; PCR = polymerase chain reaction.

Information from reference 8.

Treatment

The effectiveness of symptom-reducing treatments (e.g., antihistamines, steroids, beta agonists, immunoglobulins) is unclear, and these treatments have potentially serious adverse effects. A systematic review20 showed little evidence to justify their use for pertussis. Antibiotics have not been shown to reduce disease duration after the paroxysmal stage begins, but they can decrease transmission risk.21 Because pertussis is highly contagious, antibiotic prophylaxis is recommended to control outbreaks.

ANTIBIOTICS

The American Academy of Pediatrics (AAP) recommends a 14-day erythromycin regimen22 to treat pertussis, although a seven-day regimen may be as effective.23 Erythromycin can cause gastrointestinal side effects (e.g., nausea, emesis, diarrhea)24 and increases the risk of pyloric stenosis in infants younger than two months.24

Newer generation macrolides (e.g., azithromycin [Zithromax] and clarithromycin [Biaxin]) have similar bacterial eradication rates as erythromycin21,25,26 with less risk of side effects2427 and better adherence.25,27 The CDC recommends erythromycin, azithromycin, or clarithromycin as preferred agents, although it only recommends azithromycin for neonates because limited data28 suggest it may be the safest choice in this group.28 Trimethoprim/sulfamethoxazole (Bactrim, Septra) has been shown to reduce pertussis transmission and is an alternative treatment for patients who are allergic to macrolides.21 Other antibiotics, such as ampicillin, have not been shown to reduce pertussis transmission or symptoms.21 Table 42123,28 summarizes antibiotic therapies for pertussis.

PROPHYLAXIS

About 80 percent of susceptible persons become infected with pertussis after close contact with an infected household member.8 Studies1 of household contacts indicate that infection is common even without symptoms. If patients are not treated during the catarrhal stage, they are considered contagious until three weeks after the paroxysmal stage ends or until five days after starting antibiotics.8,22

The CDC and AAP advocate antibiotic prophylaxis to control pertussis outbreaks.8,22 This approach is controversial,21,29,30 however, and no systematic review has evaluated the effectiveness of prophylaxis for preventing new pertussis infections. Optimal doses and duration of antibiotic prophylaxis are uncertain, but the CDC recommends the same drugs and dosing as it does for antibiotic treatment (Table 42123,28).8 In the United States, where pertussis vaccination rates are high, antibiotic prophylaxis is advised only in those who are in close contact with persons with pertussis, particularly incompletely immunized children or adults who are in close contact with high-risk children.8,22 Local and state health departments are responsible for managing outbreaks and have protocols that are recommended for physician use.

TABLE 4

Antibiotic Therapies for Pertussis

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

Prevention

Although pertussis vaccination has significantly reduced reported pertussis rates, its protectiveness is short-lived and incomplete. Immunity begins to decline four to 12 years after vaccination, causing adolescent and adult susceptibility.31 Therefore, neonates are susceptible to pertussis infection because they have not yet been immunized and they receive little passive immunity from their susceptible mothers.

The estimated effectiveness of original whole-cell pertussis vaccines was about 85 percent.32 Rare adverse reactions included hypotonic, hyporesponsive episodes; high fever; seizures; and anaphylaxis. Currently approved acellular vaccines produce fewer adverse reactions than whole-cell vaccines and have similar effectiveness.33 Two tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines recently were approved by the U.S. Food and Drug Administration for use in adolescents and adults. Boostrix is approved for 10- to 18-year-olds, and Adacel is approved for 11- to 64-year-olds.34 These booster vaccines produce antibodies35 that may decline at the same rate following natural B. pertussis infection.36 Boostrix has been shown to be 62 to 92 percent effective against pertussis in adolescents and adults,37 although the duration of this protection is unknown. Routine vaccination of adolescents and adults may be cost-effective and improve overall health outcomes.38

The CDC's Advisory Committee on Immunization Practices recommends the Tdap vaccine for 11- to 12-year- olds rather than the tetanus-diphtheria (Td) booster currently given to adolescents.34 The committee also recommends the Tdap vaccine for 13- to 18-year-olds who did not receive an 11- to 12-year Td booster and for 11- to 18-year- olds who were vaccinated with Td.34 The committee recommends a single-dose Tdap booster rather than the Td booster for 19- to 65-year-olds.39 Future studies are needed to determine if this strategy will reduce pertussis-related morbidity and mortality.

