Surveillance for transmission and antibiotic adverse events among neonates and adults exposed to a healthcare worker with pertussis.
BACKGROUND
During a hospital obstetric rotation, a medical student demonstrated classic symptoms of pertussis. The diagnosis was confirmed by isolation of Bordetella pertussis. Because this exposure occurred in a high-risk hospital setting, control measures were undertaken to prevent transmission and illness.


OBJECTIVE
To identify secondary cases of pertussis, to determine compliance with chemoprophylaxis recommendations, and to monitor for adverse events associated with chemoprophylaxis following a hospital exposure to pertussis.


METHODS
More than 500 individuals were potentially exposed, including 168 neonates; antimicrobial chemoprophylaxis was administered to 281 individuals. Fifty-eight neonates and 194 adults began azithromycin chemoprophylaxis; 18 neonates and 2 adults began erythromycin chemoprophylaxis.


METHODS
Active surveillance was instituted for (1) secondary cases of pertussis among healthcare coworkers, obstetric patients, their neonates, and labor companions and (2) antibiotic compliance and tolerance.


RESULTS
No secondary cases of pertussis were confirmed by laboratory tests; however, 26 suspected cases and 5 clinically compatible cases were identified. Antibiotic courses were completed by 95% of the individuals who initiated therapy. Neonates taking azithromycin had statistically significantly less gastrointestinal distress compared with neonates taking erythromycin (12% vs 50%; P = .002); there were no cases of infantile hypertrophic pyloric stenosis.


CONCLUSIONS
Although it was not possible to assess the effectiveness of the antibiotic regimens, the lack of laboratory-confirmed secondary cases suggests control measures were successful. Data from the 58 neonates who received azithromycin suggest it may be well tolerated in this age group.
Friedman
Dara S
DS
Epidemiology Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Curtis
C Robinette
CR
Schauer
Stephanie L
SL
Salvi
Susan
S
Klapholz
Henry
H
Treadwell
Thomas
T
Wortzman
Jerry
J
Bisgard
Kristine M
KM
Lett
Susan M
SM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001886:Bordetella pertussis / Q000302:isolation & purification; D001942:Breast Feeding / Q000706:statistics & numerical data; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000032:analysis / Q000517:prevention & control*; D008404:Massachusetts; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods; D049590:Postpartum Period / Q000187:drug effects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013337:Students, Medical; D014917:Whooping Cough / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*
D000900:Anti-Bacterial Agents