Pertussis: review of epidemiology, diagnosis, management and prevention.
Bordetella pertussis--the cause of pertussis or whooping cough--is an exclusively human pathogen. Disease elimination by vaccination should, therefore, be possible, but has proved elusive. Many industrialised countries with long established immunisation programs are currently seeing a resurgence of pertussis, despite universal vaccination with high uptake, with the highest burden in the least immunised age groups (infants under 6 months of age and persons over 10 years old). However, low recognition and reporting and insensitive diagnostic tests mean that the true burden of pertussis is still underestimated. Recently, efforts to improve diagnostic yield include the expanded use of polymerase chain reaction and serological tests but both have significant limitations. The range of antibiotics available for treatment and prophylaxis has expanded to include the newer macrolides, azithromycin and clarithromycin, and a range of universal and targeted vaccination strategies have been implemented or proposed. This paper reviews the current epidemiology of pertussis in developed countries, including modes of clinical presentation, diagnosis, management and potential vaccination strategies.
Wood
Nicholas
N
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, University of Sydney, New South Wales, Australia. nicholw3@chw.edu.au
McIntyre
Peter
P
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D001886:Bordetella pertussis / Q000276:immunology*; D017291:Clarithromycin / Q000627:therapeutic use; D019049:Developed Countries; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use; D010567:Pertussis Vaccine; D016133:Polymerase Chain Reaction; D014917:Whooping Cough / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy
D000900:Anti-Bacterial Agents; D018942:Macrolides; D010567:Pertussis Vaccine; D017963:Azithromycin; D017291:Clarithromycin