RESURGENCE OF PERTUSSIS IN FRANCHE-COMTE - EVOLUTION OF MORBIDITY AT BESANCON HOSPITAL (1976-1995)

Because we have encountered a resurgence of pertussis in 1994 (13 case s against less than 3 cases during the previous 10 years) we have stud ied evolution of pertussis morbidity at Besancon hospital. During a 20 years period (January 1976-April 1995) 73 children were hospitalized for suspected pertussis. The diagnosis of pertussis was retained among 69 on the basis of the presence of a paroxysmal cough for more than 1 4 days duration. 93 % were under 1 year of age and 40 % were under 3 m onths. There is no sex predilection bur a seasonal prevalence with a s ummer peak disease. The average duration of symptom before presentatio n was 11 days (3-30 days) and pertussis was recognized in 50 % of case s. In presence of a paroxysmal cough, exceptionnaly followed by a forc eful inspiratory effort (4 times), absence of fever, absolute lymphocy tosis and absence of inflammatory response are also helpful in diagnos is. The average duration of hospitalization was 18 days (3-68 days) an d development was favourable in 68 cases. Three malignant whooping cou gh were observed among infant under 2 months of age, 1 of whom was die d. Western-Blot techniques were used to analyze antibody responses to the principal toxins of Bordetella pertussis (Institut Pasteur Paris) and permitted to confirm diagnosis of pertussis in 9 cases. A contamin ation was obvious in 38 % of patients. Our study emphasizes necessity to begin pertussis vaccination at 2 months of age and booster doses to children and adults are provided perhaps with acellular pertussis vac cines : 63 % of pertussis cases occured in infants badly vaccinated or not and 37 % of pertussis cases occured in infants less than 2 months of age before age of the first vaccination.