zithromax and Whooping-Cough

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Diagnosis, Differential; Diphtheria-Tetanus-Pertussis Vaccine; Humans; Male; Microscopy, Electron, Scanning; Polymerase Chain Reaction; Respiratory Mucosa; Whooping Cough

Bordetella pertussis--the cause of pertussis or whooping cough--is an exclusively human pathogen. Disease elimination by vaccination should, therefore, be possible, but has proved elusive. Many industrialised countries with long established immunisation programs are currently seeing a resurgence of pertussis, despite universal vaccination with high uptake, with the highest burden in the least immunised age groups (infants under 6 months of age and persons over 10 years old). However, low recognition and reporting and insensitive diagnostic tests mean that the true burden of pertussis is still underestimated. Recently, efforts to improve diagnostic yield include the expanded use of polymerase chain reaction and serological tests but both have significant limitations. The range of antibiotics available for treatment and prophylaxis has expanded to include the newer macrolides, azithromycin and clarithromycin, and a range of universal and targeted vaccination strategies have been implemented or proposed. This paper reviews the current epidemiology of pertussis in developed countries, including modes of clinical presentation, diagnosis, management and potential vaccination strategies.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Clarithromycin; Developed Countries; Humans; Macrolides; Pertussis Vaccine; Polymerase Chain Reaction; Whooping Cough

Whooping cough is a highly contagious disease. Infants are at highest risk of severe disease and death. Erythromycin for 14 days is currently recommended for treatment and contact prophylaxis, but is of uncertain benefit.. To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 1, 2007); MEDLINE (January 1966 to March 2007); EMBASE (January 1974 to March 2007).. All randomised and quasi-randomised controlled trials of antibiotics for treatment of, and contact prophylaxis against, whooping cough.. Three to four review authors independently extracted data and assessed the quality of each trial.. Thirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; 2 investigated prophylaxis regimens. The quality of the trials was variable.Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long-term (erythromycin for 10 to 14 days) in eradicating Bordetella pertussis (B. pertussis) from the nasopharynx (relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05), but had fewer side effects (RR 0.66, 95% CI 0.52 to 0.83). Trimethoprim/sulfamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long-term antibiotics. Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis.. Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Clarithromycin; Contact Tracing; Erythromycin; Erythromycin Estolate; Erythromycin Ethylsuccinate; Humans; Infant; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Pertussis chemoprophylaxis is indicated for contacts at risk of death or of severe complications if infected with Bordetella pertussis; e.g. neonates and infants

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Clarithromycin; Drug Administration Schedule; Erythromycin; Humans; Risk Factors; Severity of Illness Index; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Clarithromycin; Drug Administration Schedule; Drug Therapy, Combination; Erythromycin; Humans; Infant; Meta-Analysis as Topic; Patient Compliance; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Whooping cough is a highly contagious disease. Infants are the population at highest risk of severe disease and death. Erythromycin for 14 days is recommended for treatment and contact prophylaxis but this regime is considered inconvenient and prolonged. The value of contact prophylaxis is uncertain.. To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough.. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004); MEDLINE (January 1966 to February 2004); EMBASE (January 1974 to August 2003); conference abstracts and reference lists of articles were searched. Study investigators and pharmaceutical companies were approached for additional information (published or unpublished studies). There were no constraints based on language or publication status.. All randomised and quasi-randomised controlled trials of antibiotics for treatment of and contact prophylaxis against whooping cough were included in the systematic review.. At least three reviewers independently extracted data and assessed the quality of each trial.. Twelve trials with 1,720 participants met the inclusion criteria. Ten trials investigated treatment regimens and two investigated prophylaxis regimens. The quality of the trials was variable. Results showed that short-term antibiotics (azithromycin for three days, clarithromycin for seven days, or erythromycin estolate for seven days) were equally effective with long-term antibiotic treatment (erythromycin estolate or erythromycin for 14 days) in the microbiological eradication of Bordetella pertussis (B. pertussis) from the nasopharynx. The relative risk (RR) was 1.02 (95% confidence interval (CI) 0.98 to 1.05). Side effects were fewer with short-term treatment (RR 0.66; 95% CI 0.52 to 0.83). There were no differences in clinical improvement or microbiological relapse between short and long-term treatment regimens. Contact prophylaxis (of contacts older than six months of age) with antibiotics did not significantly improve clinical symptoms or the number of cases that developed culture positive B. pertussis.. Antibiotics are effective in eliminating B. pertussis from patients with the disease, rendering them non-infectious, but do not alter the subsequent clinical course of the illness. Effective regimens include: three days of azithromycin, seven days of clarithromycin, seven or 14 days of erythromycin estolate, and 14 days of erythromycin ethylsuccinate. Considering microbiological clearance and side effects, three days of azithromycin or seven days of clarithromycin are the best regimens. Seven days of trimethoprim/sulfamethoxazole also appeared to be effective for the eradication of B. pertussis from the nasopharynx and may serve as an alternative antibiotic treatment for patients who cannot tolerate a macrolide. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Clarithromycin; Contact Tracing; Erythromycin; Erythromycin Estolate; Erythromycin Ethylsuccinate; Humans; Infant; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Clarithromycin; Humans; Infant; Macrolides; Whooping Cough

