You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

 

Characteristic Case classification status Characteristic comparisons
Confirmed Probable Noncase % Cases, n = 39 Attack rate, %
Link to preschool
   Student 4 22 91 67 22
   Staff 2 0 26 5 7
   Household/other† 5 6 ND 28 ND
   Hospitalized 2 2 ND 10 ND
Symptoms
   Apnea 2 2 ND 10 ND
   Cough >2 wk 11 28 ND 100 ND
   Inspiratory whoop 5 2 ND 18 ND
   Paroxysmal cough 9 13 ND 56 ND
   Posttussive vomiting 4 4 ND 21 ND
Age‡
   <18 mo 1 1 7 8 22
   18 mo–4 y 2 13 41 58 27
   ≥4 y 1 8 43 35 17
Up-to-date pertussis vaccinations‡ 3 21 88 92 21
No. pertussis vaccinations‡
   <3 1 1 3 8 40
   3 0 1 4 4 20
   ≥4 3 20 81 88 22
Time from vaccination to symptom onset, y‡§
   <1 1 6 39 27 15
   1–<2 1 7 22 31 27
   2–3 1 5 13 23 32
   >3 1 4 14 19 26
Classroom‡
   1A 1 1 11 8 15
   2A 0 1 11 4 8
   2B 0 3 10 12 23
   3A 0 5 12 19 29
   3B 2 6 9 31 47
   4A 1 1 7 8 22
   4B 0 1 9 4 10
   4C 0 2 7 8 22
   4D 0 2 6 8 25
   Kindergarten 0 0 9 0 0

Table. Characteristics of students, staff, and household members associated with an outbreak of pertussis in a preschool, Florida, USA*

*ND, not determined.
†Other, symptomatic camp counselors unaffiliated with the preschool who had contact with children or siblings that attended the preschool.
‡Values and calculations are only for students in the preschool.
§For noncases, time from vaccination to symptom onset used January 1, 2014, as onset date.

CME

Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USA

  • Authors: James Matthias, MPH; P. Scott Pritchard, MPH; Stacey W. Martin, MSc; Cristina Dusek, BSN, RN; Erika Cathey, MPH; Rebecca D'Alessio, BSN; Marjorie Kirsch, MD
  • CME Released: 1/15/2016
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 1/15/2017
Start Activity


Target Audience and Goal Statement

This activity is intended for primary care physicians, pediatricians, infectious disease specialists, and other physicians who care for individuals at risk for pertussis.

The goal of this activity is to evaluate the efficacy of the pertussis vaccine in an outbreak of pertussis in a preschool.

Upon completion of this activity, participants will be able to:

  1. Evaluate the epidemiology and prevention of pertussis
  2. Assess the efficacy of the pertussis vaccine in preventing clinical pertussis in the current study
  3. Analyze the attack rate of pertussis in a preschool in the current study
  4. Distinguish the most common symptoms of pertussis among children in the current study


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Authors

  • James Matthias, MPH

    Florida Department of Health, Tallahassee, Florida, USA

    Disclosures

    Disclosure: James Matthias, MPH, has disclosed no relevant financial relationships.

  • P. Scott Pritchard, MPH

    Florida Department of Health, Tallahassee, Florida, USA

    Disclosures

    Disclosure: P. Scott Pritchard, MPH, has disclosed no relevant financial relationships.

  • Stacey W. Martin, MSc

    Centers for Disease Control and Prevention, Atlanta, Georgia, USA

    Disclosures

    Disclosure: Stacey W. Martin, MSc, has disclosed no relevant financial relationships.

  • Cristina Dusek, BSN, RN

    Florida Department of Health, Tallahassee, Florida, USA

    Disclosures

    Disclosure: Cristina Dusek, BSN, RN, has disclosed no relevant financial relationships.

  • Erika Cathey, MPH

    Florida Department of Health, Tallahassee, Florida, USA

    Disclosures

    Disclosure: Erika Cathey, MPH, has disclosed no relevant financial relationships.

