The next issue of The Medical Letter (September 17, 2012) will include an article on Prevention and Treatment of Pertussis. The impetus for an article on this topic is a large outbreak of the disease in 2012; more cases have been reported this year than in any one of the past 30 years. Some deaths have occurred, mainly in infants less than 3 months old. Use of a 30-year yardstick is appropriate because the acellular pertussis vaccine, which has replaced whole-cell pertussis vaccine in the US, first became available here in 1992. Reactions to the whole-cell vaccine were fairly common and played a part in the development of a back-to-nature movement that preached against immunization of children. The acellular vaccine is less antigenic than the whole-cell vaccine; it causes far fewer reactions, but confers a shorter duration of protection.

Pertussis is a bacterial infection, but it is difficult to diagnose and to treat. In the typical case (which may not be what you see in partly immunized subjects), the first symptoms are those of an upper respiratory infection. This is the catarrhal stage, which lasts about 2 weeks. Treatment with antimicrobial drugs given at this stage can prevent or at least ameliorate the symptoms of the second, or paroxysmal stage, which features the well-known fits of coughing followed by the characteristic whoop. Treatment at this stage probably is of little benefit to the patient, but it may prevent spread of the disease to others. Both stages are generally afebrile, or close to it. The difficulty of making a timely diagnosis is compounded by the absence of any rapid diagnostic test.

So what should we do about all this? Read the next issue of The Medical Letter to find out.

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