Voices of Meningitis

31 05 2012

The National Association of School Nurses (NASN) has a message for parents: when it comes to vaccinating preteens and teens against meningococcal meningitis, immunization rates don’t measure up.

Vaccination is the most effective way to help protect against meningococcal meningitis, but many parents may be unaware of the importance of vaccination or that their teens may need a second dose to help keep them protected during the years when they are at greatest risk of infection.

The result? Nearly 40 percent of U.S. teens have not been vaccinated and remain vulnerable to this potentially devastating disease.

The NASN’s Voices of Meningitis campaign is calling on communities across the country to “boost” their vaccination rates by letting parents know that health officials recommend vaccination for preteens and teens beginning at 11 or 12 years of age with a booster dose by 18 years of age.

Meningococcal meningitis may be rare, but it is a serious bacterial infection that can kill an otherwise healthy child in just a single day. If you have preteen or teen children, contact their school nurse or health care provider today to discuss vaccination; even if your child was previously vaccinated, a second dose may now be needed for the best protection against meningococcal meningitis.

Visit VoicesOfMeningitis.org to learn more, and join the conversation on Facebook. We did.





Ask Emily

24 05 2012

Will you explain the differences (and similarities) between endemic and epidemic diseases?

Yes, and I’ll throw in “outbreak” and “pandemic” for good measure.

First, anything that is endemic, whether a disease or an organism, occurs only in a specific group or area. “Endemic” implies “occurs only in.” So, the marine iguana, which occurs only on the Galapagos Islands, is an endemic species to those islands—it doesn’t live anywhere else. Substitute a disease for “marine iguana,” and you get the start of an idea of what an endemic disease is.

But there are a few extensions of that idea. First, an endemic disease can be one that occurs only in a certain area—and in this global society, that’s becoming increasingly rare. An example is Venezuelan equine encephalitis, which lurks in neotropical areas, usually in horses, but occasionally crops up among humans in these regions.

Endemic can also mean, however, that the disease has a constant presence in the population or area, perhaps at low levels, but always there—it never quite reaches zero in the defined population. Tuberculosis is an example of a disease that is endemic in many areas of the world, often carried around by people who don’t even know they’re infected.

Endemicity also comes in subtypes, depending on when infection occurs. If it occurs mostly in children in the population, the disease is holoendemic. Malaria is an example. A hyperendemic disease like influenza, on the other hand, is usually an equal-opportunity infector.

Is it possible for an endemic to become epidemic? Yes. If a disease that’s been lying low in a population suddenly shows sharp uptick in the population, that’s an outbreak. An epidemic is a burst of disease activity that spreads beyond the local population. So something that is endemic because it never quite hits zero cases—like measles—or something that’s endemic because it’s so localized, like Venezuelan equine encephalitis—could break out of its usual population bounds and spread across other populations.

Back to our endemic marine iguanas: If they suddenly kicked up their population levels on Galapagos alone but nowhere else, that would be an outbreak of iguanas. If they broke away from the Galapagos and established a claw-hold on the mainland, they’d be an epidemic of iguanas.

If the iguanas—or a disease—were to break the bounds of its immediate continental confines and spread to other continents or globally, that’s called a pandemic. A pandemic of iguanas is probably not a realistic concern, but the human population has already faced down a few pandemics in recent memory, including the Spanish flu, and still grapples with the pandemic of HIV/AIDS. While influenza remains the watchword for pandemic anxieties, no one can genuinely predict what the nature of the next pandemic will be.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of Wikimedia





Adults Young and Old Need Vaccines

21 05 2012

Adults know to wash hands and wear condoms to prevent infections. And we try to eat fruits and veggies to stay healthy. Some days, we even exercise.

One thing we don’t do enough of is get vaccinated.

Other than the flu vaccine in the autumn, I seldom think about vaccines for myself. I bet I’m not alone.

But, we should remember to vaccinate.

We make sure our kids wear seatbelts and helmets, cross the street at the light and keep a weather eye on the ocean for sneaker waves, and get all the vaccines they need.

For the most part, we follow the same safety rules, except for that one about vaccines.

I am determined to get myself fully vaccinated and to nag encourage friends to do the same. I don’t want to get sick and think “if only.”

