KEYWORDS:
Pertussis, Surveillance, Infant, Mortality, Prevention Measures

BACKGROUND:
Since November 1999, twelve infants infected with pertussis have died in Texas. All but one was infected before they were old enough for their first dose of vaccine.

OBJECTIVE:
Present epidemiological profiles of the infants and measures to prevent pertussis-related infant deaths in a graphic format on a baby quilt.

METHOD:
The epidemiological profile of each pertussis-infected person who died in Texas from 1999 through October, 2002 was extracted from case histories compiled from hospital records, family interviews, and autopsy reports. Profiles include age, sex, symptoms, number of household members, number of epidemiologically-linked cases with onset before or after the infant, number of provider visits prior to diagnosis, and number of prior cases reported in the county.

RESULT:
Pertussis investigations showed that all of these pertussis-related deaths occurred in infants who were 2 weeks through 2 months of age. Often an older family member had a cough illness with an onset prior to the infant’s. Infants may be more likely to be diagnosed due to the severity of their illness, but some have several physician visits prior to diagnosis. The infant profiles were used to design prevention measures to protect the population shown to be at risk for pertussis mortality.

CONCLUSION:
Because the infants most at risk are those too young to vaccinate, and the only symptom of pertussis may be apnea, educational messages targeted for prevention included considering pertussis in the diagnosis of infants who are coughing or having difficulty breathing, protecting infants from people who are coughing, and treating symptomatic household members of families who are expecting a baby or have a young infant. Vaccinating babies on schedule at 2, 4, 6, and 12-18 months of age is important to decrease the risk of severe pertussis infections as early as possible.

LEARNING OBJECTIVES:
Profile pertussis deaths in Texas and targeted prevention messages.