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Management
• Hospitalization all infants <4 mo
• Isolation
• No proven benefit of bronchodilators,
corticosteroids, antihistamines, and
antitussive agents
• Antibiotics
Work-up findings
• Absolute lymphocyte count often >/= 10,000
• Degree of leukocytosis is associated with
disease severity
– 60,000= pneumonia or pulm HTN
• CXR may be normal or show nonspecific
perihilar infiltrates
• PCR or culture
Antimicrobial therapy
• Top choice is azithromycin
• Caution regarding idiopathic hypertrophic
pyloric stenosis in infants
• Alternatives: the other macrolides or bactrim
Postexposure Prophylaxis
• All household and close contacts of index case
• High risk individuals (pregnant,
immunodeficient, persons who have contact
with infants, persons with chronic medical
condition)
• Effective when initiated within 21 days of the
onset of cough
Immunization
• DTaP • Tdap
– 2/4/6 months – Booster between 11-12
– 15-18 months yrs
– 4-6 years – Pregnant women in 3rd
trimester of every
pregnancy
– Adults 1 dose every 10
years
Efficacy and Effectiveness
• The efficacy is approximately 85% in
preventing typical pertussis (95% for diptheria
and tetanus)
• Effectiveness demonstrated by marked decline
in cases since vaccine introduction in 1940s
• In one large study 5 doses of Dtap was
associated with decreased risk of pertussis
and estimated vaccine effectiveness of 89%
• Protection after an infection is not life-long
Vaccine Risks
• Pain, redness, swelling (more common after 4th)
• Mild fever
• Fussiness, fatigue, lack of appetite
• Nausea, vomiting, diarrhea
• Extensive swelling of limb (3 in 100)
• Severe reactions (1 in 10,000)
– Fever >105
– Febrile seizures
– Inconsolable crying
– Hypotonic-hyporesponsive syndrome = child is listless
and lethargic with poor muscle tone for several hours
Contraindications and Precautions
• Do not give in patients who have had a severe
allergic reaction or to a person with a severe
allergy to any of the vaccine components
• Use precaution in:
– Those who have had a moderate or severe acute
illness with or without fever
– Guillain-Barre within 6 wks after a previous dose
of tetanus toxoid-containing vaccine
– A history of Arthus-type hypersensitivity reaction
Protecting Infants
• “Borrowed” Immunity- from the mom getting
the vaccine between 27-36 wks gestation,
antibodies cross placenta
• “Cocooning”- family members and those close
to the baby getting vaccinated
Children’s Hospital of Philadelphia
Vaccine Education Center
https://www.chop.edu/centers-programs/vaccine-education-center