If you’re like-minded, I’ve listed the diseases for which there are vaccines for adults 19 years of age and older. Not every adult will need every vaccine, so print out this post and take it to your provider, find out what vaccines you need, and realize that you may need more vaccines if you’re traveling outside the US:

  • Flu is a respiratory illness. It can cause fever, chills, sore throat, cough, muscle or body aches, headaches, tiredness, and a runny or stuffy nose. You get over it after several miserable days, unless you develop complications, some of which can be life-threatening.
  • Tetanus, diphtheria, and pertussis vaccines are combined for adults. Tetanus is caused by certain bacteria entering the body through a break in the skin. It’s the one that causes lockjaw, and can cause spasms and seizures. It has a surprisingly high death rate of 10 – 20% of cases. Diphtheria is caused by bacteria spread person-to-person and can damage the heart, kidneys and nerves. Pertussis, also called whooping cough, is a very contagious disease caused by bacteria. In some parts of the world, it’s called the 100-day cough. The “whoop” is most often heard from babies, for whom it can be a lethal infection.
  • Varicella, also called chickenpox, is a virus that spreads easily and causes a blistery rash, itching and fever. For some, it can cause severe complications including pneumonia or sepsis.
  • Human papillomavirus (HPV) is a sexually transmitted infection that is very common in the population. Most people get it and get over it, but some will develop genital warts or cervical or other types of cancers.
  • Zoster or shingles is caused by once having had chickenpox. The virus stays in the body after the chickenpox clears up and goes away, and years later can reactivate, causing pain and itching, followed by a rash.
  • Measles, mumps, rubella vaccines are also combined for adults. Measles is caused by a virus that makes you feel like you have a bad cold, along with a rash on the body and white spots in the mouth. It can develop into pneumonia or ear infections, sometimes requiring hospitalization. Rubella is also caused by a virus and brings with it a rash and fever. This infection can be devastating to the fetus if a woman is pregnant when infected. Mumps is caused by a virus with symptoms of fever, fatigue and muscle aches followed by the swelling of the salivary glands. Rarely it will cause fertility problems in men, meningitis or deafness.
  • Pneumococcal disease is caused by bacteria and can appear as pneumonia, meningitis, or a bloodstream infection, all of which can be dangerous.
  • Meningococcal disease is caused by various bacteria, and the available vaccines prevent many of these infections. The symptoms are varied and include nausea, vomiting, sensitivity to light and mental confusion. This disease can lead to brain damage, hearing loss, or learning disabilities.
  • Hepatitis A is caused by a virus. It’s generally a mild liver disease, but can rarely severely damage the liver.
  • Hepatitis B is also caused by a virus that damages the liver. Most adults are infected for a short time, but some become chronically infected. The infection can cause jaundice, cirrhosis or even liver cancer.

More information on these infections can be found on the CDC website.

Talk to your provider about these vaccines. Who can afford to get sick these days?

By Trish Parnell

Image courtesy of Lancaster Homes





Phoenix

17 05 2012

(Years ago, we at PKIDs had a lengthy argument/discussion with a few public health officials about the need to recommend that young kids be vaccinated against meningitis. We didn’t win. This post, reprinted from Parents Who Protect, illustrates why it’s important that someday, all young children be protected.)

Guest post by Clare from Parents Who Protect

It has taken me several weeks to pull myself together, to sit down and take a breath. I don’t imagine this will ever get easier or hurt any less. But I have to tell this story and hope that because of it, one less child will die from meningitis, meningococcemia, or any meningococcal disease.

I have always thought this saying to be true, “An ounce of prevention is worth a pound of cure.” Therefore, on the one-month anniversary of Phoenix’s death, the time has come to tell his story.

Phoenix is my beautiful, intelligent and amazing son. I want every parent to know that he was a precious child who was loved, cherished and cared for by his parents and his twin brother. In just a few days, I went from being a happy mother of two playful little boys to a grief-stricken mother trying to find meaning in such a tragic death.

On the morning of February 9, 2012, Phoenix woke with a mild fever. He played with his brother, ate his breakfast, and then played some more. After eating lunch he laid down for his nap and around 2:00 p.m., woke up with vomiting and with diarrhea. Being the mother of twins, I am used to having both boys sick at the same time, so I thought it was a bit odd that Gryphon showed no signs of being sick at all. After getting Phoenix all cleaned up and settled down, I decided to check his temperature again. When I saw that it was now 104 degrees, I strapped him in the car and headed to the emergency room.

As we arrived at the ER, I noticed a small spot on his arm. I couldn’t linger on this thought because things started moving pretty fast with the doctors and nurses checking his vital signs and asking me a lot of questions. I couldn’t keep my eyes off of Phoenix. I started to realize he was now acting very strange; it was like he was hallucinating. He seemed at peace and started to sing to me.

Nobody, not even the doctor, recognized his symptoms. The hospital staff had decided to just keep an eye on him and monitor his temperature. Phoenix asked me to take him to the bathroom, and while he was sitting on the toilet, he kept losing his balance and falling off. Immediately I knew something was wrong, so I started screaming for help. Several nurses came into the room, and at this time, the doctor decided to do a spinal tap. Even though it is such a painful procedure, my precious Phoenix didn’t move at all.

The doctor and staff called for the helicopter to transport him to Oakland Children’s Hospital. In the meantime, the results came back positive for meningitis. When my husband came into the room, Phoenix’s face lit up and he asked his baba for milk and cookies. He appeared to be responsive and cheerful and started to sing E-I-E-I-O. The anesthesiologist suggested we put him under to help eliminate any pain that he may be feeling. That was the last time we heard his sweet voice.

When the helicopter arrived, I demanded to be transported with him. As we were walking out to get in, the hospital chaplain walked with me. We stopped to pray for a miracle. It was at that moment I knew my baby was dying.

After a 50 minute helicopter ride, we arrived at the hospital. While they were getting him out, I could see that his tiny body was covered in purple splotches called petechiae; his legs, his arms, and his torso. Phoenix was raced to the ICU. Coming into the room, I could see at least four doctors and ten nurses scrubbed in and ready to go. I was asked by the head nurse to stay in the waiting room and was told they would brief me on his condition.

Those were the longest two hours of my life. When she came back and told me Phoenix was the sickest boy in that hospital, I felt sick to my stomach. My husband had not yet made it to the hospital, so I stood there alone and in shock, trying to make sense of all that I was being told. As soon as my husband arrived with Phoenix’s twin brother, Gryphon, we were taken straight into the ER to make sure that Gryphon didn’t have the same thing as Phoenix. The decision was made to keep Gryphon under observation for the night until we could get a better grasp on what was happening with our baby son. The nurses came in periodically and updated us on Phoenix’s condition. I couldn’t bear being separated from either one of my boys.

I was so worn down that I couldn’t possibly process all the information that was being given to me. At times, I didn’t understand it, or maybe I simply didn’t want to believe it. I cuddled up to Gryphon and tried to fall asleep with him. Around 2:00 a.m., Gryphon started laughing in his sleep, sat up, hugged the air, and said, “I love you.” Little did I know that, at around the same time, Phoenix’s heart had stopped for 15 minutes. I didn’t know it then, but I know now that Phoenix had come to say goodbye to Gryphon.

For the next three days, machines kept Phoenix’s little body alive. Then, we received the most devastating news we hoped never to hear: “Your son, at this moment, is the sickest boy in the whole world.” Phoenix was hooked up to countless IVs, lines, and machines, at least 15, going into his little body at one time. They also had him on an ECMO machine that was inserted into his arteries to help oxygenate the blood. He was so unstable to move that they could not do a CT scan on his brain because his heart had stopped, and his temperature had reached 106 degrees. They held off until Sunday evening to do the CT scans.

From Friday to Sunday evening, we heard from the doctors, “Your son possibly has severe brain damage due to his high fevers, he has pneumonia, looks like we will have to amputate some toes and fingers, looks like we will have to amputate all four limbs.” It was shocking and horrible; it was hell.

On Sunday evening, they were finally able to move him and did a CT scan. The scan confirmed there was no brain activity. Monday came, and the neurologist confirmed that he was, in fact, brain dead. Throughout this extremely long weekend, the chaplain of the hospital stayed close with us. Sister Breanice was an absolute saint, and through her words and kindness helped Bart and I become at peace with where Phoenix was about to go. She was right there as we watched the surgeon take the ECMO out of his body, and she was right there as Bart and I held his little hands and watched his strong heart slowly die. Our baby was pronounced dead around 1:00 p.m. on Monday, February 13.

Please pardon my anger and sadness when I express how devastating it was to read the article regarding Phoenix in the local newspapers, a simply-put story regarding a nameless three year old who had contracted the meningococcal disease. There was no follow up to his condition, no call to action for parents to talk to their healthcare professionals, not even a note on what symptoms parents should look for in their own children.

No one knows where Phoenix contracted this disease. What I know, after doing my own research, is that this disease is only carried by humans and is passed along in close contact situations: crowded areas, high schools, dormitories and even preschools! I also know that this disease has a high fatality rate in children and adolescents, and many who are lucky enough to survive usually don’t escape its devastation without the loss of a limb, some form of brain damage, hearing loss, or kidney failure .

As a mother, I don’t understand how something like this can happen. That “something” being that any child in theUnited States could die from a disease that currently can be prevented by a vaccine. That is right: there are vaccines that help prevent the spread of disease and pointless deaths.

I am sure many of you have heard of polio, measles, mumps, and rubella, and how our society has done its best to eradicate these dangerous diseases. Every child that is born is required to get vaccinated at some point, and I am a parent who says, “That is great!” Why should our children die from a disease that can be prevented? How often do we hear of an outbreak of polio? Not often, or really ever. Thanks to vaccines.

I understand that there are many families who choose not to vaccinate. I respect your right to choose. However, I do vaccinate my children and expect to be given all of the necessary information to make an informed decision. Herein lies the problem: I was never made aware of the vaccinations available for meningitis. It is hard to believe that we currently have vaccines which protect against types A,C,Y and W135. One of the vaccines is approved for use in children as young as nine months of age.

There are five different strains of bacteria that can cause meningococcal disease, and we can currently vaccinate against four of the five. The vaccine is offered to teenagers, college students, military personnel and other selected groups. Although this disease is known to have a high mortality rate in young children, for some reason, this is the age group not offered the vaccine.

I am lost. No, I am more than lost. I am angry and saddened that this disease can take the life a child, and no one seems to care. Why aren’t the younger children protected with a vaccine recommendation? Without any kind of public outcry, pleas of parents who have lost their most valuable treasures are going unheard.

Our government needs to help protect our children and change the way our medical system works. Something has to be done but won’t be until we raise our voices loud enough to be heard. I didn’t want to be an advocate. I would much rather be holding my precious son in my arms, watching him play with his brother, tucking him in at night.

I have to say that without the love and support from our friends and family, I am not sure my husband and I would have gotten through this. So, I must ask you, from one parent to another: wasn’t Phoenix’s life worth that ounce of prevention?





Whooping Cough Booster Shot – Gotta Have It!

14 05 2012

(Welcome to the CDC folks again! Today they’re talking about whooping cough and the booster shot kids need.)

Another fitful night. A mom lies awake, listening helplessly as her child coughs and coughs. This mom knows tomorrow will be another day of school missed. Soccer practice missed. And for her, another day of work missed. She wonders wearily when it will end.

This cough is whooping cough, also called the “100-day cough” because of its long duration. And the child? Not an infant, as one might expect, but a preteen, 11 years old.

Whooping cough—or pertussis—is a serious and very contagious respiratory disease that can cause long, violent coughing fits and the characteristic “whooping” sound that follows when a person gasps for air.

Whooping cough has been on the rise in preteens and teens. In 2009, a quarter of the 16,858 cases of pertussis reported in the United States were among 10- through 19-year-olds.

Most children get vaccinated against whooping cough as babies and get a booster shot before starting kindergarten or first grade. But protection from these vaccines wears off, leaving preteens at risk for infection that can cause prolonged illness, disruptions in school and activities, and even hospitalization.

To boost immunity, the Centers for Disease Control and Prevention (CDC) recommends the Tdap vaccine for all 11- and 12-year-olds.

“It’s important for preteens to get a one-time dose of Tdap to protect themselves and those around them from whooping cough,” says Anne Schuchat, MD, director of CDC’s National Center for Immunization and Respiratory Diseases. “Young infants are most vulnerable to serious complications from pertussis and can be infected by older siblings, parents, or other caretakers.” For infants, whooping cough can be deadly.

“Unfortunately, the most recent survey shows that only a little more than half of teens have received the Tdap vaccine,” says Dr. Schuchat. “By taking their preteen to get Tdap, parents can protect their child and help stop this disease from spreading.”

Tdap is one of three vaccines CDC specifically recommends for preteens. The others are the meningococcal vaccine, which protects against meningococcal disease, including bacterial meningitis, and, for girls, the HPV vaccine, which prevents cervical cancer. Boys and young men can get HPV vaccine to prevent genital warts. Of course, the flu vaccine is recommended for everyone six months and older.

Preteens should also be up-to-date on so-called childhood vaccines to prevent hepatitis B, chickenpox, polio, measles, mumps, and rubella.

