1195. Clinical and Laboratory Diagnosis of Pertussis in Kansas City Children in the Era of Tdap
Session: Poster Abstract Session: Other Bacterial Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Infection with Bordetella pertussis continues to cause significant morbidity and mortality. The burden of disease in the Kansas City area was sought based on cases with positive testing at Children’s Mercy Hospital (CMH) from 2005-2010.

Methods: This is a retrospective study of 211 laboratory-confirmed (PCR or culture) cases tested for pertussis at CMH from 2/2005 through 4/2010. Chart review was performed for demographics, symptomatology, presenting location, laboratory tests, imaging, treatment, and vaccine status. Clinical definition of pertussis was based on WHO guidelines from retrospective chart review and/or physician diagnosis. Comparisons were made between CMH PCR & culture results and patients with a physician diagnosis of pertussis. 

Results: 210 charts were available for review; clinical definition could not be determined or not met for 56 and 23 respectively. Age range was 1-192 months (median 8 mos), with 56% <1 year of age and 13% over 10 years. 52% were female, 74% White, and 49% had Medicaid status. Of 131 patients with a clinical diagnosis of pertussis: 63% had cough >2 weeks, 96% had paroxysms, 60% had post-tussive emesis, 24% had apnea, 17.5% had choking, 32% had hypoxia, and 22% had bradycardia, mean WBC 26,000 and mean ALC 26,000. Treatment was documented in 130/131(99%) of patients. Vaccine status was available in 143 patients, with 66% being appropriate for age. 69/164(42%) had more than one visit prior to diagnosis, and 87(42%) presented initially to their PCP, 104(50%) to CMH, and 19(9%) elsewhere. Of those with an xray, the majority had normal findings (65%). Sensitivity of culture and PCR in detection of clinically diagnosed pertussis was 84%(95/113) and 99%(128/129) respectively. 8 culture-confirmed and 22 PCR positive patients were categorized as negative for clinical pertussis disease based on WHO criteria and physician diagnosis. 

Conclusion: Classic presentations, primarily in young infants, were seen and patients were treated appropriately. However, nearly half had delay in diagnosis and vaccine status was suboptimal. Clinical sensitivity of PCR was higher than culture in pertussis diagnosis. Future study will focus on enhancing documentation and vaccination rates in this vulnerable population. 

Subject Category: P. Pediatric and perinatal infections

Jeremiah Raney, D.O., Housestaff/GME, Childrens Mercy Hospital, Kansas City, MO, Rangaraj Selvarangan, PhD, Children's Mercy Hospital and Clinics, Kansas City, MO, Ashley Sherman, Biostatistics, Childrens Mercy Hospital, Kansas City, MO and Angela Myers, MD, MPH, Children's Mercy Hospital, Kansas City, MO


J. Raney, None

R. Selvarangan, None

A. Sherman, None

A. Myers, None

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