Suffer the Infants: A Severe Case of Pertussis in Oregon, 2012

Abstract

Pertussis remains a public health concern in Oregon, especially among young infants. The disease can be severe in this age group and is associated with a high inpatient cost. This report describes an Oregon infant who was hospitalized with pertussis for 90 days, required extracorporeal oxygenation for 43 days, suffered complications including stroke, and had hospital charges totaling $1.5 million. Pertussis morbidity among young infants argues for vaccination of women during each pregnancy and of infants beginning promptly at two months of age.Pertussis is often considered a merely persistent but ultimately self-limited nagging cough. However, afflicted infants may suffer hospitalization, serious complications, and sometimes death. 1 We report a severe case of pertussis and review recent public health data to describe the burden of pertussis among infants in Oregon. CASE REPORTA 3,136-gram Hispanic girl was born at 35 weeks' estimated gestational age via normal spontaneous vaginal delivery, was vaccinated at birth with hepatitis B vaccine, and had an uneventful postnatal course. The family subscribed to vaccination, and the baby's siblings were current with pertussis-containing vaccines. The mother had declined tetanus, diphtheria, and acellular pertussis vaccine (Tdap) offered during pregnancy. She received it two weeks after delivery.At 18 days of life, the baby was brought to an emergency department for a choking episode after being bottle-fed breast milk. According to the patient's father, prior to being brought to the emergency department, the baby had

Extracorporeal Membrane Oxygenation for Pertussis: Predictors of Outcome Including Pulmonary Hypertension and Leukodepletion

“…While the exact mechanism is unknown, pertussis toxin-mediated hyperinflammation and leukocyte activation has been shown to be 14 involved [19]. Only a handful of case reports have described patients with pertussis and PHTN surviving after ECMO [31][32][33][34]. We report that pulmonary hypertension was significantly and independently related to mortality; however, the majority of the patients in our study (69 of 73) had PHTN or RV failure.…”

“…An infant with pertussis in Oregon who required 43 days of ECMO support and a 90-day hospital stay totaled $1.5 million dollars. [34] The Australia and New Zealand Paediatric Intensive Care group (ANZPIC) also report a heavy financial burden of over $1 million per year in direct pertussis-related hospitalization costs [20].…”

Five-Year Follow-up of a Severe Case of Pertussis in Oregon, 2012

“…We previously described a severe case of pertussis in an Oregon neonate born in 2012 at 35 weeks’ gestational age. 1 The patient was admitted to the hospital with pertussis at age 3 weeks and remained there for 90 days, including 75 days in a pediatric intensive care unit (PICU). Her hospital course was characterized by severe complications, including pneumonia, severe pulmonary hypertension, medically treated necrotizing enterocolitis, a left middle cerebral artery stroke, seizures, hyperbilirubinemia, dysphagia, encephalopathy, renal failure, benzodiazepine dependence, and bronchiolitis obliterans.…”