A survey of the domestic epidemiological characteristics and clinical manifestations of pertussis

Seock Hwa Yoon; Yong Hee Hong; Hee Kyung Lee; Jong Hyun Lee; Meeyong Shin

doi:10.4168/aard.2018.6.1.54

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Yoon, Hong, Lee, Lee, and Shin: A survey of the domestic epidemiological characteristics and clinical manifestations of pertussis

Original Article

Allergy Asthma Respir Dis 2018;6(1):54-61.

Published online: 5 January 2018

DOI: https://doi.org/10.4168/aard.2018.6.1.54

A survey of the domestic epidemiological characteristics and clinical manifestations of pertussis

Seock Hwa Yoon¹, Yong Hee Hong¹, Hee Kyung Lee², Jong Hyun Lee², Meeyong Shin¹

¹Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

²Department of Pediatrics, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea

Correspondence to: Meeyong Shin https://orcid.org/0000-0003-3699-8741 Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea Tel: +82-32-621-5406, Fax: +82-32-621-5560, E-mail: smy0218@schmc.ac.kr

• This research was supported by the Soonchunhyang University Research Fund.

Received 26 May 20175 July 2017 Accepted 19 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This report describes the results of a survey of the characteristics of pertussis in children from a single institution and com-pares it to data from the Korea Centers of Disease Control (KCDC).

Methods

We retrospectively evaluated the medical records of 17 and 6 patients diagnosed with pertussis and parapertussis, respectively, at Soonchunhyang University Bucheon Hospital from January 2005 to January 2017.

Results

Of the 17 patients with pertussis, 9 were under 1 year of age (52.9%), 3 were aged between 1 and 10 years (17.6%), and 5 were over 10 years of age (29.4%). Seven patients (41.2%) had never received diphtheria-tetanus-acellular pertussis vaccines, of which 5 were infants below 2 months of age and 2 were 10 years old and lived in China. Four patients showed the initial symptoms of cough in China. The sources of infection were the parents (2 cases) and the siblings (8 cases). All patients showed prolonged severe cough and the average duration of cough was 26 days. Severe symptoms, including dyspnea, cyanosis, apnea, and seizures, were observed in the children under 2 months of age. According to the recent 10-year KCDC data, the highest rate of pertussis diagnosis was noted in infants (47.8%), followed by adolescents (18.7%). Six patients with parapertussis also presented with prolonged severe cough without any other severe symptoms. Lymphocytosis was not found, unlike the patients with pertussis.

Conclusion

The possibility of pertussis and parapertussis should be considered among patients with prolonged severe cough, especially in infants and adolescents.

Keywords: Bordetella pertussis, Bordetella parapertussis, Diphtheria-tetanus-acellular pertussis vaccines

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Fig. 1.

Age distribution of pertussis: comparison to Korea Centers for Disease Control and Prevention (KCDC).

Fig. 2.

Monthly incidence of pertussis: comparison to Korea Centers for Disease Control and Prevention (KCDC).

Fig. 3.

Pertussis incidence from 2005 to 2016 (Korea Centers for Disease Control and Prevention data.

Table 1.

Clinical characteristics of pertussis according to age

Variable	Total (n=17)	Age<1 yr (n=9)	Age≥1 yr (n=8)	P-value∗
Disease duration (day)	26.2±9.0	29.1±8.8	23.0±8.6	0.161
Symptom
Cough	17 (100)	9 (100)	8 (100)	NA
Sputum	8 (47.1)	4 (44.4)	4 (50.0)	1.000
Rhinorrhea	9 (52.9)	5 (55.6)	4 (50.0)	1.000
Fever	2 (11.8)	1 (11.1)	1 (12.5)	1.000
Vomiting	4 (23.5)	4 (44.4)	0 (0)	0.113
Cyanosis	5 (29.4)	5 (55.6)	0 (0)	0.048
Dyspnea	5 (29.4)	5 (55.6)	0 (0)	0.048
Apnea	2 (11.8)	2 (22.2)	0 (0)	0.506
Convulsion	2 (11.8)	2 (22.2)	0 (0)	0.506
Severity				0.001
Severe^†	8 (47.1)	8 (88.9)	0 (0)
Mild^‡	9 (52.9)	1 (11.1)	8 (100)
Infiltration on the chest x-ray				0.661
No	13 (76.5)	6 (66.7)	7 (87.5)
Yes	4 (23.5)	3 (33.3)	1 (12.5)
WBC (/mm³)	16,494.2±6,690.7	17,961.1±6,035.1	12,093.3±7,860.3	0.166
Lymphocyte (%)	61.5±19.1	69.8±9.9	36.8±19.8	0.033
Absolute No. of lymphocyte	10,560.7±5,884.8	12,767.1±4,938.4	3,941.3±2,299.6	0.033

Values are presented as mean±standard deviation or number (%).

