Nosocomial pertussis in healthcare workers from a pediatric emergency unitin France

OBJECTIVE: After pertussis was diagnosed in July 1997 in a 55-year-old nurs e (case) from a pediatric emergency unit who had a respiratory illness and paroxysmal cough for 5 weeks, an epidemiological investigation was initiate d to determine if other healthcare workers (HCWs) from the same unit also h ad pertussis. DESIGN: Interviews were conducted to assess symptoms occurring in the previ ous months. Two sera were collected 2 to 3 months apart for 59 of 61 HCWs o f the unit. The IgG response to pertussis toxin was determined using Wester n blot assay. SETTING: Pediatric emergency unit (61 HCWs) of a 2,500-bed university hospi tal. RESULTS: There was a total of 10 (5 confirmed and 5 probable) cases of pert ussis identified in this outbreak. Nine HCWs (15%) had results suggesting r ecent or acute pertussis. To avoid transmission to patients and other HCWs, all HCWs with cough were treated for 14 days with erythromycin, and those having acute cough were given a 5-day sick leave. Despite these measures, a new acute pertussis case was identified in a 41-year-old nurse, with a pos itive culture from nasopharyngeal aspirates. Thus, all HCWs in the unit wer e prescribed spiramycin for 10 days to prevent any further spread of pertus sis. CONCLUSION: Pertussis should be considered a threat to HCWs who are in cont act with children. For HCWs, diagnosis of pertussis should be made on a cli nical basis, giving greater importance to sensitivity of diagnosis criteria , and on early bacterial identification by culture of the organism or by po lymerase chain reaction. RECOMMENDATIONS: In case of pertussis in an HCW, all staff in the unit who have had unprotected and intensive contact with that person should be provi ded with macrolide treatment to stop any transmission to colleagues and to young patients. Furthermore, the possibility of providing these HCWs with a cellular pertussis vaccines warrants further investigation.