  1. Mattoo S, Cherry JD. Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies. Clin Microbiol Rev. 2005;18:326-82.

  2. Centers for Disease Control and Prevention. Pertussis—United States, 1997–2000. MMWR Morb Mortal Wkly Rep. 2002;51:73-6.

  3. Edwards KM. Overview of pertussis: focus on epidemiology, sources of infection, and long term protection after infant vaccination. Pediatr Infect Dis J. 2005;24(6 suppl):S104-8.

  4. Guris D, Strebel PM, Bardenheier B, Brennan M, Tachdjian R, Finch E, et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 1990–1996. Clin Infect Dis. 1999;28:1230-7.

  5. Hopkins RS, Jajosky RA, Hall PA, Adams DA, Connor FJ, Sharp P, et al. Centers for Disease Control and Prevention. Summary of notifiable diseases—United States, 2003. MMWR Morb Mortal Wkly Rep. 2005;52:1-85.

  6. Centers for Disease Control and Prevention. National Immunization Program. Pertussis and pertussis vaccine. Epidemiology and prevention of vaccine-preventable diseases [slide presentation]. Accessed August 30, 2005, at: http://www.cdc.gov/nip/ed/slides/pertussis8p.ppt.

  7. Centers for Disease Control and Prevention. Pertussis deaths—United States, 2000. MMWR Morb Mortal Wkly Rep. 2002;51:616-8.

  8. Centers for Disease Control and Prevention. Guidelines for the control of pertussis outbreaks. 2000 (amendments made in 2005 and 2006). Accessed March 21, 2006, at: http://www.cdc.gov/nip/publications/pertussis/guide.htm.

  9. Yaari E, Yafe-Zimerman Y, Schwartz SB, Slater PE, Shvartzman P, Andoren N, et al. Clinical manifestations of Bordetella pertussis infection in immunized children and young adults. Chest. 1999;115:1254-8.

  10. Heininger U, Klich K, Stehr K, Cherry JD. Clinical findings in Bordetella pertussis infections: results of a prospective multicenter surveillance study. Pediatrics 1997;100:E10. Accessed March 21, 2006, at: http://www.pediatrics.org/cgi/content/full/100/6/e10.

  11. Tozzi AE, Rava L, Ciofi degli Atti ML, Salmaso S for the Progetto Pertosse Working Group. Clinical presentation of pertussis in unvaccinated and vaccinated children in the first six years of life. Pediatrics. 2003;112:1069-75.

  12. Deeks S, De Serres G, Boulianne N, Duval B, Rochette L, Dery P, et al. Failure of physicians to consider the diagnosis of pertussis in children. Clin Infect Dis. 1999;28:840-6.

  13. Deen JL, Mink CA, Cherry JD, Christenson PD, Pineda EF, Lewis K, et al. Household contact study of Bordetella pertussis infections. Clin Infect Dis. 1995;21:1211-9.

  14. De Serres G, Shadmani R, Duval B, Boulianne N, Dery P, Douville FM, et al. Morbidity of pertussis in adolescents and adults. J Infect Dis. 2000;182:174-9.

  15. Loeffelholz MJ, Thompson CJ, Long KS, Gilchrist MJ. Comparison of PCR, culture, and direct fluorescent-antibody testing for detection of Bordetella pertussis. J Clin Microbiol. 1999;37:2872-6.

  16. Heininger U, Schmidt-Schläpfer G, Cherry JD, Stehr K. Clinical validation of a polymerase chain reaction assay for the diagnosis of pertussis by comparison with serology, culture, and symptoms during a large pertussis vaccine efficacy trial. Pediatrics 2000;105:E31. Accessed March 21, 2006, at: http://pediatrics.aapublications.org/cgi/content/full/105/3/e31.

  17. Edelman K, Nikkari S, Ruuskanen O, He Q, Viljanen M, Mertsola J. Detection of Bordetella pertussis by polymerase chain reaction and culture in the nasopharynx of erythromycin-treated infants with pertussis. Pediatr Infect Dis J. 1996;15:54-7.

  18. Roush S, Birkhead G, Koo D, Cobb A, Fleming D. Mandatory reporting of diseases and conditions by health care professionals and laboratories. JAMA. 1999;282:164-70.

  19. Brown MO, St Anna L, Ohl M. Clinical inquiries. What are the indications for evaluating a patient with cough for pertussis?. J Fam Pract. 2005;54:74-6.

  20. Pillay V, Swingler G. Symptomatic treatment of the cough in whooping cough. Cochrane Database Syst Rev. 2003(4):CD003257.

