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Summary: Whooping cough (pertussis) is a contagious disease caused by Bordetella pertussis that can be prevented by vaccination. The disease is particularly severe in infants who are less than 3 months old, who are not protected against the disease and are often contaminated by their parents. Atypical presentations are frequent and neonatal pertussis is rare. We report a case of malignant whooping cough in a newborn infant probably contaminated by her mother. Diagnosis was suspected clinically because of persistent coughing fits and was confirmed by serology. Treatment was successful. We discuss the diagnostic, therapeutic, and preventive issues of whooping cough in developing countries. In Africa, where complementary investigations such as PCR are seldom accessible, a careful clinical study and the analysis of the absolute rate of lymphocytes could be an alternative for the diagnosis of whooping cough. Vaccination of teenagers and adults is also problematic in poor countries. High-performance new vaccine candidates may contribute to a better control of whooping cough. [Copyright &y& Elsevier]

Abstract: Universal vaccination of infants against pertussis has transformed the epidemiology of the disease. Pertussis has however become frequent, although not often diagnosed, in adolescents and adults and thus contributes to permanent transmission of Bordetella pertussis in France and contamination of young infants at risk of severe disease. Control of transmission of pertussis in France necessitates reinforcement of vaccination with late boosters in adolescents and adults and, in addition, education of physicians to recognize and treat early cases ofpertussis, especially in adolescents and adults with a persistant or chronic cough, and to take appropriate prophylactic measures (antibiotics and recall vaccination) of those in contact with confirmed cases. Effective treatment does little to reduce symptoms but it does reduce transmission. Macrolides are the recommended treatment for pertussis. [Copyright &y& Elsevier]

Abstract: The evolution of the epidemiology of pertussis, new licensed macrolides and vaccines, new recommendations for vaccination among adolescents and adults need an update of the French guidelines for prevention of the disease around one or grouped cases of the disease. A particular attention should be raised to the diagnosis of whooping cough in adults who are presently the main reservoir of Bordetella pertussis. Whooping cough in adults presents as an unexplained prolonged cough with nocturnal exacerbation witch accounts for most of the contaminations of young infants. A bacteriological confirmation of pertussis should be provided before implementation of preventive measures: culture and PCR are presently the gold standard for the diagnosis of pertussis in infants, children and even adults who have been coughing for less than 20 days. Later on, serology (Elisa, immuno-empreinte) is the only technique available, but cannot be interpreted if the patient has been vaccinated less than one year ago. Infants under three months should be admitted to hospital and every case submitted to respiratory isolation. Eviction from the community should be pronounced within the five first days following the onset of an effective antibiotic treatment. New macrolides should be favoured: clarithromycine for seven days or azithromycine for five days. Household contacts should be given the same prophylactic antibiotic treatment: children and adolescent not correctly immunized, parents of the index case as adults parents of not or not completely immunized infants. The vaccination program of the household should be updated. The same measures should be applied in case of grouped cases (at least two contemporary or consecutive cases in the same area). In that case, the Public Health System doctors should be involved in the investigation and the classification of the cases. The close contacts not or not completely immunized should be prescribed and antibiotic prophylaxis and an update of their vaccination program. Among the occasional contacts, high-risk people only should be treated. In the day care centres an antibioprophylaxis should be given to children who have received less than four vaccine shots against pertussis and to the personnel contact to the cases as well. In the schools, the antibiotic prophylaxis should be prescribed to all children of the classroom(s) not completely vaccinated and to the teacher(s) as well. In the boarding schools and institutions with handicapped children, antibiotic prophylaxis could be applied to every member if the pertussis vaccine coverage is at less than 50%. In hospitals, coughing personnel should wear masks and investigations towards pertussis should be performed in people with a more than seven day unexplained cough. Preventive measures should be applied in case of confirmation of pertussis. [Copyright &y& Elsevier]

Whooping cough is a respiratory infection particularly severe for infants. The agents of the disease are the bacteria Bordetella pertussis and B. parapertussis. Before vaccination, the disease affected majority of the children. Due to the high circulation of the bacteria, adolescents and adults were regularly in contact with the bacteria and had natural boosters. Forty years after generalized vaccination in some countries, a change in the transmission of the disease is observed. Children between 2 and 5–10 years of age are not infected (depending of the vaccine used and the vaccine calendar) because they were vaccinated in their infancy. However, adolescents and adults are becoming susceptible because they do not receive any vaccinal or natural boosters. They can be infected and contaminated infants are too young to be vaccinated. Clinical symptoms in adolescents and adults, previously vaccinated or infected, are very variable and for this reason biological diagnosis are now necessary to confirm the infection. These diagnostics are culture, PCR and serology. [Copyright &y& Elsevier]

Objectives. – The resurgence of whooping cough observed in France convinced us to develop a specific PCR assay to detect B. pertussis in nasopharyngeal secretions in parallel of the culture. The aim of our study was to show the value of the PCR in routine diagnosis.Material and methods. – From November 1996 to August 2000, in two hospitals located in the Yvelines (France), the children consulting for a cough compatible with the diagnosis of whooping cough were included in this study. A questionnaire including clinical, biological and radiological items was completed for each one of these patients. A culture of Bordetella and a detection by PCR of B. pertussis were carried out on each nasopharyngeal aspirate. The diagnosis of whooping cough was retained if the detection was positive in PCR and/or culture.Results. – Among the 215 investigated children with suspected cases of whooping cough, the diagnosis was positive for 45 (20.9%), of which 39 were less than one year old (median: three months). Sixteen (35.5,%) were positive at the same time for both the PCR and the culture, 26 (57.8%) for only PCR and three (6.7%) for only culture. The PCR was positive in 93.3% of the cases. The results were obtained with an average time of 48 hours. The culture was positive in 61.2% of the cases with an average time of six days. The monthly distribution of the cases of whooping cough was very inhomogeneous and of epidemic appearance. The majority of the cases was located between two periods: 42% between November 1996 and September 1997 and 40% between November 1999 and August 2000. Among the infected children, 15 were less than two months old and were not yet vaccinated ; among the 24 others infants, a delay in the vaccine calendar was noted in 50% of the cases. Four children between six and 14 years old were correctly vaccinated. The evolution was favourable in all the children.Conclusion. – The PCR due to its sensitivity, its specificity and its rapidity offers to the clinician a powerful tool for the diagnosis of whooping cough. Nevertheless, the culture must be associated with the PCR, in order to follow the epidemiology and the sensitivity to antibiotics of B. pertussis. [Copyright &y& Elsevier]