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Pertussis (Whooping Cough) (Bordetella pertussis)

2014 Case Definition


CSTE Position Statement(s)

  • 13-ID-15

Background

Bordetella pertussis is the most poorly controlled bacterial vaccine-preventable disease in the U.S., with peaks in disease occurring every 3-5 years. Although routine childhood vaccination has resulted in substantial reductions in disease, the number of reported pertussis cases has been steadily increasing since the 1980s. Notable peaks in disease occurred in 2004 (25,827 cases, 27 deaths), 2010 (27,550 cases, 27 deaths), and most recently in 2012 when more than 41,000 cases and 18 deaths were reported, the largest number of cases in the U.S. since 1959. Furthermore, the epidemiologic features of pertussis have changed in recent years with an increasing burden of disease among fully-vaccinated children and adolescents.

Clinical Criteria

In the absence of a more likely diagnosis, a cough illness lasting ≥2 weeks, with at least one of the following signs or symptoms:
  • Paroxysms of coughing; OR
  • Inspiratory whoop; OR
  • Post-tussive vomiting; OR
  • Apnea (with or without cyanosis) (FOR INFANTS AGED <1 YEAR ONLY)

Laboratory Criteria for Diagnosis

  • Isolation of B. pertussis from a clinical specimen
  • Positive PCR for pertussis

Epidemiologic Linkage

Contact with a laboratory-confirmed case of pertussis*.

Case Classification

Probable

  • In the absence of a more likely diagnosis, a cough illness lasting ≥2 weeks, with
    • At least one of the following signs or symptoms:
      • Paroxysms of coughing; or inspiratory "whoop”; or
      • Post-tussive vomiting; or
      • Apnea (with or without cyanosis) (FOR INFANTS AGED <1 YEAR ONLY)
    And
    • Absence of laboratory confirmation;
    And
    • No epidemiologic linkage to a laboratory-confirmed case of pertussis.
OR, FOR INFANTS AGED <1 YEAR ONLY:
  • Acute cough illness of any duration, with
    • At least one of the following signs or symptoms:
      • Paroxysms of coughing; or
      • Inspiratory "whoop"; or
      • Post-tussive vomiting; or
      • Apnea (with or without cyanosis)
    • And
    • Polymerase chain reaction (PCR) positive for pertussis.
OR, FOR INFANTS AGED <1 YEAR ONLY:
  • Acute cough illness of any duration, with
    • At least one of the following signs or symptoms:
      • Paroxysms of coughing; or
      • Inspiratory "whoop"; or
      • Post-tussive vomiting; or
      • Apnea (with or without cyanosis)
    • And
    • Contact with a laboratory-confirmed case of pertussis.

Confirmed

  • Acute cough illness of any duration, with isolation of B. pertussis from a clinical specimen.
  • OR
  • Cough illness lasting ≥ 2 weeks, with
    • At least one of the following signs or symptoms:
      • Paroxysms of coughing; or
      • inspiratory "whoop”; or
      • Post-tussive vomiting; or
      • Apnea (with or without cyanosis) (FOR INFANTS AGED <1 YEAR ONLY)
    And
    • Polymerase chain reaction (PCR) positive for pertussis.
OR
  • Cough illness lasting ≥ 2 weeks, with
    • At least one of the following signs or symptoms:
      • Paroxysms of coughing; or
      • inspiratory "whoop”; or
      • Post-tussive vomiting; or
      • Apnea (with or without cyanosis) (FOR INFANTS AGED <1 YEAR ONLY)
    And
    • Contact with a laboratory-confirmed case of pertussis*.

Case Classification Comment(s)

*Note: An illness meeting the clinical case definition should be classified as "probable" rather than "confirmed" if it occurs in a patient who has contact with an infant aged <1 year who is Polymerase Chain Reacton (PCR) positive for pertussis and has ≥1 sign or symptom and cough duration <14 days (classified as "probable" case).

Related Case Definition(s)




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