KEYWORD1:
epidemiology, immunizations, azithromycin, erythromycin, pertussis, whooping cough, chemoprophylaxis, transmission

BACKGROUND:
Pertussis, an endemic cause of infant morbidity and mortality in the United States, is increasingly recognized as a cause of cough illness in adolescents and adults. Pertussis among health care workers caring for susceptible populations is particularly concerning. During her obstetrical rotation, a medical student working at a Massachusetts hospital contracted culture-confirmed pertussis. While infectious, the student cared for antepartum and postpartum patients and their infants, and interacted with patients’ labor companions and hospital coworkers. Fifty-eight neonates and 194 adults began azithromycin chemoprophylaxis, providing us with the largest such cohort of neonates ever studied; 18 neonates and 2 adults began erythromycin chemoprophylaxis.

OBJECTIVE:
To aid the hospital in surveillance for pertussis cases among employees, patients, and the patients’ close contacts, determine compliance with chemoprophylaxis recommendations, and monitor for adverse events associated with chemoprophylaxis.

METHOD:
Surveillance for pertussis cases and assessment of antibiotic use and adverse events were accomplished through active surveillance at the hospital among employees and through standardized questionnaires that were administered to potentially exposed employees and patients. Persons with clinical syndromes suggestive of pertussis were tested for Bordetella pertussis infection.

RESULT:
No confirmed secondary pertussis cases were identified. Antibiotic courses were completed by 95% of persons initiating therapy. The most commonly reported adverse event in neonates was gastrointestinal distress (GID); 50% of neonates taking erythromycin demonstrated evidence of GID compared with 12% of neonates taking azithromycin (p=0.0007). No cases of infantile hypertrophic pyloric stenosis were identified among the neonates.

CONCLUSION:
The lack of confirmed transmission was unexpected. Azithromycin chemoprophylaxis among neonates was well tolerated.
LEARNINGOBJECTIVES:
At the conclusion of this session, the participant will be able to (1) describe the epidemiologic trend of pertussis among infants, children, adolescents, and adults, and (2) describe compliance and adverse events associated with chemoprophylaxis for pertussis among this cohort of neonates and adults.