title: Measures to control an outbreak of pertussis in a neonatal intermediate care nursery after exposure to a healthcare worker.
abstract: BACKGROUND
  Hospitalized premature infants are particularly vulnerable to morbidity and mortality from pertussis. Effective prevention and investigative and control measures are not well described.
  
  
  OBJECTIVE
  To identify the source of nosocomial pertussis in a 2-month-old premature infant in a neonatal intermediate care nursery (ICN) and to critically review the investigation and outbreak control measures.
  
  
  METHODS
  An ICN and a neonatal intensive care unit.
  
  
  METHODS
  We queried healthcare workers (HCWs) and family members about cough illness and contacted potentially exposed patients to determine whether they had symptoms of pertussis. Culture and polymerase chain reaction (PCR) testing for Bordetella pertussis were performed by the hospital laboratory with specimens collected from symptomatic patients and HCWs. Levels of pertussis toxin immunoglobulin G antibodies were measured in HCWs with cough of at least 14 days' duration at a public health laboratory. Extensive control measures were instituted.
  
  
  RESULTS
  Four ICN HCWs met the clinical case definition for presence of pertussis. Serologic test results were positive for 3 of the HCWs. The primary case patient was a 36-year-old HCW with a cough illness of 3-weeks' duration that was accompanied by paroxysms, whoop, posttussive emesis, and pneumothorax. Among the 4 affected HCWs, the duration of cough illness prior to identification of the infant index patient ranged from 11 to 25 days. Outbreak control measures included isolation of the infant case patient, furlough and treatment of symptomatic HCWs, administration of chemoprophylaxis to contacts, and surveillance for additional cases. Seventy-two infant patients and 72 HCWs were exposed and were given antibiotic prophylaxis. One additional case of pertussis, confirmed by PCR and culture, occurred in a resident physician who declined prophylaxis; she had cared for the index patient but had no contact with symptomatic HCWs.
  
  
  CONCLUSIONS
  HCWs or patients may serve as the source of pertussis in nosocomial outbreaks, which can result in substantial morbidity and outlay of resources for control measures. Our review suggested that a diagnosis of pertussis should be an early consideration for HCWs with cough illness. Targeted pertussis immunization of HCWs, employee health policies that provide for testing and furlough of HCWs with prolonged cough, and monitoring of HCWs for compliance with infection control measures could reduce the morbidity and costs associated with pertussis outbreaks. These measures will require evaluation of their effectiveness.
authors.affiliation: Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY 40202, USA. k0brya01@louisville.edu
authors.forename: Kristina A
authors.initials: KA
authors.lastname: Bryant
authors.forename: Kraig
authors.initials: K
authors.lastname: Humbaugh
authors.forename: Kyle
authors.initials: K
authors.lastname: Brothers
authors.forename: Judy
authors.initials: J
authors.lastname: Wright
authors.forename: F Brian
authors.initials: FB
authors.lastname: Pascual
authors.forename: John
authors.initials: J
authors.lastname: Moran
authors.forename: Trudy V
authors.initials: TV
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D001886:Bordetella pertussis / Q000302:isolation & purification; D002487:Centers for Disease Control and Prevention, U.S.; D004196:Disease Outbreaks / Q000517:prevention & control*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D017053:Infection Control / Q000379:methods*; D017757:Infectious Disease Transmission, Professional-to-Patient; D007363:Intensive Care Units, Neonatal; D007629:Kentucky; D011159:Population Surveillance; D014481:United States; D014917:Whooping Cough / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin