1951. Pediatric Bordetella parapertussis Emergence in the Era of Acellular Pertussis Vaccine
Session: Poster Abstract Session: Clinical: Respiratory Track
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
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  • Background:

    Bordetella parapertussis is infrequently identified as a separate disease entity from Bordetella pertussis. While isolated outbreaks of B. parapertussis are reported in the US, there is little data comparing the epidemiology and clinical features of B. parapertussis to B. pertussis. We sought to compare pediatric disease caused by B. parapertussis to B. pertussis during the period from 2010-2015.

    Methods:

    Microbiology laboratory records were reviewed from 1984 to 2015 (Figure 1) to identify cases of pertussis and parapertussis. Demographic data, vaccination status, and clinical course were collected for cases from 2010-2015 when PCR utilizing targets differentiating pertussis and parapertussis was routinely used. FisherÕs Exact Test was used for categorical variables.

    Results:

    312 patients with B. pertussis and 27 with B. parapertussis (8%) were included. No difference in gender was seen. Immunization status was similar, but not optimal in patients with parapertussis (74%) and pertussis (67%). A bimodal age distribution was found for pertussis cases with peaks at 2-6 months and 5-11 years, while parapertussis cases predominated from 5 to 11 years of age (Figure 2). An increase in parapertussis cases was seen from 2013-2015 as pertussis cases declined (Figure 3). While presentation and course were similar, patients with parapertussis were more likely to exhibit staccato cough (p=0.013) and tachypnea (p=0.01). More patients with pertussis were hospitalized (24%) compared to those with parapertussis (7%) (p=0.05); however, patients with parapertussis were more likely to be diagnosed on their first visit to a provider (p=0.02). Providers were more likely to provide prophylaxis to household members when the child was diagnosed with pertussis compared to parapertussis (p=0.0001).  

    Conclusion:

    B. parapertussis is an emerging pathogen and infection is likely under-recognized. While previously described as a mild pertussis syndrome, our patients were identified on their first physician visit leading to earlier treatment, which may mitigate disease spread. Guidelines for testing and treatment are needed, especially in households with young infants or immunocompromised hosts.

    Rachel Lieberman, MD1, Angela Myers, MD, MPH, FPIDS2, Grant Hamill, MD1, Jacob Ward, DO1 and Mary Anne Jackson, MD, FIDSA, FPIDS3, (1)Pediatrics, Children's Mercy Hospitals & Clinics, Kansas City, MO, (2)Children's Mercy Hospital, Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, MO, (3)Pediatrics, Children's Mercy Hospital, Kansas City, MO

    Disclosures:

    R. Lieberman, None

    A. Myers, None

    G. Hamill, None

    J. Ward, None

    M. A. Jackson, None

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