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: clarithromycin for seven days or azithromycin 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 antibiotic prophylaxis 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 ch

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Child; Clarithromycin; Cross Infection; Drug Combinations; Enzyme-Linked Immunosorbent Assay; France; Humans; Pertussis Vaccine; Polymerase Chain Reaction; Whooping Cough

Bordetella pertussis is among the leading causes of vaccine-preventable deaths and morbidity globally. Human asymptomatic carriage as a reservoir for community transmission of infections might be a target of future vaccine strategies, but has not been demonstrated. Our objective was to demonstrate that asymptomatic nasopharyngeal carriage of Bordetella pertussis is inducible in humans and to define the microbiological and immunological features of presymptomatic infection.. Healthy subjects aged 18-45 years with an antipertussis toxin immunoglobin G (IgG) concentration of <20 international units/ml were inoculated intranasally with nonattenuated, wild-type Bordetella pertussis strain B1917. Safety, colonization, and shedding were monitored over 17 days in an inpatient facility. Colonization was assessed by culture and quantitative polymerase chain reaction. Azithromycin was administered from Day 14. The inoculum dose was escalated, aiming to colonize at least 70% of participants. Immunological responses were measured.. There were 34 participants challenged, in groups of 4 or 5. The dose was gradually escalated from 103 colony-forming units (0% colonized) to 105 colony-forming units (80% colonized). Minor symptoms were reported in a minority of participants. Azithromycin eradicated colonization in 48 hours in 88% of colonized individuals. Antipertussis toxin IgG seroconversion occurred in 9 out of 19 colonized participants and in none of the participants who were not colonized. Nasal wash was a more sensitive method to detect colonization than pernasal swabs. No shedding of Bordetella pertussis was detected in systematically collected environmental samples.. Bordetella pertussis colonization can be deliberately induced and leads to a systemic immune response without causing pertussis symptoms.. NCT03751514.

Topics: Adolescent; Adult; Azithromycin; Bordetella pertussis; Humans; Middle Aged; Nasopharynx; Pertussis Vaccine; Whooping Cough; Young Adult

Antibiotic postexposure prophylaxis (PEP) following pertussis exposure is recommended but has never been evaluated in healthcare personnel (HCP) vaccinated with acellular pertussis vaccine (Tdap).. Tdap-vaccinated HCP were randomized to receive azithromycin PEP or no PEP following pertussis exposure. Acute and convalescent nasopharyngeal swabs and sera were obtained for pertussis testing by polymerase chain reaction (PCR) and anti-pertussis toxin (PT) immunoglobulin G, respectively. A nasopharyngeal aspirate was also collected for PCR and culture from subjects who reported respiratory symptoms within 21 days following identification of the exposure. Pertussis infection was defined as a positive culture or PCR, a 2-fold rise in anti-PT titer, or a single anti-PT titer of ≥94 enzyme-linked immunosorbent assay units/mL. Daily symptom monitoring without PEP was considered noninferior to PEP after pertussis exposure if the lower limit of the 1-sided 95% confidence interval (CI) for the reduction in pertussis was greater than -7%.. During 30 months of study, 86 subjects were randomized following a pertussis exposure. Using the predefined definition of infection, pertussis infection did not develop in 41 (97.6%) of 42 subjects who received azithromycin PEP and 38 (86.4%) of 44 subjects who did not receive PEP (absolute risk difference, -11.3%; lower bound of the 1-sided 95% CI, -20.6%; P = .81). However, no subject developed symptomatic pertussis confirmed with culture or a specific PCR assay, and possibly no subject developed subclinical pertussis infection based upon additional serologic testing.. Using the predefined definition of pertussis infection, noninferiority for preventing pertussis following exposure was not demonstrated for daily symptom monitoring of Tdap-vaccinated HCP without PEP when compared with antibiotic PEP. However, the small number of exposed HCP warrants further study of this approach.. NCT00469274.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antibodies, Bacterial; Antitoxins; Azithromycin; Diphtheria-Tetanus-acellular Pertussis Vaccines; Female; Health Personnel; Humans; Immunoglobulin G; Male; Middle Aged; Nasopharynx; Occupational Exposure; Post-Exposure Prophylaxis; Treatment Outcome; Whooping Cough; Young Adult

