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Review ArticleClinical Review

Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults

Dennis A. Brooks and Richard Clover
The Journal of the American Board of Family Medicine November 2006, 19 (6) 603-611; DOI: https://doi.org/10.3122/jabfm.19.6.603
Dennis A. Brooks
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Richard Clover
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    Figure 1.

    Reported cases of pertussis in the United States, 1976–2004.8,9

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    Figure 2.

    Relationship between time since pertussis vaccination and attack rate.12

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    Table 1.

    CDC Definitions of Clinical, Confirmed, and Probable Cases of Pertussis

    A clinical case is defined as an acute cough illness lasting ≥14 days in a person with at least one pertussis-associated symptom (ie, paroxysmal cough, post-tussive vomiting without other apparent cause, or inspiratory whoop) or, in an outbreak setting, ≥14 days of cough with no other symptoms.
    A confirmed case is defined as a cough illness of any duration in a person from whom B. pertussis is isolated, or a case that meets the clinical case definition and is confirmed by polymerase chain reaction (PCR) or by epidemiologic linkage to a culture- or PCR-confirmed case.
    A probable case meets the clinical case definition but is neither laboratory confirmed nor epidemiologically linked to a laboratory-confirmed case.
    Confirmed and probable cases of pertussis should be reported to the National Notifiable Disease Surveillance System (NNDSS) of the US Centers for Disease Control and Prevention.
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    Table 2.

    Stages of Pertussis Infection24

    DurationCharacteristic Signs and Symptoms
    Incubation period7 to 10 days (range, 4 to 21 days)—
    Catarrhal stage7 to 14 daysInsidious onset of coryza, sneezing, and a mild, nonspecific cough that gradually becomes more severe
    In infants: excessive sneezing or ‘throat clearing’
    Paroxysmal stage1 to 6 weeks (up to 10 weeks)Bursts, or paroxysms, of numerous, rapid coughs followed by a long inspiratory effort often associated with a high-pitched whoop; post-tussive vomiting.
    In infants: paroxysms of coughing, but may not have sufficient musculature to develop a whoop. In addition, they may experience gagging, gasping, or eye bulging, and occasionally bradycardia or cyanosis.
    Convalescent stageWeeks to monthsRecovery gradual, with cough becoming less paroxysmal and then disappearing. Fever is generally minimal
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    Table 3.

    DTaP/Tdap Vaccination: Recommendations of the Advisory Committee on Immunization Practices37–39

    DoseAgeMinimum Interval
    Routine Primary Immunization of Infants
        12 months–
        24 months4 weeks
        36 months4 weeks
        415 to 18 months*6 months
        54 to 6 years†
    Booster dosing of adolescents:11 to 12 years–
    13 to 19 years‡
    Dosing of Adults§
        All adults who expect to be in close contact with a vulnerable infant19 to 64 years
        Health care personnel19 to 64 years
    • * May be given at 12 months.

    • † If 4th dose given before age 4 years.

    • ‡ Catch-up vaccination recommended if Td not received at 11 to 12 years; vaccination with Tdap encouraged for those who received Td at 11 to 12 years with a 5-year interval between Td and Tdap.

    • § A single dose of Tdap booster to replace the next scheduled dose of tetanus diphtheria vaccine.

    • ¶Infant who has not received 2 to 3 doses of DTaP.

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The Journal of the American Board of Family Medicine: 19 (6)
The Journal of the American Board of Family Medicine
Vol. 19, Issue 6
November-December 2006
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Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults
Dennis A. Brooks, Richard Clover
The Journal of the American Board of Family Medicine Nov 2006, 19 (6) 603-611; DOI: 10.3122/jabfm.19.6.603

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Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults
Dennis A. Brooks, Richard Clover
The Journal of the American Board of Family Medicine Nov 2006, 19 (6) 603-611; DOI: 10.3122/jabfm.19.6.603
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  • Article
    • Abstract
    • Epidemiology and Transmission of Disease
    • Pathogenesis of Infection
    • Clinical Manifestations and Complications of Infection
    • Complications of Pertussis
    • Diagnosis of Pertussis
    • Management of Pertussis
    • Conclusions
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