Skip to main content

Advertisement

Log in

Pertussis and parapertussis in children and adults with a persistent cough: an observational study

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

We aimed to determine the prevalence, symptoms and course of pertussis and parapertussis among patients at any age with a cough of unknown aetiology that had lasted for ≥ 7 days and to assess the diagnostic value of the symptoms included in the World Health Organisations’ (WHO) clinical case definition of pertussis.

Methods

Patients were enrolled between the 23 April 2012 and 31 December 2014 at 25 general practitioner (GP) centres and three paediatric hospitals. Pertussis was confirmed by culture and/or polymerase chain reaction (PCR) and/or quantitative serology. Parapertussis was confirmed by culture and/or PCR.

Results

Altogether, 549 patients were recruited. Of them, 22 (4.0%; 95% CI 2.5–6.0) had pertussis (predominately diagnosed by positive serology 17/22) and 7 (1.3%; 95% CI 0.5–2.6) had parapertussis. Patients with pertussis were more likely to have inspiratory whooping and posttussive emesis than those with a cough of another/unknown aetiology. However, the presence or absence of these two symptoms did not definitively confirm or exclude pertussis. The sensitivity and specificity of the WHO’s clinical definition was 0.77 and 0.38, respectively.

Conclusions

The prevalence of pertussis and parapertussis among patients with a persistent cough of unknown aetiology in Estonia is low. As clinical symptoms alone cannot be used to distinguish pertussis, we recommend that laboratory testing for pertussis is performed in all patients with a persistent cough regardless of age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National ambulatory medical care survey: 2006 summary. Natl Health Stat Rep. 2008;3:1–39.

    Google Scholar 

  2. Schappert SM, Nelson C. National ambulatory medical care survey: 1995–96 summary. Vital Health Stat. 1999;13:1–122.

    Google Scholar 

  3. Heininger U. Update on pertussis in children. Expert Rev Anti Infect Ther. 2010;8:163–73.

    Article  PubMed  Google Scholar 

  4. Marchello C, Dale AP, Thai TN, Han DS, Ebell MH. Prevalence of atypical pathogens in patients with cough and community-acquired pneumonia: a meta-analysis. Ann Fam Med. 2016;14:552–66.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Burns DL, Meade BD, Messionnier NE. Pertussis resurgence: perspectives from the Working Group Meeting on pertussis on the causes, possible paths forward, and gaps in our knowledge. J Infect Dis. 2014;209:S32–5.

    Article  PubMed  Google Scholar 

  6. Senzilet LD, Halperin SA, Spika JS, Alagaratnam M, Morris A, Smith B. Pertussis is a frequent cause of prolonged cough illness in adults and adolescents. Clin Infect Dis. 2001;32:1691–7.

    Article  CAS  PubMed  Google Scholar 

  7. Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E, Donegan K, et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet. 2014;384:1521–8.

    Article  PubMed  Google Scholar 

  8. Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci USA. 2014;111:787–92.

    Article  CAS  PubMed  Google Scholar 

  9. Schwartz KL, Kwong JC, Deeks SL, Campitelli MA, Jamieson FB, Marchand-Austin A, et al. Effectiveness of pertussis vaccination and duration of immunity. CMAJ. 2016;188:E399–406.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Carbonetti NH. Bordetella pertussis: new concepts in pathogenesis and treatment. Curr Opin Infect Dis. 2016;29:287–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Domenech de Cellès M, Magpantay FMG, King AA, Rohani P. The pertussis enigma: reconciling epidemiology, immunology and evolution. Proc R Soc B. 2016;283:20152309. http://dx.doi.org/10.1098/rspb.2015.2309

    Article  Google Scholar 

  12. Jõgi P, Oona M, Toompere K, Lutsar I. Estimated and reported incidence of pertussis in Estonian adults: a seroepidemiological study. Vaccine. 2015;33:4756–61.

