Whooping Cough
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Highly communicable,
vaccine-preventable disease that lasts for many weeks and is
typically manifested in children with paroxysmal spasms of
severe coughing, whooping, and posttussive vomiting.
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Bordetella pertussis, a
gram-negative coccobacillus.
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This disease results in high
morbidity and mortality in many countries every year. In the
United States, 5000-7000 cases are reported each year.
Incidence of pertussis has increased steadily since the
1980s. The incidence in 2002 was 3.01/100,000 when 8,296
cases of pertussis were reported.
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Major complications are most
common among infants and young children and include hypoxia,
apnea, pneumonia, seizures, encephalopathy, and
malnutrition. Young children can die from pertussis and 13
children died in the United States in 2003. Most deaths
occur among unvaccinated children or children too young to
be vaccinated.
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Occurs through direct contact with
discharges from respiratory mucous membranes of infected
persons.
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Children who are too young to be
fully vaccinated and those who have not completed the
primary vaccination series are at highest risk for severe
illness. Like measles, pertussis is highly contagious with
up to 90% of susceptible household contacts developing
clinical disease following exposure to an index case.
Adolescents and adults become susceptible when immunity
wanes.
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National reporting through the
National Electronic Telecommunications System for
Surveillance (NETSS) and through several Enhanced
Surveillance Sites throughout the United States.
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Pertussis is an endemic illness.
In the United States epidemics occur every 3-5 years. The
most recent epidemic occurred in 1996. Overall increase in
cases since 1990, with disproportionate increase in
adolescents and adults.
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Understanding pertussis
pathogenesis and immunity; protecting infants from severe
pertussis; control of pertussis outbreaks; diagnosing
pertussis in a timely, accurate, and standardized fashion;
understanding the true burden of disease in different age
and socioeconomic groups; evaluating the impact of a
licensed pertussis vaccine in persons
> 14 years
of age; evaluating the impact of acellular vaccines on
prevention programs; and determining the prevalence of
erythromycin-resistant
B. pertussis.
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Characterize strains using newly
developed molecular typing methods (e.g., pulsed-field gel
electrophoresis and gene-sequencing analysis) to elucidate
epidemiology and virulence factors, examine isolates for
antimicrobial susceptibility and to identify resistance
mechanisms; study transmission of pertussis within
populations (e.g., how adults/adolescents transmit the
organism to others); study efficacy of acellular pertussis
vaccines among persons
> 14 years of age; study
effectiveness of acellular pertussis vaccines to control
outbreaks; apply/evaluate new diagnostic tests.
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