Although universal immunization against Bordetella pertussis (whooping cough) infection has resulted in dramatic reductions in the incidence of pertussis, outbreaks continue to occur in countries with excellent vaccine coverage. Treatment of infection may ameliorate symptom severity during the catarrhal phase of pertussis but has no effect on established paroxysms, emesis, or apnea if given during the paroxysmal or convalescent phases. Erythromycin, recommended for treatment of pertussis to prevent transmission of infection, is poorly tolerated because of gastrointestinal side effects. We compared the safety and efficacy of erythromycin with azithromycin for treatment of pertussis in a large, randomized, controlled trial that enrolled children from primary care practices in 1 American and 11 Canadian urban centers.. Children who were 6 months to 16 years of age and had cough illness that was suspected to be or was culture confirmed as pertussis were randomized to azithromycin (10 mg/kg on day 1 and 5 mg/kg on days 2-5 as a single dose) or erythromycin estolate (40 mg/kg/day in 3 divided doses for 10 days) with stratification by center. The primary outcome measure was bacteriologic cure of infection as determined by cultures of nasopharyngeal aspirates. Culture-positive participants had a second aspirate collected at the end of therapy (days 5-7 for azithromycin, days 10-12 for erythromycin) and 1 week after therapy. Bacteriologic cure was defined as negative cultures at the end of therapy. Bacteriologic relapse was defined as a positive culture 1 week after completion of therapy and after a negative end-of-therapy culture. Secondary outcomes were pertussis diagnosed by serology and polymerase chain reaction (PCR), treatment-associated adverse events, compliance, and presence of clinical symptoms at the end of the treatment course. Serology was performed using standard enzyme-linked immunosorbent assay methods. A participant was considered to have pertussis when the PCR was positive or a 4-fold increase in pertussis toxin antibody between baseline and follow-up visits was observed. PCR was performed using a 1046-bp ClaI DNA fragment from B pertussis. Adverse events (nausea, vomiting, diarrhea, any gastrointestinal complaint, or other) were determined by a parent-completed diary that was reviewed with study personnel during study visits. Compliance was measured by review of the parent medication diary during study visits and observation of medication containers by the pharmacist at study completion. Symptoms were determined by history collected by study personnel at enrollment and subsequently from the diary. The design of the study was an equivalence trial, aimed at demonstrating that the bacteriologic failure rates with the 2 therapies did not differ by >8%. For the safety analysis, all participants who received at least 1 dose of study drug were included. In the per-protocol efficacy analysis, all culture-positive participants with end-of-treatment cultures were considered.. A total of 477 children were enrolled and randomly assigned to either azithromycin (n = 239) or erythromycin (n = 238). Of these children, 114 (24%) grew B pertussis from nasopharyngeal specimens (azithromycin group: 58 of 239 [24%]; erythromycin group: 56 of 238 [23%]); these children composed the efficacy cohort for the per-protocol and intention-to-treat analyses. Serology and PCR added 52 children to the number considered to have pertussis for a total of 35% (166 of 477) of all children who presented with cough illness. In the safety analysis (antibiotic side effects, compliance) and comparison of cough symptoms after treatment, all randomized children are reported in their assigned treatment group. At end of therapy, bacterial eradication was demonstrated in all 53 patients in the azithromycin group and all 53 patients in the erythromycin group with follow-up cultures available (eradication 100%; 95% confidence interval [CI]: 93.3-100). No bacterial recurrence was demonstrated in children with 1 week posttreatment nasopharyngeal cultures available (51 and 53 participants in the azithromycin and erythromycin arms, respectively [0%, 95% CI: 0-7.0; and 0%, 95% CI: 0-6.7]). No serious adverse events attributable to study drug were observed. Gastrointestinal adverse events were reported less frequently in azithromycin (18.8%; 45 of 239) than in erythromycin estolate (41.2%; 98 of 238) recipients (90% CI on difference: -29.0% to -15.7%) as a result of less nausea (2.9% vs 8.4%; 95% CI: -8.9% to -2.0%), less vomiting (5.0% vs 13.0%; 95% CI: -4.9% to -1.4%), and less diarrhea (7.1% vs 11.8%; 95% CI: -9.0% to -0.3%). Children who were randomized to azithromycin were much more likely to have complied with antimicrobial therapy over the treatment period. In the azithromycin group, 90% of children took 100% of prescribed doses, whereas only 55% of children in the erythromycin group took 100% of prescribed doses.. In this large, multicenter, randomized trial, we found that azithromycin is as effective as erythromycin estolate for the treatment of pertussis in children. Gastrointestinal adverse events were much more common with erythromycin treatment than azithromycin. Compliance with therapy was markedly better with azithromycin than with erythromycin in this study.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Child; Child, Preschool; Cough; Erythromycin Estolate; Female; Gastrointestinal Diseases; Humans; Infant; Male; Nasopharynx; Patient Compliance; Prevalence; Whooping Cough

