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JAMA. 2002;288:40.

MMWR. 2002;51:394-395

On May 2, 2002, the North Carolina Department of Health and Human Services notified CDC about an infant aged 10 months adopted from Russia who had culture-confirmed pertussis diagnosed. On April 8, the adoptive parents picked him up in the orphan ward at hospital A in Bryansk and noticed that the child had upper respiratory congestion and cough. The adoptive parents reported that the infant had not received any vaccinations and that another infant living in the same room in hospital A had a severe cough. The adopted infant subsequently was examined by a local physician, who diagnosed his condition as a "cold," and the infant was taken to the U.S. Embassy in Moscow, where the parents were interviewed for an immigrant visa for the child.

On April 24, the infant and his parents traveled from Moscow to Raleigh, North Carolina, through New York on commercial airline flights. On April 26, the infant was seen as an outpatient at a local clinic; a culture of a nasopharyngeal swab confirmed infection with Bordetella pertussis. The infant improved after treatment with clarithromycin and was administered the first dose of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). The parents were placed on azithromycin for prophylaxis.

CDC is collaborating with the U.S. Embassy, adoption agencies, visa applicant medical clinics in Moscow, and the airline to identify and notify persons who might have been exposed to the infant during his communicable period. The airline is working to identify those passengers who might have been exposed to the infant during his flights to North Carolina. CDC is collaborating with state health departments, who are notifying and ensuring appropriate chemoprophylaxis and vaccination for exposed passengers in their jurisdiction.

Health-care providers and public health officials are advised to consider pertussis when evaluating or notified of a person with an acute illness characterized by cough with paroxysms, whoop, or post-tussive gagging or vomiting. Following are CDC guidelines on the management of patients with pertussis and their contacts:

• For symptomatic patients, test by culture of nasopharyngeal aspirate or swab; a nasopharyngeal Dacron^TM swab should be used. Swabs or aspirate should be placed in Regan Lowe transport media if direct inoculation of selective media is not possible.
  
• For hospitalized patients, respiratory isolation (droplet precautions) is recommended for at least the first 5 days of antimicrobial treatment.
  
• For symptomatic patients, the treatment of choice for pertussis is erythromycin for 14 days. Trimethoprim-sulfamethoxozole is an alternative antibiotic. Limited clinical data suggest that newer macrolides, such as azithromycin for 5-7 days or clarithromycin for 14 days, might be as effective as erythromycin in the treatment of pertussis and are alternatives for patients who cannot tolerate erythromycin.
  
• For exposed persons, chemoprophylaxis is recommended to limit secondary transmission. Exposure is defined as having face-to-face contact, having direct contact with respiratory, oral, or nasal secretions, or being in the same room with a coughing pertussis case-patient. The recommended chemoprophylaxis regimen is erythromycin for 14 days. Alternative therapies are the same as for symptomatic patients.
  
• Pertussis vaccination should be initiated or continued according to the recommended schedule for exposed children aged <7 years who are undervaccinated or who have received <4 DTaP doses. Exposed children may receive DTaP dose 2 or 3 if 4 weeks have elapsed after dose 1 or 2, respectively. Children may receive DTaP dose 4 as early as age 12 months, and preferably 6 months after dose 3. Children should be administered DTaP dose 5 unless a dose was given within the last 3 years or they are aged 7 years.
  

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