These recommendations are supported by the American Academy of Pediatrics, the American Academy of Family Physicians, and the Society for Adolescent Health and Medicine.

To learn more, visit CDC’s adolescent vaccine website or call 800-CDC-INFO.





Why You Have to Vaccinate

7 05 2012

In 2000, public health workers slapped high fives and declared measles eliminated in the U.S. This meant that the disease wasn’t being passed person-to-person in this country.

In 2011, we had 222 cases of measles in the U.S.—a 15-year high.

Most of the 222 infected individuals were either unvaccinated or their vaccination status was unknown.

How did this happen? The answer is, almost all of the infections were imported. They came from U.S. residents returning from trips outside the country, or from visitors from foreign lands. The travelers carried the germ and, in some cases, infected others once they arrived.

Almost half of these cases came from countries with easy access to vaccines; the WHO European Region. The rub is, there are some Europeans who choose not to vaccinate themselves or their children, and the same is true in this country.

When a disease is floating around a community, it finds those who are unprotected and boom, we have disease outbreaks.

Most of the time, most of the diseases that are vaccine-preventable are not going to kill a child. They might not hospitalize him, or even make him feel really bad.

But, no one can say which disease will harm which child, and how much harm it will cause.

Kids do die from measles and chickenpox and other vaccine-preventable diseases. Or they don’t die and they only lose a limb, or their hearing, or they just need a liver transplant. Or any number of other health problems may occur that are still better than dying.

But like I said, no one can say how one child will be affected by one disease. So when I answer the phone here at PKIDs, and a parent on the other end asks if they really need to vaccinate their child against XYZ disease, I don’t have a problem telling them: you really do.

By Trish Parnell

Image courtesy of Vox efx





When to Seek Help for a Cough

3 05 2012

As a parent, you may wonder whether you or your child with a cough has pertussis, but when you go to the doctor, he or she may not agree or even suggest testing.

The truth of the matter is that the accurate diagnosis of pertussis is challenging. Classic symptoms such as severe coughing spells and the inspiratory whoop are striking and strongly suggest pertussis, but they are not always present, especially in previously vaccinated or previously infected adolescents and adults. Additionally, as described in Dr. Cherry’s recent post, available tests are most sensitive early in disease when the bacteria is present in the nose, but this is often before pertussis is suspected. Accurate diagnosis also depends upon the likelihood of having been exposed to someone with pertussis. Communities across the U.S. are experiencing pertussis outbreaks and many children and adults present to their health care provider with a cough.

So, how do doctors know what to look for?

Background
Pertussis occurs in ALL age groups but is most severe in young infants. While pertussis-containing vaccines have been available since the 1940s, pertussis outbreaks continue to occur every year in the U.S. The number of reported cases has been increasing steadily since the 1980s, especially among young infants and adolescents. According to the Centers for Disease Control and Prevention (CDC), more than 27,000 people were diagnosed with pertussis in 2010.

Pertussis is most severe in young infants who are too young to have received any or all doses of vaccine; in fact, about 3 of every 4 infants less than 6 months old develop complications like pneumonia or seizures and about 1 of every 100  infants less than 2 months old die. Unfortunately, many infants get pertussis from adolescents and adults who don’t realize that they have it.

Pertussis is transmitted in respiratory droplets by coughing and sneezing, and people with pertussis can be contagious for up to 3 weeks after developing symptoms. Pertussis is so contagious that when someone in the house has it, virtually everyone else in the house that is not immune will also get it. In fact, studies have shown that if ten unimmunized people are in a room with someone who is infected, 8 or 9 of them will also develop pertussis.

Vaccination is the most effective way to prevent pertussis, but protection is not lifelong. Vaccination is highly effective, however, it does not prevent all disease and immunity decreases over time. This is also the case after natural infection and is why even people who have had pertussis before should still get a booster dose. This decreased immunity through time is also why we have seen an increase in pertussis among adolescents and adults.

What Parents Should Look For
The official set of symptoms used to identify cases of pertussis is:

A cough that lasts for at least 14 days and either episodes of multiple, rapid coughs without any break, whooping when breathing in or a cough so severe that vomiting occurs.

