Pljm. Mertens et al., An epidemic of pertussis among elderly people in a religious institution in the Netherlands, EUR J CL M, 18(4), 1999, pp. 242-247
Citations number
22
Categorie Soggetti
Microbiology
Journal title
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
An epidemic of pertussis is described among elderly people in a religious i
nstitution in the Netherlands in 1992. Subjects were evaluated for their va
ccination status and for history and presence of respiratory symptoms. Spec
imens were collected for culture, polymerase chain reaction, and serologica
l evaluation. None of the 75 residents and 19 of 24 nonresident personnel h
ad been vaccinated against pertussis. The overall attack rate of clinical p
ertussis, defined as persistent cough lasting at least 2 weeks, was 49%. In
five subjects with clinical pertussis, either culture or polymerase chain
reaction or both were positive for Bordetella pertussis. A significant (at
least 4-fold) change in specific antibody titre was observed in 85% (41/48)
and 20% (10/49) of subjects with and without clinical pertussis, respectiv
ely (P < 0.0001, chi-square 41.1). The attack rate of laboratory-confirmed
pertussis was 42% (41/98). This rate was 5% (1/19), 20% (1/5), and 53% (39/
74) in vaccinated personnel, nonvaccinated personnel, and nonvaccinated res
idents, respectively (not significant). Among residents aged between 55-74
years and 75-94 years, the attack rates were 47% (17/36) and 58% (22/38), r
espectively (relative risk = 0.8; 95% confidence interval 0.5-1.3). Four of
75 residents (5%) died from intracranial bleeding, while they were symptom
atic for pertussis. It is concluded that the attack rate of pertussis was h
igh among nonvaccinated elderly and that pertussis tended to increase with
age. There may be a considerable risk of mortality from pertussis in this p
opulation. Physicians should be alert to the diagnosis of pertussis in the
elderly with nocturnal and prolonged periods of coughing.