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

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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.


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.


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.


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.

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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.

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Correspondence to Piia Jõgi.

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Ethical approval

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

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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).

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

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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).

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