Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-12-02T19:43:59.656Z Has data issue: false hasContentIssue false
  • English
  • Français

Containment of Pertussis in the Regional Pediatric Hospital During the Greater Cincinnati Epidemic of 1993

Published online by Cambridge University Press:  02 January 2015

Celia D.C. Christie ,
Anne Marie Glover ,
Mary Jane Willke ,
Mary L. Marx ,
Shirley F. Reising  and
Nancy M. Hutchinson
Celia D.C. Christie
Affiliation:
Children's Hospital Medical Center, Divisions of Infectious Diseases, Cincinnati, Ohio Hospital Epidemiology, Cincinnati, Ohio Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
Anne Marie Glover
Affiliation:
Hospital Epidemiology, Cincinnati, Ohio
Mary Jane Willke
Affiliation:
Employee Health, Cincinnati, Ohio
Mary L. Marx
Affiliation:
Hospital Epidemiology, Cincinnati, Ohio
Shirley F. Reising
Affiliation:
Children's Hospital Medical Center, Divisions of Infectious Diseases, Cincinnati, Ohio Clinical Microbiology, Cincinnati, Ohio Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
Nancy M. Hutchinson
Affiliation:
Hospital Epidemiology, Cincinnati, Ohio
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe methods of preventing nosocomial pertussis in patients, employees, and visitors to a hospital during a communitywide epidemic in Greater Cincinnati.

Design:

Six-month descriptive study of the methods, effectiveness, and cost of a program to prevent nosocomial pertussis.

Setting:

Three hundred sixty-one bed, tertiary-care, university, pediatric hospital.

Results:

We educated 3,764 hospital employees about pertussis. We evaluated 206 employees with respiratory illnesses, based on clinical presentation, pertussis exposure, and work setting. Eighty-seven had pertussis: 84 coughed for ≥2 weeks (outbreak clinical case definition), 65 had paroxysms, 27 whooped, 22 had posttussive emesis, and 13 were positive by direct fluorescent antibody or culture for Bordetella pertussis. Seventy-nine employees were sent on 5-day furloughs. Six hundred twenty-two employees received 14 days of erythromycin (579) or trimethoprim-sulfamethoxazole (43). Symptomatic patients were identified at triage in the emergency department and placed in respiratory isolation. Suspect pertussis cases were admitted in respiratory isolation. Among 49 toddlers who were given erythromycin and managed in “coughing respiratory cohorts,” eight had proven pertussis. Inpatients were restricted to assigned nursing units. Respiratory masks were required for those entering the test referral center, where more than 3,500 pertussis cultures were performed. Hospitalwide visitor restriction was enforced for those aged 14 years or younger and for those with respiratory symptoms. Only parents and guardians were permitted to visit the newborn intensive care unit. A child-care service managed 488 inpatient sibling visitors. Four symptomatic children in the employees' child-care center were excluded pending physician evaluation; one had pertussis.

Conclusions:

