[Action to be taken when facing one or more cases of whooping-cough].
The evolution of the epidemiology of pertussis, new licensed macrolides and vaccines, new recommendations for vaccination among adolescents and adults need an update of the French guidelines for prevention of the disease around one or grouped cases of the disease. A particular attention should be raised to the diagnosis of whooping cough in adults who are presently the main reservoir of Bordetella pertussis. Whooping cough in adults presents as an unexplained prolonged cough with nocturnal exacerbation witch accounts for most of the contaminations of young infants. A bacteriological confirmation of pertussis should be provided before implementation of preventive measures: culture and PCR are presently the gold standard for the diagnosis of pertussis in infants, children and even adults who have been coughing for less than 20 days. Later on, serology (Elisa, immuno-empreinte) is the only technique available, but cannot be interpreted if the patient has been vaccinated less than one year ago. Infants under three months should be admitted to hospital and every case submitted to respiratory isolation. Eviction from the community should be pronounced within the five first days following the onset of an effective antibiotic treatment. New macrolides should be favoured: clarithromycin for seven days or azithromycin for five days. Household contacts should be given the same prophylactic antibiotic treatment: children and adolescent not correctly immunized, parents of the index case as adults parents of not or not completely immunized infants. The vaccination program of the household should be updated. The same measures should be applied in case of grouped cases (at least two contemporary or consecutive cases in the same area). In that case, the Public Health System doctors should be involved in the investigation and the classification of the cases. The close contacts not or not completely immunized should be prescribed and antibiotic prophylaxis and an update of their vaccination program. Among the occasional contacts, high-risk people only should be treated. In the day care centres an antibiotic prophylaxis should be given to children who have received less than four vaccine shots against pertussis and to the personnel contact to the cases as well. In the schools, the antibiotic prophylaxis should be prescribed to all children of the classroom(s) not completely vaccinated and to the teacher(s) as well. In the boarding schools and institutions with handicapped children, antibiotic prophylaxis could be applied to every member if the pertussis vaccine coverage is at less than 50%. In hospitals, coughing personnel should wear masks and investigations towards pertussis should be performed in people with a more than seven day unexplained cough. Preventive measures should be applied in case of confirmation of pertussis.
Floret
D
D
Service d'urgence et de réanimation pédiatrique, hôpital Edouard-Herriot, place d'Arsonval, 69437 Lyon cedex 03, France. daniel.floret@chu-lyon.fr
Bonmarin
I
I
Deutsch
P
P
Gaudelus
J
J
Grimprel
E
E
Guérin
N
N
Guiso
N
N
Morer
I
I
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002648:Child; D017291:Clarithromycin / Q000627:therapeutic use; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D004338:Drug Combinations; D004797:Enzyme-Linked Immunosorbent Assay; D005602:France / Q000453:epidemiology; D006801:Humans; D010567:Pertussis Vaccine / Q000008:administration & dosage; D016133:Polymerase Chain Reaction; D014917:Whooping Cough / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D010567:Pertussis Vaccine; D017963:Azithromycin; D017291:Clarithromycin