Sensitivity and specificity of the World Health Organization pertussis clinical case definition.
OBJECTIVE
Bordetella pertussis continues to circulate even in countries with good childhood vaccination coverage. This study was undertaken to define the relationship between documented disease and the clinical criteria proposed by the World Health Organization (WHO).


METHODS
Nasopharyngeal swab samples were collected from previously healthy 6-14-year-old school children in Tehran, presenting with persistent cough of at least 2- week duration. Specimens were examined for Bordetella pertussis and Bordetella parapertussis by culture and polymerase chain reaction (PCR).


RESULTS
Out of 6601 students, 328 (5.0%) had been coughing for at least 2 weeks. Of these children with cough, 182 (55.5%) experienced whooping, 194 (59.1%) suffered a paroxysmal cough, and 73 (22.3%) had post-tussive vomiting. Twenty-one (6.4%) samples tested positive for B. pertussis and six (1.8%) for B. parapertussis by PCR. Culture of four (1.2%) specimens was positive for B. pertussis. In comparison to PCR, the sensitivity and the specificity of the WHO clinical criteria (year 2000) were 95.2% and 15.0%, respectively.


CONCLUSIONS
Pertussis remains one of the etiologies of prolonged cough, even in communities with high immunization in children. The specificity of the WHO criteria is low in diagnosing pertussis compared with PCR.
Pediatric Infectious Diseases Research Center, Mofid Children's Hospital, Shariati Street, Tehran, Iran.
Roxana Mansour
RM
Ghanaie
Abdollah
A
Karimi
Hossein
H
Sadeghi
Abdolreza
A
Esteghamti
Fateme
F
Falah
Shahnaz
S
Armin
Alireza
A
Fahimzad
Ahmadreza
A
Shamshiri
Manige
M
Kahbazi
Faride
F
Shiva
D000293:Adolescent; D001431:Bacteriological Techniques; D001885:Bordetella Infections / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D042483:Bordetella parapertussis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D001886:Bordetella pertussis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D002648:Child; D003371:Cough / Q000209:etiology*; D003470:Culture Media; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D014917:Whooping Cough / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D014944:World Health Organization
D003470:Culture Media