The prevention of severe pertussis and pertussis deaths in young infants

ABSTRACT

Introduction: Today, in the developed world, virtually all deaths due to Bordetella pertussis illnesses occur in young infants.

Areas Covered: Pertussis in young infants is characterized by an afebrile cough illness with coryza, apnea, seizures, cyanosis, and emesis. Severe illness is associated with high leukocyte and lymphocyte counts, rapid respiratory and cardiac rates and pneumonia. Many routine intensive care treatment procedures are detrimental: these include steroids and nitric oxide. Preventative measures include: quarantine, prophylactic antimicrobial agents and immunizations of the mother to be with Tdap between 27 and 36 weeks gestation.

Expert Opinion: Infants deaths are due to the irreversible pulmonary hypertension which is caused by aggregates of leukocytes in the small vessels in the lung. The leukocytosis with lymphocytosis is due to pertussis toxin. It can be treated by exchange blood transfusions. However for this to be successful it needs to be started before shock or organ failure has occurred. To prevent pertussis in young infants, attention needs to be directed to the diagnosis and treatment of pertussis in adolescents and adults. Also important are antimicrobial prophylaxis in the infant and the immunization of mothers to be with Tdap vaccine during all pregnancies.

KEYWORDS:

• Pertussis
• leukocytes
• lymphocytes
• pertussis toxin
• exchange transfusion
• infants
• pulmonary hypertension

Article highlights

• Pertussis deaths in the United States were declining before the vaccine era.

• Today infant pertussis deaths still occur. About 5% of the infant pertussis cases die.

• The source of pertussis in infants is unrecognized pertussis in an adolescent or an adult. Greater awareness of adolescent and adult pertussis is necessary to stop transmission to infants.

• Pertussis in infants is a distinctive illness but most cases are incorrectly diagnosed.

• The prompt diagnosis of infant pertussis and appropriate antimicrobial treatment will prevent death.

• Immunization of the pregnant woman with Tdap can be expected to prevent virtually all pertussis deaths in the first 2 months of life.

• The cause of pertussis deaths in infants is irreversible pulmonary hypertension due to leukocytosis with lymphocytosis.

• Some routine treatments in pediatric intensive care units may be contribute to pertussis deaths in young infants.

• The recommended treatment for extreme leukocytosis in young infants with pertussis is an exchange blood transfusion.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.