Factors Associated with Time to Appropriate Treatment in Pertussis Cases in Georgia, 2009 to 2013

Abstract

Pertussis is endemic in the United States, with periodic epidemics that continue to highlight its importance as a public health issue. The clinical presentation of pertussis can vary by age and vaccination status. However, little is known about the factors that affect time to antibiotic treatment of pertussis cases. We analyzed 5 years of data from the Georgia Department of Public Health to understand how factors such as age, symptoms, and vaccination status can alter the clinical picture of pertussis and affect time to treatment. We used multivariable linear regression to assess the impact of each variable on time to antibiotic treatment. There was little consistency across age groups for symptom and demographic predictors of time to antibiotic treatment. Overall, the multivariate linear regression showed that among patients <18 years old, none of the variables had an impact on time to antibiotic treatment greater than ؊0.25 to 1.47 days. Among patients >18 years old, most variables had little impact on time to treatment, though two (paroxysmal cough in >18-to 40-year-olds and hospitalization in individuals over 40) were associated with an additional 5 days in time to treatment from cough onset. This study highlights how the difficulties in pertussis diagnosis, particularly among adults, can affect time to antibiotic treatment; adults may not begin antibiotic treatment until there is an accumulation of symptoms. Health care providers need to recognize the variety of symptoms that pertussis can present with and consider confirmatory testing early.

Evaluating the role of cough duration in the pertussis case definition among Michigan cases, 2000–2010

“…To address this issue, we used conservative statistical methods, substituting a negative response for missing bivariate data. It is also reassuring that our cough attributes had similar frequencies to those reported in other surveillance studies (Bortolussi et al, 1995; Domínguez et al, 2017; Goodenough et al, 2016; Jõgi et al, 2018; Kilgore et al, 2016; McNamara et al, 2017; Shakib et al, 2009).…”

“…While pertussis incidence has been declining in the U.S. since the mid-20th century, the past three decades have been characterized by increased incidence with cyclic and large epidemics (Kilgore et al, 2016; Winter et al, 2014). Pertussis incidence among both adolescents and adults has increased, despite diagnostic challenges of atypical or mild symptoms and delayed healthcare seeking behaviors (Goodenough et al, 2016; Kilgore et al, 2016). Delay in treatment increases the risk of transmission and further fuels the large-scale outbreaks (Goodenough et al, 2016; Kenyon et al, 2014; Skoff et al, 2012; Winter et al, 2014).…”

“…Pertussis incidence among both adolescents and adults has increased, despite diagnostic challenges of atypical or mild symptoms and delayed healthcare seeking behaviors (Goodenough et al, 2016; Kilgore et al, 2016). Delay in treatment increases the risk of transmission and further fuels the large-scale outbreaks (Goodenough et al, 2016; Kenyon et al, 2014; Skoff et al, 2012; Winter et al, 2014). In light of the changing epidemiology, and the risk for greater spread with delayed diagnosis, clinical characteristics continue to be a relevant, if frequently ignored, diagnostic criteria for clinicians in the identification of pertussis, especially among adults and vaccinated individuals (Domínguez et al, 2017; Goodenough et al, 2016).…”

“…paroxysms, post-tussive vomiting) have higher specificity (Domínguez et al, 2017; Ebell et al, 2017; Jõgi et al, 2018; Moore et al, 2017). The shifting age epidemiology of pertussis cases, with longer time to treatment (Goodenough et al, 2016), makes it less likely that cases will be laboratory positive, and requires broader utilization of the clinical case definition, thereby improving reporting of probable pertussis cases to better characterize population-level susceptibility.…”

Clinical Evaluation of a New Rapid Immunochromatographic Test for Detection of Bordetella Pertussis Antigen

“…Pertussis has non-speci c symptoms such as rhinorrhea, sneezing, and non-speci c cough during the catarrhal phase, and characteristic symptoms such as paroxysms, whooping, post-tussive vomiting, and apnea during the paroxysmal phase [9,10]. The severity and characteristics of the symptoms vary depending on the age of the patient, duration of infection, and vaccination [11,12]. Since there are often no speci c clinical symptoms, it is di cult to diagnose based on clinical symptoms alone [13].…”