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Pertussis is an endemic (common) disease in the United States, with peaks in disease every 3 to 5 years and frequent outbreaks. In 2010, 27,550 cases of pertussis were reported — and many more cases go unreported. The primary goal of pertussis outbreak control efforts is to decrease morbidity (amount of disease) and mortality (death) among infants; a secondary goal is to decrease morbidity among persons of all ages.
Pertussis outbreaks can be difficult to identify and manage. Other respiratory pathogens often cause clinical symptoms similar to pertussis, and co-circulation with other pathogens (bacterial and viral) does occur. In order to respond appropriately (e.g., provide appropriate antibiotic prophylaxis), it is important to confirm that Bordetella pertussis is circulating in the outbreak setting and to determine whether other pathogens are contributing to the outbreak. Polymerase chain reaction (PCR) tests vary in specificity, so obtaining culture confirmation of pertussis for at least one suspicious case is recommended any time there is suspicion of a pertussis outbreak.
Pseudo outbreaks of pertussis have resulted because of false positive test results with PCR. This underscores the importance of recognizing clinical signs and symptoms and practicing careful laboratory testing.
Institutional outbreaks of pertussis are common. Outbreaks at middle and high schools can occur as protection from childhood vaccines fades. In school outbreaks, prophylaxis is recommended for close classroom and team contacts — and the pertussis booster vaccine (Tdap) depending on age. Pertussis outbreaks in hospitals and other clinical settings can put infants and other patients at risk.
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