However, it is important to realize that symptoms are not always typical, especially in previously vaccinated older children, adolescents and adults. The way that pertussis presents depends upon your age and vaccination status:

Infants and young children
The most ‘typical’ presentation occurs in young children:

  • Stage 1 –   Pertussis starts with mild cold symptoms like runny nose, mild cough and watery eyes  This stage typically lasts for about 1 to 2 weeks.
  • Stage 2 –  Despite resolution of other symptoms, severe cough develops.  ‘Whooping cough’ refers to episodes of multiple, rapid coughs without any break.  The episodes can be so severe that the lungs run out of air resulting in a forced inhalation that sounds like a ‘whoop.’  The cough can also be accompanied by vomiting.    Infants and children can look quite ill when coughing but appear well in between episodes.  This stage can last for 1 to several weeks.
  • Stage 3 –  The coughing episodes begin to resolve and become less common over several weeks  to months.
  • All Stages – Fever is not a major symptom of pertussis.

Babies are less likely to show these classic symptoms. They tend to have coughing associated with gagging or gasping and ”apneic’ episodes, during  which they briefly stop  breathing.  Infants and young children may also turn blue during coughing spells because they can’t get enough oxygen due to the severe, repeated coughing. Young infants may also show no interest in eating and might experience seizures. 

If parents notice any of these signs or symptoms, they should have their child seen by a health care provider right away for testing and antibiotics—this is especially important for young infants since they are at the greatest risk for severe disease. Antibiotic treatment can decrease the duration of symptoms and make them less severe, but it is most effective when given early in the infection.  Antibiotics also help decrease the likelihood of spreading pertussis to others.

Adolescents and adults
Older children, adolescents and adults with pertussis are more likely to have milder symptoms that can mimic other cough illnesses, especially if they have been immunized or previously infected, however, they can still develop severe disease:

  • The primary symptom is often a persistent cough lasting at least 7 days, usually without a fever.
  • Severe coughing episodes and whooping may occur, but is more common in unimmunized individuals.
  • Coughing episodes can be severe enough to cause rib fractures, difficulty sleeping, poor bladder control, damage to the lung cavity and even bleeding in the brain.  Vomiting with cough can also occur and is considered to be highly suggestive of pertussis in adults.
  • The average duration of cough in adults is 1 to 1 1/2 months.
  • Adolescents and adult who recently had pertussis may experience a return of symptoms if they get another respiratory infection shortly after recovering.

Because older children, adolescents and adults are less likely to have typical symptoms, they often are not tested or treated, and unknowingly spread pertussis to others. Pertussis should therefore be considered in anyone with a coughing illness with no fever or a mild fever, especially if they have been around someone with pertussis or a cough illness or they have regular contact with infants and young children who are at risk for severe disease.

A Final Word about Testing
Testing for pertussis is most sensitive in the first 3 to 4 weeks of infection. Bacteria that cause pertussis can usually be detected from the very beginning of the illness through the first two weeks of the cough stage; however,  in people who have been vaccinated, like adolescents and adults, the bacteria may not be detectable for even that long. Since adolescents and adults often do not go to the doctor until late in their illness, there may no longer be any bacteria present. Therefore, choice of test is important:

  • Bacterial culture is the gold standard but it is difficult to perform, takes a long time (up to 2 weeks) and is less likely to be positive later during the disease or  in previously immunized individuals.   It is most sensitive when performed within 2 weeks of cough onset.
  • Pertussis PCR is now widely available, very sensitive and provides results quickly.   Bacteria can be detected even 7 days after taking antibiotics, but false positives can also occur.  PCR tests should NOT be done on anyone without symptoms, even close contacts of confirmed cases.  PCR tests are most sensitive when done within 4 weeks of cough onset.
  • Serology is a test that is performed on blood samples and detects antibodies to pertussis.  This test is usually positive by the time a patient decides to see the doctor about a cough. However, because young infants don’t make antibodies to the protein that the test measures, it is not useful in infants.  In people who were previously immunized, false positives may occur, so doctors need to look at relative levels of antibodies.  This test is most useful in adults and adolescents because testing is usually done too late for culture or PCR tests.  Serology testing can be performed within 2-8 weeks of cough onset.  If the test is done too early in the infection, it may be falsely negative.

Parents who suspect pertussis in themselves or their children should discuss their concerns with their healthcare providers. Providers should be able to help in determining the best approach for making a diagnosis and managing treatment. 

Kristen A. Feemster, MD MPH MSHP
Assistant Professor of Pediatrics
Pereleman School of Medicine at the University of Pennsylvania
Attending Physician, Division of Infectious Diseases
Physician-Scientist at the Vaccine Education Center
The Children’s Hospital of Philadelphia