Nosocomial pertussis in healthcare workers from a pediatric emergency unit in France.
OBJECTIVE
After pertussis was diagnosed in July 1997 in a 55-year-old nurse (case) from a pediatric emergency unit who had a respiratory illness and paroxysmal cough for 5 weeks, an epidemiological investigation was initiated to determine if other healthcare workers (HCWs) from the same unit also had pertussis.


METHODS
Interviews were conducted to assess symptoms occurring in the previous months. Two sera were collected 2 to 3 months apart for 59 of 61 HCWs of the unit. The IgG response to pertussis toxin was determined using Western blot assay.


METHODS
Pediatric emergency unit (61 HCWs) of a 2,500-bed university hospital.


RESULTS
There was a total of 10 (5 confirmed and 5 probable) cases of pertussis identified in this outbreak. Nine HCWs (15%) had results suggesting recent or acute pertussis. To avoid transmission to patients and other HCWs, all HCWs with cough were treated for 14 days with erythromycin, and those having acute cough were given a 5-day sick leave. Despite these measures, a new acute pertussis case was identified in a 41-year-old nurse, with a positive culture from nasopharyngeal aspirates. Thus, all HCWs in the unit were prescribed spiramycin for 10 days to prevent any further spread of pertussis.


CONCLUSIONS
Pertussis should be considered a threat to HCWs who are in contact with children. For HCWs, diagnosis of pertussis should be made on a clinical basis, giving greater importance to sensitivity of diagnosis criteria, and on early bacterial identification by culture of the organism or by polymerase chain reaction.


CONCLUSIONS
In case of pertussis in an HCW, all staff in the unit who have had unprotected and intensive contact with that person should be provided with macrolide treatment to stop any transmission to colleagues and to young patients. Furthermore, the possibility of providing these HCWs with acellular pertussis vaccines warrants further investigation.
Gehanno
J F
JF
Institute of Occupational Health, Charles Nicolle-Rouen University Hospital, Rouen, France.
Pestel-Caron
M
M
Nouvellon
M
M
Caillard
J F
JF
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000635:transmission*; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control; D017758:Infectious Disease Transmission, Patient-to-Professional; D018942:Macrolides; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D016272:Occupational Health; D010371:Pediatric Nursing; D014917:Whooping Cough / Q000635:transmission*
D000900:Anti-Bacterial Agents; D018942:Macrolides