The Increasing Incidence of Pertussis in Massachusetts Adolescents and Adults, 1989–1998

Abstract

From 1989 to 1998, the incidence of pertussis increased in Massachusetts adolescents and adults, reaching 71 and 5 per 100,000, respectively, by 1998, whereas the incidence in children remained stable. By 1998, 92% of cases occurred in adolescents and adults. Nationally, in contrast, adolescents and adults had incidences of only 5 and 0.8 per 100,000, respectively, and accounted for 47% of cases. The availability of a specific serologic test and active surveillance by public health personnel in Massachusetts are at least partial explanations. The rise in incidence may be real, however, because, as diagnostic efforts increased, the percentage of patients with a positive serologic test result also increased. Cases identified in adolescents and adults were quite severe: 83% and 87%, respectively, experienced paroxysmal cough, 45% and 41% experienced vomiting, and 41% and 52% experienced a cough lasting >4 weeks. Administration of acellular pertussis vaccine in these age groups could prevent this substantial morbidity.

Performance of Commercial Enzyme-Linked Immunosorbent Assays for Detection of Antibodies to Bordetella pertussis

“…Various cutoff values for anti-PT IgG in adolescents and adults have been proposed, and they are summarized in Table 3. In Massachusetts a high specificity was obtained using approximately Ն200 EU/ml anti-PT IgG (Ն20 g/ml) (25). In the Netherlands, a cutoff of Ն125 EU/ml anti-PT IgG with higher specificity and a cutoff of Ն62 EU/ml with slightly lower specificity have been used (4,20) In Germany, a cutoff of approximately Ն40 EU/ml anti-PT IgG together with approximately Ն40 EU/ml anti-FHA IgA was suggested (23).…”

A multiplex PCR for detection of Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, and Bordetella pertussis in clinical specimens

“…pertussis and experience milder symptomology with persistent (non-whooping) cough of 2 or more weeks and only occasional pneumonia, whooping cough, apnea, and/or vomiting [25,26].…”

High frequency of pertussis in older children and adolescents with prolonged cough in Turkey

“…In the present study, IS481 PCR assay was performed for diagnosis of pertussis in vaccinated children and adolescents with a cough of two to four weeks' duration. However, disadvantages to PCR include its relatively high cost, more limited availability, and the potential for false-negative or false-positive results 32,33 .…”