Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-27T05:05:39.469Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology and Control of Pertussis Outbreaks in a Tertiary Care Center and the Resource Consumption Associated With These Outbreaks

Published online by Cambridge University Press:  02 January 2015

Surbhi Leekha ,
Rodney L. Thompson  and
Priya Sampathkumar
Surbhi Leekha*
Affiliation:
Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
Rodney L. Thompson
Affiliation:
Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota Infection Prevention and Control Unit, Mayo Clinic, Rochester, Minnesota
Priya Sampathkumar
Affiliation:
Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota Infection Prevention and Control Unit, Mayo Clinic, Rochester, Minnesota
*
Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905) leekha.surbhi@mayo.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To describe the epidemiology and control of 2 separate outbreaks of pertussis at a large tertiary care center and the resource consumption associated with these outbreaks.

Design.

Descriptive study.

Setting.

The Mayo Clinic in Rochester, Minnesota, a tertiary care center catering to both referral patients and patients from the community.

Methods.

We reviewed routine and enhanced surveillance data collected by infection prevention and control practitioners during the outbreaks. Pertussis was diagnosed either on the basis of a nasopharyngeal specimen positive for Bordetella pertussis by use of polymerase chain reaction (PCR) or on the basis of a compatible clinical syndrome along with an epidemiologic link to PCR-confirmed cases.

Results.

Two pertussis outbreaks, the first community based and the second hospital based (ie, due to transmission among healthcare personnel), occurred during the period from October 2004 through October 2005. In the first outbreak from November 2004 through March 2005, there were 109 cases diagnosed; 105 (96%) of these cases were diagnosed on the basis of a nasopharyngeal specimen positive for B. pertussis by use of PCR. Adolescents 10-19 years of age were most affected (77 cases [71%]). Only 13 cases (12%) occurred among healthcare personnel; however, many healthcare personnel required postexposure prophylaxis. A second outbreak of 122 cases occurred during the period from July through October 2005; of these 122 cases, 96 (79%) were diagnosed on the basis of a nasopharyngeal specimen positive for B. pertussis by use of PCR, and 64 (52%) involved healthcare personnel. There were many instances of transmission among healthcare personnel and from patients to healthcare personnel, but no documented transmission from healthcare personnel to Patients. The outbreaks were controlled by aggressive case finding, treatment of those infected, prophylaxis of all healthcare personnel and patients who had contact with both probable and confirmed cases, implementation of educational efforts, and compliance with respiratory etiquette. Vaccination of healthcare personnel against pertussis began in October 2005.

Conclusion.

