Infectivology Xagena

School age children presenting with persistent cough: pertussis after vaccination

A prospective cohort study has estimated the prevalence and clinical severity of whooping cough ( pertussis ) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination.

Participants were 279 children in the United Kingdom, aged 5 to 15 years, who presented in primary care with a persistent cough of two to eight weeks’ duration.
Exclusion criteria were cough likely to be caused by a serious underlying medical condition, known immunodeficiency or immunocompromise, participation in another clinical research study, and preschool pertussis booster vaccination received less than one year previously.

The main outcome measure was evidence of recent pertussis infection based on an oral fluid anti-pertussis toxin IgG titre of at least 70 arbitrary units.
Cough frequency was measured in six children with laboratory confirmed pertussis.

56 ( 20% ) children had evidence of recent pertussis infection, including 39 ( 18% ) of 215 children who had been fully vaccinated.

The risk of pertussis was more than three times higher ( 21/53; 40% ) in children who had received the preschool pertussis booster vaccination seven years or more previously than in those who had received it less than seven years previously ( 20/171; 12% ).

The risk of pertussis was similar between children who received five and three component preschool pertussis booster vaccines ( risk ratio for five component vaccine 1.14 ).

Four of six children in whom cough frequency was measured coughed more than 400 times in 24 hours.

In conclusion, pertussis can still be found in a fifth of school age children who present in primary care with persistent cough and can cause clinically significant cough in fully vaccinated children. ( Xagena )

Wang K et al, BMJ 2014;348:g3668