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Humans; Infant; Microbial Sensitivity Tests; Polymerase Chain Reaction; Prospective Studies; RNA, Bacterial; Severity of Illness Index; Treatment Outcome; Whooping Cough

A prospective, open, noncomparative study was conducted to assess the efficacy and safety of azithromycin given once daily for 3 or 5 days to eradicate Bordetella pertussis from the upper respiratory tract of infants and young children. Seventeen children received azithromycin in a dose of 10 mg/kg on day 1 followed by 5 mg/kg once daily for four consecutive days, and 20 were given 10 mg/kg once daily for 3 days. Seven days after the initiation of therapy, 33 of 35 (94.3%) patients had negative cultures for Bordetella pertussis. On day 14, cultures from all 34 evaluable patients were negative. These findings suggest that a controlled, comparative study of erythromycin versus short-term administration of azithromycin is justified.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Culture Media; Female; Humans; Infant; Male; Prospective Studies; Treatment Outcome; Whooping Cough

The recommended treatment for pertussis is erythromycin, 40 to 50 mg/kg per day for 2 weeks. The newly developed macrolides, clarithromycin and azithromycin, have been demonstrated to be superior to erythromycin because of improved absorption and a longer half-life. As a result, we conducted two separate comparison studies to evaluate the efficacies of clarithromycin, 10 mg/kg per day, twice a day for 7 days, and azithromycin, 10 mg/kg per day, once a day for 5 days, compared with the standard erythromycin regimen. A total of 17 patients, including 10 infants 1 year of age or less, for whom pertussis had been confirmed by culture, were allocated to receive either clarithromycin or azithromycin treatment, and each patient was matched (age, sex, and immunization status) with historical control subjects who had been treated with erythromycin. Eradication rates examined at 1 week after treatment were as follows: 9 of 9 with clarithromycin versus 16 of 18 with erythromycin (psi M-H = 1.13), and 8 of 8 with azithromycin versus 13 of 16 with erythromycin (psi M-H = 1.23). No bacterial relapse after treatment was detected in either group. All isolated strains of Bordetella pertussis were susceptible to clarithromycin, azithromycin, and erythromycin, and no change in drug susceptibility has been confirmed for the past 20 years in Japan. Because of the very low incidence of pertussis resulting from widespread use of acellular pertussis vaccination, this study did not enroll a large number of patients; however we conclude that short-term treatment with clarithromycin or azithromycin is expected to be equal or superior to the standard long-term erythromycin regimen for pertussis.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Child; Child, Preschool; Clarithromycin; Drug Administration Schedule; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Treatment Outcome; Whooping Cough

Bordetella pertussis is the primary agent of the acute respiratory disease pertussis. It has been reported that the disease has recently become more common, especially in adults and adolescents, and adaptation of the pathogen is thought to have an important influence on the recurrence of the disease. This study aims to determine the effect of erythromycin, azithromycin, and trimethoprim-sulfamethoxazole used in the treatment of pertussis on the virulence gene expressions (prn, ptxS1, fhaB), biofilm-forming and growth of B. pertussis. In this study, the minimum inhibitory concentration (MIC) values of azithromycin and erythromycin in B. pertussis local strain Saadet were determined to be 0.09 μg/mL and 0.3 μg/mL, respectively. However, the Tohama-I and Saadet strains were resistant to trimethoprim-sulfamethoxazole (MIC>32 μg/mL). The biofilm-forming of the Saadet strain decreased with the increase in antibiotic doses. It was observed that 1/32MIC erythromycin and 1/32MIC azithromycin upregulated the expression of fhaB in Tohama-I, whereas the expression of ptxS1 and prn significantly decreased in sub-MICs of erythromycin. In the Saadet strain, only ptxS1 was highly expressed at 1/16MIC azithromycin and erythromycin (p > 0.05). This is the first study to investigate the effect of sub-MIC antibiotics on the expression of virulence genes and biofilm-forming of B. pertussis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Biofilms; Bordetella pertussis; Erythromycin; Gene Expression; Humans; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Post-exposure prophylaxis (PEP) for pertussis is recommended for household contacts of pertussis cases in the United States within 21 days of exposure, but data on PEP effectiveness for prevention of secondary cases in the setting of widespread pertussis vaccination are limited. We implemented a multi-state evaluation of azithromycin PEP use and effectiveness among household contacts.. Culture- or PCR-confirmed pertussis cases were identified through surveillance. Household contacts were interviewed within 7 days of case report and again 14-21 days later. Interviewers collected information on exposure, demographics, vaccine history, prior pertussis diagnosis, underlying conditions, PEP receipt, pertussis symptoms, and pertussis testing. A subset of household contacts provided nasopharyngeal and blood specimens during interviews.. Of 299 household contacts who completed both interviews, 12 (4%) reported not receiving PEP. There was no evidence of higher prevalence of cough or pertussis symptoms among contacts who did not receive PEP. Of 168 household contacts who provided at least one nasopharyngeal specimen, four (2.4%) were culture or PCR positive for B. pertussis; three of these received PEP prior to their positive test result. Of 156 contacts with serologic results, 14 (9%) had blood specimens that were positive for IgG anti-pertussis toxin (PT) antibodies; all had received PEP.. Very high PEP uptake was observed among household contacts of pertussis patients. Although the number of contacts who did not receive PEP was small, there was no difference in prevalence of pertussis symptoms or positive laboratory results among these contacts compared with those who did receive PEP.