    Article  PubMed  Google Scholar 

  13. Jõgi P, Oona M, Toompere K, Leedo S, Epstein J, Lutsar I. Seroprevalence of IgG antibodies to pertussis toxin in children and adolescents in Estonia. Vaccine. 2014;32:5311–5.

    Article  PubMed  Google Scholar 

  14. Ebell MH, Marchello C, Callahan M. Clinical diagnosis of Bordetella Pertussis infection: a systematic review. J Am Board Fam Med. 2017;30:308–19.

    Article  PubMed  Google Scholar 

  15. Teepe J, Broekhuizen BD, Ieven M, Loens K, Huygen K, Kretzschmar M, et al. Prevalence, diagnosis, and disease course of pertussis in adults with acute cough: a prospective, observational study in primary care. Br J Gen Pract. 2015;65:e662–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dalby T, Harboe ZB, Krogfelt KA. Seroprevalence of pertussis among Danish patients with cough of unknown etiology. Clin Vaccine Immunol. 2010;17:2016–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Park S, Lee SH, Seo KH, Shin KC, Park YB, Lee MG, et al. Epidemiological aspects of pertussis among adults and adolescents in a Korean outpatient setting: a multicenter. PCR-based study. J Korean Med Sci. 2014;29:1232–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Strebel P, Nordin J, Edwards K, Hunt J, Besser J, Burns S, et al. Population-based incidence of pertussis among adolescents and adults, Minnesota, 1995–1996. J Infect Dis. 2001;183:1353–9.

    Article  CAS  PubMed  Google Scholar 

  19. Gilberg S, Njamkepo E, Du Chatelet IP, Partouche H, Gueirard P, Ghasarossian C, et al. Evidence of Bordetella pertussis infection in adults presenting with persistent cough in a French area with very high whole-cell vaccine coverage. J Infect Dis. 2002;186:415–8.

    Article  PubMed  Google Scholar 

  20. Harnden A, Grant C, Harrison T, Perera R, Brueggemann AB, Mayon-White R, et al. Whooping cough in school age children with persistent cough: prospective cohort study in primary care. BMJ. 2006;333:174–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lutsar I, Anca I, Bakir M, Usonis V, Prymula R, Salman N, et al. Epidemiological characteristics of pertussis in Estonia, Lithuania, Romania, the Czech Republic, Poland and Turkey—1945 to 2005. Eur J Pediatr. 2009;168:407–15.

    Article  PubMed  Google Scholar 

  22. Health Board. Immunisation schedule and immunisation rates. 2017. http://www.terviseamet.ee/nakkushaigused/vaktsineerimine/riiklik-immuniseerimiskava-ja-selle-taeitmine.html. Accessed 25 May 2017.

  23. Jõgiste A, Varjas J, Järviste A. Läkaköha tõrje tulemusi. Eesti Arst. 2005;84:31–5.

    Google Scholar 

  24. Heininger U, Andre P, Chlibek R, Kristufkova Z, Kutsar K, Mangarov A, et al. Comparative epidemiologic characteristics of pertussis in 10 central and eastern European countries, 2000–2013. PLoS One. 2016;11:e0155949.

    Article  PubMed  PubMed Central  Google Scholar 

  25. ECDC. Pertussis surveillance report 2010. 2011. http://ecdc.europa.eu/en/publications/Publications/pertussis_report_2010_euvacnet.pdf. Accessed 15 June 2017.

  26. WHO. WHO-recommended standards for surveillance of selected vaccine preventable diseases. 2003. http://apps.who.int/iris/bitstream/10665/68334/1/WHO_V-B_03.01_eng.pdf. Accessed 15 June 2017.