Control measures appeared effective. Pertussis occurred in 87 (2%) employees. Among 102 children hospitalized with pertussis, respiratory isolation was delayed in nine cases, and one case was nosocomial. Program expenses totalled $85,400. Adult booster immunization with acellular pertussis vaccine might represent the safest and least expensive strategy for preventing epidemic pertussis, and controlled trials of acellular pertussis vaccine in hospital employees are needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 10 , October 1995 , pp. 556 - 563
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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. Centers for Disease Control and Prevention. Resurgence of pertussis—United States, 1993. MMWR 1993;42:952–961.Google Scholar
2. Lambert, HJ. Epidemiology of a small pertussis outbreak in Kent County, Michigan. Public Health Rep 1965;80:365–369.CrossRefGoogle ScholarPubMed
3. Jenkinson, D. Duration of effectiveness of pertussis vaccine; evidence from a 10-year community study. BMJ 1988;296:612–614.CrossRefGoogle Scholar
4. Cromer, BA, Goydos, J, Hackell, J, Mezzatesta, J, Dekker, C, Mortimer, EA. Unrecognized pertussis infection in adolescents. Am J Dis Child 1993;147:575–577.Google Scholar
5. Aoyama, T, Tacheuchi, Y, Goto, A, Iwai, H, Murase, Y, Iwata, T. Pertussis in adults. Am J Dis Child 1993;146:163–166.Google Scholar
6. Christie, CD, Baltimore, RS. Pertussis in neonates. Am J Dis Child 1989;143:1199–1202.Google Scholar
7. Christie, CD, Baltimore, RS. Conqueluche chez le nouveau-ne. Pediatrie 1990;80:23–26.Google Scholar
8. Linneman, CC Jr Nasenbury, J. Pertussis in the adult. Annu Rev Med 1977;28:179–185.Google Scholar
9. Morse, SI. Pertussis in adults. Ann Intern Med 1968;68:953–954.Google Scholar
10. Trollfors, B, Rabo, E. Whooping cough in adults. BMJ 198;283:696–697.Google Scholar
11. Robertson, PW, Goldberg, H, Jarvie, BH, Smith, DD, Whybin, LR. Bordetella pertussis infection: a cause of persistent cough in adults. Med J Aust 1987;146:522–525.Google Scholar
12. Mink, CA, Cherry, JD, Christenson, P, et al. A search for Bordetella pertussis infection in university students. Clin Infect Dis 1992;14:464–471.Google Scholar
13. Nelson, JD. The changing epidemiology of pertussis in young infants: the role of adults as reservoirs of infection. Am J Dis Child 1978;132:371–373.CrossRefGoogle ScholarPubMed
14. Herwaldt, LA. Pertussis in adults: what physicians need to know (review). Arch Intern Med 1991;115:1510–1515.CrossRefGoogle Scholar
15. Linneman, CC Jr, Ramundo, N, Perlstein, PH, Minton, SD, Englender, GS. Use of pertussis vaccine in an epidemic involving hospital staff. Lancet 1975;2:540–543.Google Scholar
16. Kurt, TL, Yeager, AS, Guenette, S, Dunlop, S. Spread of pertussis by hospital staff. JAMA 1972;221:264–267.Google Scholar
17. Addis, DG, Davis, JP, Meade, BJ, et al. A pertussis outbreak in a Wisconsin nursing home. J Infect Dis 1991;164:704–710.Google Scholar
18. Steketee, RW, Wassilak, SG, Adkins, WN, et al. Evidence for a high attack rate and erythromycin prophylaxis in pertussis outbreak in a facility for the developmentally disabled. J Infect Dis 1988;157:434–440.Google Scholar
19. Fisher, MC, Long, SS, McGowan, KL, et al. Outbreak of pertussis in a residential facility for handicapped people. J Pediatr 1989;114:934–939.CrossRefGoogle Scholar
20. Hardy, IR, Hoekstra, E, Wells, V, et al. Large pertussis outbreak, Cincinnati, 1993: high attack rate among vaccinated preschool children. Abstracts of the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy, October 4-7, 1994, Orlando, FL; American Society for Microbiology 1994, Washington, DC.Google Scholar
21. Christie, CD, Marx, M, Marchant, CM, Reising, SF. The 1993 epidemic of pertussis in Cincinnati: resurgence of disease in a highly immunized population of children. N Engl J Med 1994;331:16–21.Google Scholar
22. Garner, JS, Simmons, BP. Guidelines for isolation precautions in hospitals. Infect Control 1983;4(suppl):245–325.Google Scholar
23. Bass, JW, Klenk, ET, Kothmeier, JB, Linnemann, CC, Smith, MH. Antimicrobial treatment of pertussis. J Pediatr 1969;75:768–781.CrossRefGoogle ScholarPubMed
24. Barraff, LJ, Wilkins, J, Wehrle, PF. The role of antibiotics, immunizations, and adenoviruses in pertussis. Pediatrics 1978;61:224–230.Google Scholar
25. Bass, JW. Pertussis: current status of prevention and treatment. Pediatr Infect Dis J 1985;4:614–619.Google Scholar
26. Bass, JW. Erythromycin for treatment of pertussis. Pediatr Infect Dis J 1986;5:154–157.Google Scholar
27. Combined Scottish Study. Diagnosis of whooping cough: comparison of serologic tests with isolation of Bordetella pertussis . Br Med J 1970;4:637–639.CrossRefGoogle Scholar
28. Long, SS, Welkon, CJ, Clark, JL. Widespread silent transmission of pertussis in families: antibody correlates of infection and symptomatology. J Infect Dis 1990;161:480–486.Google Scholar
29. Christie, CD, Marx, ML, Wells, V, Daniels, JA, Adcock, MP. Control of pertussis in Cincinnati schools and daycare centers during the Greater Cincinnati pertussis epidemic of 1993. Poster presentation, Society for Healthcare Epidemiology of America, San Diego, California, April 1995. Abstract S33.Google Scholar