Topics: Azithromycin; Bordetella pertussis; Humans; Pertussis Toxin; Post-Exposure Prophylaxis; United States; Whooping Cough

Neonatal pertussis is a resurging disease, possibly due to waning immunity in pregnant women. We report seven cases of neonatal pertussis (

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Female; Hospitals, Teaching; Humans; India; Infant, Newborn; Length of Stay; Male; Prognosis; Retrospective Studies; Treatment Outcome; Whooping Cough

We report the first detection of a macrolide-resistant Bordetella pertussis strain in Japan. The isolate was highly resistant to the macrolides (minimum inhibitory concentrations for erythromycin and clarithromycin: > 256 µg/ml, for azithromycin: 32 µg/ml) and A2047G mutation was identified in the 23S rRNA. The Multilocus Sequence Typing and Multilocus Variable Number of Tandem Repeat Analysis genotypes of this isolate were MT195 and ptxP1/ptxA1/prn1/fim3A/fhaB3, respectively, suggesting a relationship with the macrolide-resistant B. pertussis lineage currently found in China. This raises the possibility that macrolide-resistant B. pertussis has already fully spread in Japan. For a better control of B. pertussis infections, the surveillance for macrolide-resistant B. pertussis is essential in not only Japan, but also other Asian countries.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Clarithromycin; Drug Resistance, Bacterial; Erythromycin; Genotype; Humans; Infant; Japan; Macrolides; Male; Microbial Sensitivity Tests; Multilocus Sequence Typing; Mutation; RNA, Ribosomal, 23S; Whooping Cough

We retrospectively assessed the effectiveness of azithromycin in preventing transmission of pertussis to a patient's household contacts. We also considered the duration between symptom onset in the primary patient and azithromycin administration. We categorized contacts into 4 groups: those treated within <7 days, 8-14 days, 15-21 days, and >21 days after illness onset in the primary patient. We studied 476 primary index patients and their 1,975 household contacts, of whom 4.5% were later identified as having pertussis. When contacts started chemoprophylaxis within <21 days after the primary patient's symptom onset, the treatment was 43.9% effective. Chemoprophylaxis started >14 days after primary patient's symptom onset was less effective. We recommend that contacts of persons with pertussis begin chemoprophylaxis within <14 days after primary patient's symptom onset.

Topics: Adolescent; Adult; Antibiotic Prophylaxis; Azithromycin; Bordetella pertussis; Child; Child, Preschool; Female; Humans; Infant; Male; Retrospective Studies; Spain; Whooping Cough; Young Adult

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Cough; Drainage; Female; Humans; Infant; Pneumothorax; Radiography, Thoracic; Respiratory Insufficiency; Treatment Outcome; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Blood Physiological Phenomena; Bordetella pertussis; Early Diagnosis; Female; Humans; Infant, Newborn; Lymphocytes; Whooping Cough

