title: Pertussis outbreak among patients and healthcare workers in a provincial dialysis facility in Japan.
abstract: BACKGROUND
  Sixteen pertussis cases in haemodialysis patients and healthcare workers were detected in a 25-bed outpatient haemodialysis facility in Japan between October 2013 and April 2014.
  
  
  OBJECTIVE
  To describe an outbreak of pertussis among patients and healthcare workers, and to identify risk factors for pertussis infection.
  
  
  METHODS
  Sputum cultures, loop-mediated isothermal amplification assays performed on nasopharyngeal swabs to detect respiratory pathogens including Bordetella pertussis, and serum anti-pertussis toxin immunoglobulin G measurements were performed for all haemodialysis patients and healthcare workers. A retrospective case-control study was performed to identify the risk factors for pertussis infection in the clinic.
  
  
  RESULTS
  Only six of the 16 pertussis patients (37.5%) had respiratory symptoms. Recent exposure to an unmasked individual with a cough was associated with pertussis infection (odds ratio 6.25, P<0.05). The outbreak was terminated successfully after enforcing the use of surgical masks among both patients and healthcare workers.
  
  
  CONCLUSIONS
  This report demonstrates the risk of pertussis transmission in a haemodialysis facility, and underscores the importance of wearing surgical masks to control a pertussis outbreak.
authors.affiliation: Department of Infection Control, Fukushima Medical University, Fukushima, Japan. Electronic address: kinakamu@fmu.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Kitakata Jin Hinyouki-Clinic, Kitakata, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Infection Control and Prevention, Division of Medical and Environmental Safety, Kagoshima University, Kagoshima, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tokuda
authors.affiliation: Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Miura
authors.affiliation: Department of Infection Control, Fukushima Medical University, Fukushima, Japan; Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Kashiwazaki
authors.affiliation: Department of Infection Control and Laboratory Diagnostics, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Aoyagi
authors.affiliation: Department of Infection Control and Laboratory Diagnostics, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kaku
authors.affiliation: Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kanemitsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001886:Bordetella pertussis / Q000235:genetics / Q000302:isolation & purification; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D003956:Dialysis; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D005260:Female; D006282:Health Personnel; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D009305:Nasopharynx / Q000382:microbiology; D010361:Patients; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D014917:Whooping Cough / Q000453:epidemiology* / Q000635:transmission
keywords: Haemodialysis facility; Outbreak; Pertussis