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Pertussis long has been recognized as a serious threat to children's health in the developing world. Despite remarkable advances in global childhood immunization rates during the past 2 decades, it is estimated that more than 350,000 infants and children still die of pertussis each year in developing countries. 17,26 What perhaps is not so well known is that pertussis remains a disease of considerable public health importance in this country. Many of the other vaccine-preventable diseases have been well controlled in the United States by widespread immunization, but pertussis remains problematic. Primary care practitioners who thought that whooping cough was disappearing after the fashion of smallpox and polio may have been surprised by the multiple outbreaks of pertussis throughout the United States in 1993. 1,6,7,10 During 1994, more than 1600 infants younger than 1 year of age were diagnosed with pertussis, making pertussis the most common vaccine-preventable illness in children in this age group. 41 This recent rise in the number of cases of pertussis has heightened interest in its diagnosis, treatment, and prevention. First, there has been greater demand for a diagnostic test that is rapid and reliable. The increasing awareness of atypical illnesses among young infants and adolescents has made laboratory confirmation particularly important. Once the diagnosis of pertussis has been established, the primary focus of attention shifts to treatment options, especially the role of antimicrobial therapy for patients and their close contacts. Finally, the development of acellular vaccines for use in pertussis prevention has stimulated renewed discussions as to whom, how, and when to vaccinate. 17 When can we begin to immunize infants with these newer vaccines? Should we consider reimmunization of adolescents and adults as well? This article reviews the clinical presentation of pertussis infection, new laboratory tests available to aid in diagnosis, new recommendations for treatment, and recent developments in pertussis vaccines. |