To investigate the prevalence of Bordetella pertussis infection in children with chronic cough and its clinical features.. A total of 106 children who were treated at the outpatient service or hospitalized from January 1, 2016 to May 31, 2017 were enrolled. Their nasopharyngeal swabs and venous blood samples were collected for Bordetella pertussis culture, multiple PCR and serum anti-pertussis toxin antibody detection. According to these results, the children were divided into pertussis group with 26 children and control group with 80 children, and clinical features were analyzed for both groups. E-test stripes were used to determine the sensitivity of Bordetella pertussis strains to erythromycin, azithromycin, doxycycline, levofloxacin, sulfamethoxazole/trimethoprim and amoxicillin.. Of the 106 children with chronic cough, 26 (24.5%) were found to have Bordetella pertussis infection. There were no significant differences in the incidence rates of typical symptoms of pertussis between the pertussis and control groups (P>0.05). E-test showed that erythromycin and azithromycin had a minimal inhibitory concentration (MIC) of >256 mg/L against five Bordetella pertussis strains, while amoxicillin had an MIC of 0.5-1 mg/L.. The presence of Bordetella pertussis infection in children with chronic cough should be taken seriously by clinicians, and children with chronic cough and Bordetella pertussis infection may not have the typical symptoms of pertussis and are mainly manifested as chronic cough. Amoxicillin may be an alternative drug for macrolide-resistant Bordetella pertussis infection.

Topics: Azithromycin; Bordetella pertussis; Child; Humans; Prevalence; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Cough; Female; Hospitalization; Humans; Infant; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Female; History, 16th Century; History, 20th Century; Humans; Infant; Oxygen Inhalation Therapy; Pertussis Vaccine; Pregnancy; Whooping Cough

Treatment with the macrolide antibiotic azithromycin (AZM) is an important intervention for controlling infection of children with

Topics: Adaptive Immunity; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Bordetella pertussis; Cytokines; Immunity, Innate; Immunization; Immunologic Memory; Immunomodulation; Lung; Mice; Pertussis Vaccine; T-Lymphocyte Subsets; T-Lymphocytes; Whooping Cough

Pertussis is characterized by intense, prolonged coughing in children often followed by a distinctive whooping sound on inspiration. However, the clinical manifestations and natural course of pertussis in disabled children are largely unknown. We experienced a case of pertussis in a disabled girl who had previously undergone a tracheostomy and laryngotracheal separation. She presented with increased tracheal secretions and required hospitalization but did not develop a cough. Pertussis was suspected from the sputum Gram stain, which revealed numerous, short gram-negative rods that did not grow on chocolate agar. A nucleic acid amplification test was positive for Bordetella pertussis and the patient improved on azithromycin. Pertussis may present without its cardinal symptoms in disabled children.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Child; Cough; Diphtheria-Tetanus-acellular Pertussis Vaccines; Disabled Persons; Disease Transmission, Infectious; Female; Humans; Immunoglobulin G; Pertussis Toxin; Radiography; Sputum; Time Factors; Tracheostomy; Whooping Cough

The aim of the study was to determine trends in the minimum inhibitory concentrations (MICs) of erythromycin used as first-line therapy and alternative antibiotics against Bordetella pertussis (B. pertussis) strains isolated from patients with whooping cough in the Czech Republic (CR) in three periods from 1967 to 2015.. In total, 135 isolates from the years 1967–2015 were analysed. The strains were divided into three groups by the year of isolation: 1967–1999 (42 strains), 2004–2010 (43 strains), and 2011–2015 (50 strains). MIC of selected antibiotics (erythromycin, clarithromycin, azithromycin, ciprofloxacin, and trimethoprim/sulfamethoxazole) were obtained by the reference agar dilution method on Bordet Gengou Agar with 15% defibrinated sheep blood.. The study set included 70 strains previously tested for MICs of erythromycin and four other antibiotics. In the three study periods, the MICs of the tested antibiotics for B. pertussis were nearly identical. All but a single strain, inhibited by erythromycin at a concentration of 0.03 mg/l, were inhibited by two concentrations of erythromycin and azithromycin (0.06 and 0.125 mg/l). Clarithromycin inhibited the strains from all three study periods at the following concentrations: 0.03, 0.06, and 0.125 mg/l. Any of the 135 strains was inhibited by ciprofloxacin at a single concentration of 0.06 mg/l and by trimethoprim/sulfamethoxazole at three concentrations (0.125, 0.25, and 0.5 mg/l).. The study set of 135 Czech strains of B. pertussis isolated in 1967–2015 appears to be homogeneous in terms of the MICs for five antimicrobials. The MICs remained in a narrow range of two to three low concentrations; the unimodal distribution of the MICs suggests the absence of resistance mechanisms. The highest MICs of erythromycin, clarithromycin, and azithromycin were equally 0.125 mg/l, that of ciprofloxacin was 0.06 mg/l, and that of trimethoprim/sulfamethoxazole was 0.5 mg/l. Over the study period of 55 years, the MICs of the study antibiotics remained in the same ranges.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Child; Child, Preschool; Ciprofloxacin; Clarithromycin; Czech Republic; Erythromycin; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough; Young Adult

