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REVIEW ARTICLE
SUMMARY
Introduction: Pertussis is not just a childhood disease, but P ertussis, also known as whooping cough, is a clas-
sical childhood disease. After a vaccine became
available, the number of notified cases fell dramatically
a respiratory infection that causes persistent cough in all
age groups, from newborns to the elderly. (1), leading to the removal of pertussis from the list of
notifiable diseases in West Germany in 1963. In many
Methods: The authors performed a selective literature
industrialized nations, however, the number of pertussis
search and reviewed national and international recom-
notifications has increased substantially in recent years,
mendations for treatment and vaccination.
especially among school-age children, adolescents, and
Results: Pertussis is found principally in young unvaccinat- adults a trend that has also been observed in former
ed infants, but school-age children, adolescents, and East Germany (2). In the present study, we performed a
adults are also affected. Up to 1% of infants contract per- systematic search of clinically relevant international
tussis, and their respiratory symptoms are often accompa- literature and reviewed national and international
nied by apnea. School-age children occasionally display recommendations for treatment and vaccination (box 1).
the coughing spasms typical of the disease. Annually, 0.2%
to 0.5% of all adolescents and adults are infected and suffer
Epidemiology and disease burden
from prolonged, frequently non-paroxysmal coughing.
Natural infection with the bacterium Bordetella pertus-
Severe and fatal cases of pertussis occur mainly in new-
sis confers only 3.5 to 12 years of protective immunity
borns and infants, and 25% of affected adults experience
against reinfection (3, 4). Data on the duration of immu-
complications. Bordetella DNA may be detected by poly-
nity are sparse, however, due to the practical difficulties
merase chain reaction (PCR) for four weeks after symptom
of distinguishing between first infection and reinfection,
onset; except in infants, the sensitivity of this diagnostic
technique is low. Although the diagnosis can be confirmed
and because the symptoms of pertussis can vary widely.
by serological tests, the methods are not well standard- The protective effect induced by acellular vaccines is
ized. Treatment with a macrolide prevents the spread of approximately 85% after three doses and lasts for at
infection, but generally does not alleviate the symptoms. least five years (1, 3), after which a gradual decrease in
Combination vaccines are the most effective means of immunity is observed. As a result, the incidence of per-
prophylaxis. tussis can be expected to be high in school-age children,
adolescents, and adults who do not receive booster vac-
Discussion: Pertussis is usually not included in the differ-
cinations, even in settings where high vaccine coverage
ential diagnosis of persistent respiratory symptoms. The
in young children has been achieved.
considerable burden of disease could be reduced in adults
In many countries, the annual incidence of pertussis
and young infants by vaccinating adults with acellular
in adolescents and adults ranges from 0.18% to 0.51%,
combination vaccines. Dtsch Arztebl 2008; 105(37): 6238
independently of vaccine coverage in childhood (5). In
DOI: 10.3238/arztebl.2008.0623
Germany, a study conducted in Rostock and Krefeld
Key words: pertussis, epidemiology, pediatric disease,
pointed to a frequency of 165 cases per 100 000 popula-
treatment concept, vaccination recommendations
tion per year (6). Whereas almost all birth cohorts since
1964 have been vaccinated in Rostock, vaccine coverage
in Krefeld was low from the 1970s until around 1995.
Nevertheless, there was no statistical difference in the
incidence of pertussis among adults in the two cities,
demonstrating that vaccination during infancy has no
influence on the incidence of disease during adulthood.
Pertussis is endemic in Germany (2). Every three to
four years, a wave of infections occurs, which at its peak
shows an incidence that is three to four times as high as
Institut fr Infektiologie Krefeld GmbH, Krefeld: Dr. med. Dipl. Biol. Riffelmann during the interepidemic periods. Due to different
Landesamt fr Gesundheit und Soziales MV, Rostock: Dr. med. Littmann,
Prof. Dr. med. Hle
surveillance systems, the notification data in Europe
Robert-Koch-Institut, Berlin: Dr. med. Hellenbrand
show stark variations, ranging from <1 (Portugal) to
Institut fr Hygiene und Labormedizin, HELIOS Klinikum Krefeld: 200 (Switzerland) registered cases per 100 000 inhabi-
Prof. Dr. med. Wirsing von Knig tants per year (7). In eastern Germany, the incidence of
Manuscript received on 6 March 2008; revised version accepted on 17 June 16. Riffelmann M, Caro, V, Guiso N, Wirsing von Knig CH, Consensus
2008. Group: Nucleic acid amplification tests for diagnosis of Bordetella
infections. J Clin Microbiol 2005, 43: 49259.
Translated from the original German by Matthew D. Gaskins
17. Wendelboe AM, Van Rie A: Diagnosis of pertussis: a historical review
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REVIEW ARTICLE
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