title: Widespread Bordetella parapertussis Infections-Wisconsin, 2011-2012: Clinical and Epidemiologic Features and Antibiotic Use for Treatment and Prevention.
abstract: BACKGROUND
  During October 2011-December 2012, concurrent with a statewide pertussis outbreak, 443 Bordetella parapertussis infections were reported among Wisconsin residents. We examined clinical features of patients with parapertussis and the effect of antibiotic use for treatment and prevention.
  
  
  METHODS
  Patients with polymerase chain reaction results positive for B. parapertussis reported during October 2011-May 2012 were interviewed regarding presence and durations of pertussis-like symptoms and receipt of azithromycin treatment. Data regarding acute cough illnesses and receipt of azithromycin prophylaxis among parapertussis patient household members (HHMs) were also collected. Using multivariate repeated measures log-binomial regression analysis, we examined associations of treatment receipt by the HHM with the earliest illness onset and prophylaxis receipt among other HHMs with the presence of any secondary cough illnesses in the household.
  
  
  RESULTS
  Among 218 patients with parapertussis, pertussis-like symptoms were frequently reported. Illness durations were significantly shorter among patients with treatment initiated 0-6 days after cough onset, compared with nonrecipients (median durations: 10 vs 19 days, P = .002). Among 361 HHMs from 120 households, compared with nonrecipients, prompt prophylaxis of HHMs was associated with no secondary cough illnesses (relative risk: 0.16; 95% confidence interval, .04-.69).
  
  
  CONCLUSIONS
  Bordetella parapertussis infection causes pertussis-like illness that might be misclassified as pertussis if B. parapertussis testing is not performed. Prompt treatment might shorten illness duration, and prompt HHM prophylaxis might prevent secondary illnesses. Further study is needed to evaluate antibiotic effectiveness for preventing parapertussis and to determine risks and benefits of antibiotic use.
authors.affiliation: Division of Public Health, Wisconsin Department of Health Services Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.
authors.forename: Ruth
authors.initials: R
authors.lastname: Koepke
authors.affiliation: Division of Public Health, Wisconsin Department of Health Services Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bartholomew
authors.affiliation: Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison.
authors.forename: Jens C
authors.initials: JC
authors.lastname: Eickhoff
authors.affiliation: Division of Public Health, Wisconsin Department of Health Services Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.
authors.forename: Roman A
authors.initials: RA
authors.lastname: Ayele
authors.affiliation: Wood County Health Department, Wisconsin Rapids.
authors.forename: Diane
authors.initials: D
authors.lastname: Rodd
authors.affiliation: Wood County Health Department, Wisconsin Rapids.
authors.forename: Joan
authors.initials: J
authors.lastname: Kuennen
authors.affiliation: Wood County Health Department, Wisconsin Rapids.
authors.forename: Jean
authors.initials: J
authors.lastname: Rosekrans
authors.affiliation: Wisconsin State Laboratory of Hygiene, Madison, Wisconsin.
authors.forename: David M
authors.initials: DM
authors.lastname: Warshauer
authors.affiliation: Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison.
authors.forename: James H
authors.initials: JH
authors.lastname: Conway
authors.affiliation: Division of Public Health, Wisconsin Department of Health Services.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D017963:Azithromycin / Q000627:therapeutic use*; D001885:Bordetella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D042483:Bordetella parapertussis / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014922:Wisconsin / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: Bordetella parapertussis; Bordetella pertussis; epidemiology