Correspondence

Nothing to Cough At

N Engl J Med 2008; 358:857February 21, 2008

Article

To the Editor:

In their Clinical Problem-Solving article, Cornia et al. (Oct. 4 issue)1 present a case of pertussis in a 73-year-old man with several outpatient visits to health care providers while he was infectious. Although the authors discuss the need for prophylactic antibiotics for his household contacts, they do not discuss the need for prophylaxis in the health care workers and other patients who may have been exposed to him in medical settings.

Health care workers with pertussis can spread disease to their patients and coworkers, and nosocomial outbreaks of pertussis can be quite expensive for health care organizations.2

Health care workers who have close contact with patients with pertussis should receive antibiotic prophylaxis. In addition, health care workers under the age of 65 years who have direct contact with patients and who have not already received tetanus, diphtheria, and acellular pertussis vaccine should be vaccinated as soon as possible.3

Perrianne Lurie, M.D., M.P.H.
Pennsylvania Department of Health, Harrisburg, PA 17120

3 References

1. 1

   Cornia PB, Lipsky BA, Saint S, Gonzales R. Nothing to cough at. N Engl J Med 2007;357:1432-1437
   Full Text | Web of Science | Medline

2. 2

   Calugar A, Ortega-Sanchez IR, Tiwari T, Oakes L, Jahre JA, Murphy TV. Nosocomial pertussis: costs of an outbreak and benefits of vaccinating health care workers. Clin Infect Dis 2006;42:981-988
   CrossRef | Web of Science | Medline

3. 3

   Kretsinger K, Broder KR, Cortese MM, et al. Preventing tetatnus, diphtheria and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. MMWR Recomm Rep 2006;55:1-37
   Medline

Author/Editor Response

We agree with Lurie's comments. In the case we describe, hospital employees and other patients with significant exposure to the index patient were identified and received prophylactic antibiotic therapy. We are not aware of any cases of pertussis infection that were attributable to exposure to the patient while he was at our hospital. Because most physicians with a mild cough will probably continue to work, we concur that reports of physicians with pertussis are particularly distressing,1 and this underscores the need for increased awareness of pertussis in adolescents and adults.

Paul B. Cornia, M.D.
Benjamin A. Lipsky, M.D.
Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108
paul.cornia@med.va.gov

Ralph Gonzales, M.D., M.S.P.H.
University of California at San Francisco, San Francisco, CA 94143

1 References

1. 1

   Flanagan MP. How to manage a pertussis outbreak in your practice. Fam Pract Manag 2005;12:31-34
   Medline

Citing Articles (1)

Citing Articles

1. 1

   Sabine Wicker, Markus A. Rose. (2010) Health Care Workers and Pertussis: An Underestimated Issue. Medizinische Klinik 105:12, 882-886
   CrossRef