WBC, white blood cells; NA, not available.

^∗ P-values were calculated by Mann-Whitney U-test for continuous variables and Fisher exact test for categorical variables.

^† “ Severe” includes patients presenting with dyspnea, tachypnea, convulsion, and cyanosis.

^‡ “ Mild” includes patients NOT presenting with dyspnea, tachypnea, convulsion, and cyanosis.

Table 2.

Differences in clinical symptoms, laboratory results, and chest radiograph findings in pertussis according to the number of DTaP vaccinations

Variable	No injection (n=7)	1-4 Injections (n=5)	5 Injections (n=5)	P-value∗
Age (yr)	3.3±5.6	0.9±1.7	10.2±3.3	0.032
Disease duration (day)	26.0±9.7	29.0±8.5	23.8±9.7	0.697
Symptom
Cough	7 (100)	5 (100)	5 (100)	NA
Sputum	5 (71.4)	1 (20.0)	2 (40.0)	0.198
Rhinorrhea	3 (42.9)	3 (60.0)	3 (60.0)	0.784
Fever	0 (0)	1 (20.0)	1 (20.0)	0.452
Vomiting	1 (14.3)	3 (60.0)	0 (0)	0.062
Cyanosis	2 (28.6)	3 (60.0)	0 (0)	0.114
Dyspnea	4 (57.1)	1 (20.0)	0 (0)	0.087
Apnea	2 (28.6)	0 (0)	0 (0)	0.198
Convulsion	2 (28.6)	0 (0)	0 (0)	0.198
Severity				0.040
Severe^†	5 (71.4)	3 (60.0)	0 (0.0)
Mild^‡	2 (28.6)	2 (40.0)	5 (100)
Infiltration on the chest x-ray				0.571
No	6 (85.7)	3 (60.0)	4 (80.0)
Yes	1 (14.3)	2 (40.0)	1 (20.0)
WBC (/mm³)	14,788.3±7,546.4	19,662.5±5,299.7	15,275.0±7,926.7	0.397
Lymphocyte (%)	68.6±9.8	68.8±11.8	25.8±7.4	0.099
Absolute No. of lymphocyte	10,407.0±5,618.0	13,957.8±5,370.4	4,227.5±3,175.6	0.174

Values are presented as mean±standard deviation or number (%).

DTaP, diphtheria-tetanus-acellular pertussis; WBC, white blood cells; NA, not available.

^∗ P-values were calculated by Kruskal-Wallis test for continuous variables and Fisher exact test for categorical variables.

^† “Severe” includes patients presenting with dyspnea, tachypnea, convulsion, and cyanosis.

^‡ “Mild” includes patients NOT presenting with dyspnea, tachypnea, convulsion, and cyanosis.

Table 3.

Comparison between clinical symptoms and laboratory results of pertussis and parapertussis

Variable	Pertussis (n=17)	Parapertussis (n=6)	P-value∗
Disease duration (day)	26.2±9.0	18.8±7.1	0.131
Symptom
Cough	17 (100)	6 (100)	NA
Sputum	8 (47.1)	3 (50.0)	1.000
Rhinorrhea	9 (52.9)	1 (16.7)	0.288
Fever	2 (11.8)	3 (50.0)	0.169
Vomiting	4 (23.5)	0 (0)	0.496
Cyanosis	5 (29.4)	0 (0)	0.354
Dyspnea	5 (29.4)	0 (0)	0.354
Apnea	2 (11.8)	0 (0)	0.971
Convulsion	2 (11.8)	0 (0)	0.971
Severity			0.114
Severe^†	8 (47.1)	0 (0)
Mild^‡	9 (52.9)	6 (100)
Infiltration on the chest x-ray			1.000
No	13 (76.5)	4 (66.7)
Yes	4 (23.5)	2 (33.3)
WBC (/mm³)	16,494.2±6,690.7	6,663.3±2,532.2	2 0.021
Lymphocyte (%)	61.5±19.1	44.5±8.2	0.112
Absolute No. of lymphocyte	10,560.7±5,884.8	2,831.6±642.7	0.030

Values are presented as mean±standard deviation or number (%).

WBC, white blood cells; NA, not available.

^∗ P-values were calculated by Mann-Whitney U-test for continuous variables and Fisher exact test for categorical variables.

^† “ Severe” includes patients presenting with dyspnea, tachypnea, convulsion, and cyanosis.

^‡ “ Mild” includes patients NOT presenting with dyspnea, tachypnea, convulsion, and cyanosis.

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