Pertussis is a highly contagious, vaccine preventable upper respiratory disease. The incidence of the disease has been rising in the past few decades. During the winter of 2015, an upper respiratory outbreak occurred in one of Israel Defense Forces basic training bases in northern Israel. Following the detection of the first primary cases, a suspected outbreak investigation was initiated in conjunction with more rigorous clinical and laboratory testing efforts to include specific antibody enzyme-linked immunosorbent assay assays and polymerase chain reaction to diagnose pertussis. Initially, 1,596 soldiers were surveyed clinically using a questionnaire and physicians' interviews for upper respiratory disease symptoms. A total of 158 soldiers were further evaluated and 38.6% (61) of those were diagnosed as having pertussis (with laboratory evidence). Based on the protocol that we developed during the course of this outbreak, a postexposure prophylaxis was given to every soldier for whom there was a high level of suspicion for infection and met the inclusion criteria for the postexposure prophylaxis protocol. The effects of the postvaccination waning immunity among a vaccinated population were demonstrated, thus the need of maintaining a high index of suspicion of Brodetella pertussis as a causative agent during respiratory diseases outbreaks in young soldiers.

Topics: Anti-Bacterial Agents; Azithromycin; Disease Outbreaks; Education; Enzyme-Linked Immunosorbent Assay; Guidelines as Topic; Israel; Military Personnel; Polymerase Chain Reaction; Surveys and Questionnaires; Whooping Cough

Use of oral erythromycin in infants is associated with infantile hypertrophic pyloric stenosis (IHPS). The risk with azithromycin remains unknown. We evaluated the association between exposure to oral azithromycin and erythromycin and subsequent development of IHPS.. A retrospective cohort study of children born between 2001 and 2012 was performed utilizing the military health system database. Infants prescribed either oral erythromycin or azithromycin as outpatients in the first 90 days of life were evaluated for development of IHPS. Specific diagnostic and procedural codes were used to identify cases of IHPS.. A total of 2466 of 1 074 236 children in the study period developed IHPS. Azithromycin exposure in the first 14 days of life demonstrated an increased risk of IHPS (adjusted odds ratio [aOR], 8.26; 95% confidence interval [CI], 2.62-26.0); exposure between 15 and 42 days had an aOR of 2.98 (95% CI, 1.24-7.20). An association between erythromycin and IHPS was also confirmed. Exposure to erythromycin in the first 14 days of life had an aOR of 13.3 (95% CI, 6.80-25.9), and 15 to 42 days of life, aOR 4.10 (95% CI, 1.69-9.91). There was no association with either macrolide between 43 and 90 days of life.. Ingestion of oral azithromycin and erythromycin places young infants at increased risk of developing IHPS. This association is strongest if the exposure occurred in the first 2 weeks of life, but persists although to a lesser degree in children between 2 and 6 weeks of age.

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Incidence; Infant; Infant, Newborn; Male; Odds Ratio; Outpatients; Prognosis; Pyloric Stenosis, Hypertrophic; Retrospective Studies; Risk Assessment; Risk Factors; United States; Whooping Cough

Topics: Adolescent; Antibiotic Prophylaxis; Azithromycin; Cough; Diagnosis, Differential; Diphtheria-Tetanus-acellular Pertussis Vaccines; Disease Outbreaks; Humans; Male; Pneumonia; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Erythromycin; Fluoroquinolones; Humans; Infant; Microbial Sensitivity Tests; RNA, Ribosomal, 23S; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Child; Cough; Disease Progression; Emergency Medical Technicians; Female; Humans; Infectious Disease Transmission, Patient-to-Professional; Oxygen Inhalation Therapy; Pertussis Vaccine; Severity of Illness Index; Unconsciousness; Vomiting; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Diseases in Twins; Early Diagnosis; Female; Germany; Humans; Infant, Newborn; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Pertussis Vaccine; Pregnancy; Pregnancy Complications, Infectious; Whooping Cough

Bordetella pertussis is a highly contagious bacterial disease currently on the rise in the United States. The most vulnerable age group is infants younger than 1 year old. The reasons for the current outbreak are multifactorial. The following is a case report describing a recent case of Bordetella pertussis infection admitted to a neonatal intensive care unit.