  21. Altunaiji S, Kukuruzovic R, Curtis N, Massie J. Antibiotics for whooping cough (pertussis). Cochrane Database Syst Rev. 2005(1):CD004404.

  22. Pertussis. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, Ill.: American Academy of Pediatrics, 2003:472–86.

  23. Halperin SA, Bortolussi R, Langley JM, Miller B, Eastwood BJ. Seven days of erythromycin estolate is as effective as fourteen days for the treatment of Bordetella pertussis infections. Pediatrics. 1997;100:65-71.

  24. Alvarez-Elcoro S, Enzler MJ. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc. 1999;74:613-34.

  25. Aoyama T, Sunakawa K, Iwata S, Takeuchi Y, Fujii R. Efficacy of short-term treatment of pertussis with clarithromycin and azithromycin. J Pediatr. 1996;129:761-4.

  26. Langley JM, Halperin SA, Boucher FD, Smith B, for the Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC). Azithromycin is as effective as and better tolerated than erythromycin estolate for the treatment of pertussis. Pediatrics 2004;114:E96–101. Accessed March 21, 2006, at: http://pediatrics.aappublications.org/cgi/content/full/114/1/e96.

  27. Lebel MH, Mehra S. Efficacy and safety of clarithromycin versus erythromycin for the treatment of pertussis: a prospective, randomized, single blind trial. Pediatr Infect Dis J. 2001;20:1149-54.

  28. Tiwari T, Murphy TV, Moran J for the National Immunization Program, Centers for Disease Control and Prevention. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC guidelines. MMWR Recomm Rep. 2005;54(RR-14):1-16.

  29. De Serres G, Boulianne N, Duval B. Field effectiveness of erythromycin prophylaxis to prevent pertussis within families. Pediatr Infect Dis J. 1995;14:969-75.

  30. Halperin SA, Bortolussi R, Langley JM, Eastwood BJ, De Serres G. A randomized, placebo-controlled trial of erythromycin estolate chemoprophylaxis for household contacts of children with culture-positive Bordetella pertussis infection. Pediatrics 1999;104:E42. Accessed March 21, 2006, at: http://pediatrics.aappublications.org/cgi/content/full/104/4/e42.

  31. Wendelboe AM, Van Rie A, Salmaso S, Englund JA. Duration of immunity against pertussis after natural infection or vaccination. Pediatr Infect Dis J. 2005;24(5 suppl):S58-61.

  32. Olin P, Rasmussen F, Gustafsson L, Hallander HO, Heijbel H for the Ad Hoc Group for the Study of Pertussis Vaccines. Randomised controlled trial of two-component, three-component, and five-component acellular pertussis vaccines compared with whole-cell pertussis vaccine [Published correction appears in Lancet 1998;351:454]. Lancet. 1997;350:1569-77.

  33. Jefferson T, Rudin M, DiPietrantonj C. Systematic review of the effects of pertussis vaccines in children. Vaccine. 2003;21:2003-14.

  34. Advisory Committee on Immunization Practices. Centers for Disease Control and Prevention. ACIP recommends adolescent vaccination for tetanus, diphtheria and pertussis vaccine [press release]. Accessed August 30, 2005, at: http://www.cdc.gov/nip/pr/pr_tdap_jun2005.htm.

  35. Pichichero ME, Rennels MB, Edwards KM, Blatter MM, Marshall GS, Bologa M, et al. Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults [Published correction appears in JAMA 2005;294:3092]. JAMA. 2005;293:3003-11.

  36. Le T, Cherry JD, Chang SJ, Knoll MD, Lee ML, Barenkamp S, et al. Immune responses and antibody decay after immunization of adolescents and adults with an acellular pertussis vaccine: the APERT Study. J Infect Dis. 2004;190:535-44.

  37. Ward JI, Cherry JD, Chang SJ, Partridge S, Lee H, Treanor J, et al.; for the APERT Study Group. Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med. 2005;353:1555-63.

  38. Lee GM, LeBaron C, Murphy TV, Lett S, Schauer S, Lieu TA. Pertussis in adolescents and adults: should we vaccinate?. Pediatrics. 2005;115:1675-84.

  39. Advisory Committee on Immunization Practice. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practice recommends adult vaccination with new tetanus, diphtheria and pertussis vaccine (Tdap) [press release]. Accessed November 15, 2005, at: http://www.cdc.gov/od/oc/media/pressrel/r051109.htm.

0 comments

More in AFP

More in PubMed

AFP Email Alerts

Free e-newsletter and email table of contents.
SIGN UP NOW

Copyright © 2006 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.