Outbreak investigation of pertussis in an elementary school: a case-control study among vaccinated students

Abstract

PurposeA pertussis patient from an elementary school, in Gyeonggi Province, Korea, was notified to public health authority on July 25, 2017. Epidemiologic investigation was conducted to identify the magnitude, possible source of infection and risk factors for this outbreak on August 17, 2017.Materials and MethodsA case was defined as the school student experiencing cough for more than two weeks with or without paroxysmal, whoop, or post-tussive vomiting. Control was defined as the student polymerase chain reaction-negative at the school. School based surveillance was implemented to identify additional cases.ResultsFrom June 29 to August 27, 2017, nine patients of pertussis were identified from an elementary school. Among nine cases, eight were confirmed by polymerase chain reaction positive. All cases had cough, one (11%) had post-tussive vomiting, and one (11%) had fever. Eight cases had macrolide for 7 days in outpatient clinic, and one case admitted in a hospital. There was no significant difference of demographic factors including gender (p=0.49), age group (p=0.97), number of series of vaccination of pertussis (p=0.52), the number of participation of after school activity (p=0.28), and the time elapsed since last vaccination (p=0.42). However, we found the history of contact within the classroom or after-school activity was only the independent risk factor among all the demographic factors collected (odds ratio, 63.61; 95% confidence interval, 4.35 to 930.79).ConclusionThe contributing factor for transmission is associated with the case-contact. Immediate identification of pertussis with use of appropriate diagnostic test may help to avoid a large number of cases.

Bordetella pertussis in School-Age Children, Adolescents, and Adults: A Systematic Review of Epidemiology, Burden, and Mortality in Asia

“…There were five studies about burden in Japan [57][58][59][60][61], four in South Korea [28,[62][63][64], one in India [29], and one which included three Asian countries (Taiwan, Malaysia, and Thailand) [55].…”

Seroprevalence of Pertussis in Healthcare Workers without Adult Pertussis Vaccine Use at a University Hospital in Korea

“…In 2003, the Korea Center for Disease Control and Prevention reported that the rate of tetanus and diphtheria/tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination among adults aged 19 years and over was only 7.3%. 21 The pertussis vaccination for adult is very important considering that there have been large outbreaks in the United States and Europe, 22 pertussis epidemic have occurred frequently in Korea, 23 24 and adult role as important mediators. 25 HCWs have a high likelihood of contact with pertussis patients and there are many immunocompromised patients and infants who are high-risk group of pertussis.…”

A systematic review of the burden of pertussis in South Korea

“…Clinical presentations associated with B. pertussis were reported in 9 studies included in this review, 21,25,26,29,31,[33][34][35][36] of which the majority were conducted in adolescents and adults. 25,26,29,[33][34][35] Regardless of age, the most common presentations of pertussis were paroxysmal cough followed by whooping cough, post-tussive vomiting and fever.…”

“…The vaccination status of confirmed or suspected pertussis cases was reported in 8 studies. 21,23,27,29,31,33,36,37 A total of five studies that focused on the pediatric population reported that the majority of the subjects delayed vaccination or were not vaccinated according to the recommended schedules. 21 The total number of studies depicted in the figure is 24 as five studies reported information for more than one group.…”

“…A total of 9 studies in this review reported data on source of infection. 21,23,24,26,29,[31][32][33]36 Out of these, 3 studies reported that close family members were the source of infection of laboratory-confirmed cases ranging from 40.5% to 85.7% of the infants. 21,23,31 Notably, one study showed that mothers were the source of a large proportion of cases in infants (34.2%).…”