Pertussis remains a public health problem. Outbreaks in healthcare facilities consume the resources of those facilities in terms of personnel, testing, treatment of cases, and prophylaxis of those individuals who were in contact with those cases. Adult vaccination may reduce the disease burden.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 5 , May 2009 , pp. 467 - 473
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Jenkinson, D. Duration of effectiveness of pertussis vaccine: evidence from a 10 year community study. Br Med J (Clin Res Ed) 1988;296:612–614.Google Scholar
2.Güris, D, Strebel, PM, Bardenheier, B, et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 1990-1996. Clin Infect Dis 1999;28:1230–1237.Google Scholar
3.Centers for Disease Control and Prevention. Pertussis. In: Atkinson, W, Hamborsky, J, Mclntyre, L, Wolfe, C, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed. Washington, DC: Public Health Foundation; 2008:81–99.Google Scholar
4.Centers for Disease Control and Prevention. Summary of notifiable diseases-United States, 2005. MMWR Morb Mortal Wkly Rep 2007;54:192.Google Scholar
5.Baggett, HC, Duchin, JS, Shelton, W, et al. Two nosocomial pertussis outbreaks and their associated costs-King County, Washington, 2004. Infect Control Hosp Epidemiol 2007;28:537–543.Google Scholar
6.Bassinet, L, Matrat, M, Njamkepo, E, Aberrane, S, Housset, B, Guiso, N. Nosocomial pertussis outbreak among adult patients and healthcare workers. Infect Control Hosp Epidemiol 2004;25:995–997.Google Scholar
7.Boulay, BR, Murray, CJ, Ptak, J, Kirkland, KB, Montero, J, Talbot, EA. An outbreak of pertussis in a hematology-oncology care unit: implications for adult vaccination policy. Infect Control Hosp Epidemiol 2006;27:92–95.Google Scholar
8.Calugar, A, Ortega-Sanchez, IR, Tiwari, T, Oakes, L, Jahre, JA, Murphy, TV. Nosocomial pertussis: costs of an outbreak and benefits of vaccinating health care workers. Clin Infect Dis 2006;42:981–988.Google Scholar
9.Pascual, FB, McCall, CL, McMurtray, A, Payton, T, Smith, F, Bisgard, KM. Outbreak of pertussis among healthcare workers in a hospital surgical unit. Infect Control Hosp Epidemiol 2006;27:546–552.CrossRefGoogle Scholar
10.de Juanes, JR, Gil, A, Gonzalez, A, Arrazola, MP, San-Martin, M, Esteban, J. Seroprevalence of pertussis antibody among health care personnel in Spain. Eur J Epidemiol 2004;19:69–72.CrossRefGoogle ScholarPubMed
11.Wright, SW, Decker, MD, Edwards, KM. Incidence of pertussis infection in healthcare workers. Infect Control Hosp Epidemiol 1999;20:120–123.Google Scholar
12.Minnesota Department of Administration. Geographic and Demographic Analysis Division. Minnesota State Demographic Center. Minnesota population estimates: number and characteristics of the current population. Available at: http://www.demography.state.mn.us/estimates.html. Accessed December 15, 2007.Google Scholar
13.Centers for Disease Control and Prevention. Chapter 11-Definitions. In: Guidelines for the Control of Pertussis Outbreaks. Atlanta, GA: Centers for Disease Control and Prevention, 2000. Available at: http://www .cdc.gov/vaccines/pubs/pertussis-guide/downloads/chapterl1.pdf. Accessed November 18, 2008.Google Scholar
14.Sloan, LM, Hopkins, MK, Mitchell, PS, et al. Multiplex Light Cycler PCR assay for detection and differentiation of Bordetella pertussis and Bordetella parapertussis in nasopharyngeal specimens. J Clin Microbiol 2002;40:96–100.Google Scholar
15.Minnesota Department of Health. Pertussis disease statistics. Available at: http://www.health.state.mn.us/divs/idepc/diseases/pertussis/stats/index.html. Accessed November 18, 2008.Google Scholar
16.Ward, A, Caro, J, Bassinet, L, Housset, B, O'Brien, JA, Guiso, N. Health and economic consequences of an outbreak of pertussis among healthcare workers in a hospital in France. Infect Control Hosp Epidemiol 2005;26:288–292.Google Scholar
17.Center for Disease Control and Prevention. Outbreaks of respiratory illness mistakenly attributed to pertussis-New Hampshire, Massachusetts, and Tennessee, 2004-2006. MMWR Morb Mortal Wkly Rep 56;2007:837–842.Google Scholar
18.Cherry, JD. Epidemiological, clinical, and laboratory aspects of pertussis in adults. Clin Infect Dis 1999;28:S112–S117.Google Scholar
19.Rothstein, E, Edwards, K. Health burden of pertussis in adolescents and adults. Pediatr Infect Dis J 2005;24:S44–S47.Google Scholar
20.Tan, T, Trindade, E, Skowronski, D. Epidemiology of pertussis. Pediatr Infect Dis J 2005;24:S10–S18.Google Scholar
21.Cherry, JD. Pertussis vaccines for adolescents and adults. Pediatrics 2005;116:755–756.Google Scholar
22.Orenstein, WA. Pertussis in adults: epidemiology, signs, symptoms, and implications for vaccination. Clin Infect Dis 1999;28:S147–S150.Google Scholar
23.US Food and Drug Administration. FDA talk paper. FDA approves a new combination vaccine to help protect both adolescents and adults against whooping cough. Available at: http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01361.html. Accessed August 14, 2008.Google Scholar
24.US Department of Health and Human Services. Definition of Health Care Personnel (HCP), March 2008. Available at: http://www.hhs.gov/ophs/programs/initiatives/vacctoolkit/definition.html. Accessed September 2, 2008.Google Scholar