  27. Li Z, Jansen DL, Finn TM, Halperin SA, Kasina A, O’Connor SP, et al. Identification of Bordetella pertussis infection by shared-primer PCR. J Clin Microbiol. 1994;32:783–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Riffelmann M, Thiel K, Schmetz J, Wirsing von Koenig CH. Performance of commercial enzyme-linked immunosorbent assays for detection of antibodies to Bordetella pertussis. J Clin Microbiol. 2010;48:4459–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kutsar K, Märtin J. Läkaköha ja paraläkaköha Eestis. Eesti Arst. 2000;4:205–2011.

    Google Scholar 

  30. ECDC. Guidance and protocol for the serological diagnosis of human infection with Bordetella pertussis. 2012. https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/bordetella-pertussis-guidance-protocol-serological-diagnosis.pdf Accessed 01 Oct 2017.

  31. Guiso N, Berbers G, Fry NK, He Q, Riffelmann M, Wirsing von König CH, et al. What to do and what not to do in serological diagnosis of pertussis: recommendations from EU reference laboratories. Eur J Clin Microbiol Infect Dis. 2011;30:307–12.

    Article  CAS  PubMed  Google Scholar 

  32. Cherry JD, Tan T, Wirsing von Konig CH, Forsyth KD, Thisyakorn U, Greenberg D, et al. Clinical definitions of pertussis: summary of a Global Pertussis Initiative roundtable meeting, February 2011. Clin Infect Dis. 2012;54:1756–64.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lasserre A, Laurent E, Turbelin C, Hanslik T, Blanchon T, Guiso N. Pertussis incidence among adolescents and adults surveyed in general practices in the Paris area, France, May 2008 to March 2009. Euro Surveill. 2011;2011:16.

    Google Scholar 

  34. Versteegh FG, Weverling GJ, Peeters MF, Wilbrink B, Veenstra-van Schie MT, van Leeuwen-Gerritsen JM, et al. Community-acquired pathogens associated with prolonged coughing in children: a prospective cohort study. Clin Microbiol Infect. 2005;11:801–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Estonian Science Foundation under Grant number 9259. The authors thank all members of the Pertussis study group of Estonia who participated in this study: (1) the GPs and nurses from the health centres: Tereza Maskina, University Family Doctors’ Centre, Merekivi Family Doctors’ Centre, Lembi Põlder Family Doctors’ Centre, Ilme Last, Ülle Trumm, Tabasalu Family Doctors’ Centre, Tiiu Tootsi, Türi Health Centre, Vee Family Doctors’ Centre, Pirtia-Kose Family Doctors’ Centre, Medicum, Hiie Karelson, Linnamõisa Family Doctors’ Centre, Saku Health Centre, Ädala Family Doctors’ Centre, Tarvo Kiudma, Eve Mõistuse Family Doctors’ Centre, Mairi Kotsar, Helvi Kansi, Plaks and Pilv Family Doctors’ Centre, Aune Rehema, Ljudmila Jakobson, Sirje Saar, Marje Koha; (2) the doctors and nurses from the hospitals: Children’s Clinic of Tartu University Hospital’s Department of the Acute Infections and Centre of Allergic Diseases of Children and Adolescents, Anaesthesiology and Intensive Care Clinic of Tartu University Hospital’s Department of Children’s Intensive Care, Tallinn Children’s Hospital and Järvamaa District Hospital; (3) the staff of Synlab Eesti OÜ, United Laboratories of Tartu University Hospital and the Laboratory of Communicable Diseases of the Health Board; (4) the staff of the Department of Microbiology, University of Tartu; (5) the staff of 5D Vision.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Piia Jõgi.

Ethics declarations

Ethical approval

The study was approved by the Ethics Committee of Tartu University.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Informed consent

Informed consent was signed by all patients and or their parent(s)/guardian(s).

Additional information

Members of the Pertussis Study Group of Estonia are listed in acknowledgements section.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jõgi, P., Oona, M., Kaart, T. et al. Pertussis and parapertussis in children and adults with a persistent cough: an observational study. Infection 46, 83–91 (2018). https://doi.org/10.1007/s15010-017-1095-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-017-1095-z

Keywords

Navigation