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Surveillance for Transmission and antibiotic Adverse Events Among Neonates and Adults Exposed to a Healthcare Worker With Pertussis

Published online by Cambridge University Press:  02 January 2015

Dara S. Friedman ,
C. Robinette Curtis ,
Stephanie L. Schauer ,
Susan Salvi ,
Henry Klapholz ,
Thomas Treadwell ,
Jerry Wortzman ,
Kristine M. Bisgard  and
Susan M. Lett
Dara S. Friedman*
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
C. Robinette Curtis
Affiliation:
Epidemic Intelligence Service, Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Stephanie L. Schauer
Affiliation:
Division of Epidemiology and Immunization, Bureau of Communicable Disease Control, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
Susan Salvi
Affiliation:
Metrowest Medical Center, Framingham, Massachusetts
Henry Klapholz
Affiliation:
Metrowest Medical Center, Framingham, Massachusetts
Thomas Treadwell
Affiliation:
Metrowest Medical Center, Framingham, Massachusetts
Jerry Wortzman
Affiliation:
Metrowest Medical Center, Framingham, Massachusetts
Kristine M. Bisgard
Affiliation:
Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Susan M. Lett
Affiliation:
Division of Epidemiology and Immunization, Bureau of Communicable Disease Control, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
*
Massachusetts Department of Public Health, 305 South Street, Jamaica Plain, MA 02130
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Abstract

Background:

During a hospital obstetric rotation, a medical student demonstrated classic symptoms of pertussis. The diagnosis was confirmed by isolation of Bordetella pertussis. Because this exposure occurred in a high-risk hospital setting, control measures were undertaken to prevent transmission and illness.

Objectives:

To identify secondary cases of pertussis, to determine compliance with chemoprophylaxis recommendations, and to monitor for adverse events associated with chemoprophylaxis following a hospital exposure to pertussis.

Patients:

More than 500 individuals were potentially exposed, including 168 neonates; antimicrobial chemoprophylaxis was administered to 281 individuals. Fifty-eight neonates and 194 adults began azithromycin chemoprophylaxis; 18 neonates and 2 adults began erythromycin chemoprophylaxis.

Methods:

Active surveillance was instituted for (1) secondary cases of pertussis among healthcare coworkers, obstetric patients, their neonates, and labor companions and (2) antibiotic compliance and tolerance.

Results:

No secondary cases of pertussis were confirmed by laboratory tests; however, 26 suspected cases and 5 clinically compatible cases were identified. Antibiotic courses were completed by 95% of the individuals who initiated therapy. Neonates taking azithromycin had statistically significantly less gastrointestinal distress compared with neonates taking erythromycin (12% vs 50%; P = .002); there were no cases of infantile hypertrophic pyloric stenosis.

Conclusions:

Although it was not possible to assess the effectiveness of the antibiotic regimens, the lack of laboratory-confirmed secondary cases suggests control measures were successful. Data from the 58 neonates who received azithromycin suggest it may be well tolerated in this age group.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 11 , November 2004 , pp. 967 - 973
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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