  • Rebecca D'Alessio, BSN

    Florida Department of Health in Leon County, Tallahassee, Florida, USA

    Disclosures

    Disclosure: Rebecca D'Alessio, BSN, has disclosed no relevant financial relationships.

  • Marjorie Kirsch, MD

    Florida Department of Health in Leon County, Tallahassee, Florida, USA

    Disclosures

    Disclosure: Marjorie Kirsch, MD, has disclosed no relevant financial relationships.

Editor

  • Thomas J. Gryczan, MS

    Copyeditor, Emerging Infectious Diseases

    Disclosures

    Disclosure: Thomas J. Gryczan, MS, has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Clinical Professor of Family Medicine, University of California, Irvine

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following financial relationships:
    Served as an advisor or consultant for: Lundbeck, Inc.; McNeil Pharmaceuticals; Takeda Pharmaceuticals North America, Inc.

CME Reviewer

  • Robert Morris, PharmD

    Associate CME Clinical Director, Medscape, LLC

    Disclosures

    Disclosure: Robert Morris, PharmD, has disclosed no relevant financial relationships.


Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

    Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME

Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USA

Authors: James Matthias, MPH; P. Scott Pritchard, MPH; Stacey W. Martin, MSc; Cristina Dusek, BSN, RN; Erika Cathey, MPH; Rebecca D'Alessio, BSN; Marjorie Kirsch, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 1/15/2016

Valid for credit through: 1/15/2017

processing....

Abstract and Introduction

Abstract

In September 2013, local county health officials in Tallahassee, Florida, USA, were notified of a laboratory-confirmed pertussis case in a 1-year-old preschool attendee. During a 5-month period, 26 (22%) students 1–5 years of age, 2 staff from the same preschool, and 11 family members met the national case definition for pertussis. Four persons during this outbreak were hospitalized for clinical management of pertussis symptoms. Only 5 students, including 2 students with pertussis, had not received the complete series of vaccinations for pertussis. Attack rates in 1 classroom for all students who received the complete series of vaccinations for pertussis approached 50%. This outbreak raises concerns about vaccine effectiveness in this preschool age group and reinforces the idea that recent pertussis vaccination should not dissuade physicians from diagnosing, testing, or treating persons with compatible illness for pertussis.

Introduction

In the United States, incidence of pertussis is greatest among infants, children 7–10 years of age, and adolescents.[1] During 2000–2012, reported pertussis cases increased >6-fold from 7,867 cases to 48,277 cases.[2] One potential contributing factor for increased incidence of pertussis is waning immunity after acellular pertussis vaccination.[3,4]

In September 2013, the Florida Department of Health in Leon County (DOH–Leon, Tallahassee, FL, USA) was notified of a PCR result positive for Bordetella pertussis for a 1-year-old vaccine-exempt preschool student. Treatment, chemoprophylaxis, and pertussis education were provided to household close contacts, classmates, parents of classmates, and staff associated with the classroom for this student. The investigation identified a 3-year-old sibling who had illness clinically compatible with pertussis before onset of pertussis in the 1-year-old student. This sibling did not attend the preschool.

On December 11, DOH–Leon received a report that a 1-month-old infant had a PCR result positive for pertussis. A public health investigation determined that the vaccinated 3-year-old sibling and mother of this infant had illnesses clinically compatible with pertussis and disease onset before that of the infant. The sibling attended the same preschool as the initial 1-year-old student, and the mother was a substitute teacher at the preschool. Less than 1 week later, another 3-year-old child who attended the preschool showed a PCR result positive for pertussis.

In response to these reports, an outbreak investigation was initiated. On December 19, the local DOH staff conducted a site visit to the preschool to prevent further transmission and determine the incidence of pertussis among students, household close contacts, and staff.

Table of Contents

  1. Abstract and Introduction
  2. Methods
  3. Results
  4. Discussion