Topics: Azithromycin; Bordetella pertussis; Communicable Diseases, Emerging; Disease Outbreaks; Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; United States; Vaccination; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Brain Diseases; Humans; Infant; Magnetic Resonance Imaging; Male; Treatment Outcome; Whooping Cough

Pertussis is a rare condition in adults. This report describes a 65-year-old man presenting to the otolaryngology service with hoarseness secondary to pertussis. He had a history of worsening cough and hoarseness occurring over several weeks. Laryngoscopy showed significant erythema at the medial edges of the vocal folds. Stroboscopy demonstrated bilateral decreased amplitude and decreased mucosal wave of the vocal folds. Polymerase chain reaction testing of the sputum revealed Bordetella pertussis. The patient was started on azithromycin, and he reported gradual resolution of the chest and laryngeal symptoms over the next few months. Pertussis, or whooping cough, is not common in the United States because of childhood vaccination protocols. Nevertheless, otolaryngologists need to be aware of this condition as a possible cause of hoarseness.

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Hoarseness; Humans; Male; Sputum; Whooping Cough

A macrolide antimicrobial drug was administered to a newborn with cough. On day 23 of hospitalization, macrolide-resistant Bordetella pertussis was isolated from nasopharyngeal aspirates. DNA sequencing and PCR-restriction fragment length polymorphism showed a 2047 A-to-G mutation in the 3 copies of the 23S rRNA gene. Monitoring for macrolide resistance is essential in infants <6 months of age.

Topics: Azithromycin; Bordetella pertussis; Clarithromycin; DNA Mutational Analysis; Drug Resistance, Bacterial; Exchange Transfusion, Whole Blood; Female; Humans; Infant, Newborn; RNA, Ribosomal, 23S; Treatment Outcome; Whooping Cough

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Female; Humans; Pertussis Vaccine; Pregnancy; Whooping Cough

An outbreak of pertussis occurred in a daycare center with 87.5% vaccination coverage.. To assess the effectiveness of the acellular pertussis vaccine and prevention of pertussis after chemoprophylaxis with azithromycin.. We studied 31 daycare children aged 3-5.5 years exposed to a child with pertussis. Nasopharyngeal swabs were obtained for Bordetella pertussis culture and polymerase chain reaction initially, and at days 21 and 60 of follow-up, in cases exhibiting symptoms.. Of the 31 daycare children 6 (19%) tested positive for 8. pertussis by PCR, 4 of whom had not been vaccinated against the disease. Of the two vaccinated children who contracted pertussis, one had milder symptoms and the other was asymptomatic. The incidence of pertussis was significantly lower in the vaccinated group (2/27) than in the unvaccinated group (4/4) (P = 0.000), with efficacy of the vaccine calculated to be 92.5%. Azithromycin chemoprophylaxis was taken only by 14 of the 25 exposed children (56%). On day 21 follow-up, there was no further laboratory-diagnosed B. pertussis cases in any of the exposed children, regardless of whether or not chemoprophylaxis was taken.. Based o the children's clinical manifestations and PCR findings a pertussis outbreak had occurred in the daycare center studied. Our findings support the importance of pertussis vaccination since all the unvaccinated children in the daycare center contracted the infection.

Topics: Anti-Bacterial Agents; Azithromycin; Chemoprevention; Child Day Care Centers; Child, Preschool; Disease Outbreaks; Follow-Up Studies; Humans; Israel; Pertussis Vaccine; Polymerase Chain Reaction; Treatment Outcome; Whooping Cough

Erythromycin has traditionally been the choice for prophylaxis and treatment of pertussis, but recently azithromycin has been recommended as another first-line agent. We evaluated treatment adherence between exposed persons giving erythromycin or azithromycin during a community-wide pertussis outbreak.. This was a case-control study. All cases and their contacts were prescribed either 56 doses of erythromycin over 14 days or 5 doses of azithromycin over 5 days. A standardized questionnaire regarding demographics, side effects, and compliance with therapy was administered by mail or telephone interviews.. Of 244 persons prescribed erythromycin, 139 (57%) completed the full course compared with 234 (93%) of 251 persons prescribed azithromycin (rate ratio [RR] 4.5; 95% confidence interval [CI], 2.9-7.0). The primary reason for not completing erythromycin was side effects in 79 (76%) persons, of whom 72 (91%) reported gastrointestinal upset, compared with azithromycin side effects in 6 (35%) of whom 5 (83%) reported gastrointestinal side effects.. Azithromycin was associated with significantly higher completion rates than erythromycin. Due to side effects, the use of azithromycin may be preferable to erythromycin in outbreaks of pertussis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Case-Control Studies; Child; Child, Preschool; Disease Outbreaks; Erythromycin; Female; Humans; Male; Medication Adherence; Whooping Cough

Azithromycin is recommended as the first-line antibiotic for the prophylaxis and treatment of pertussis, a common vaccine-preventable communicable disease. Azithromycin is better tolerated than other macrolide antibiotics. Access to azithromycin is limited, as the product information and the Pharmaceutical Benefits Scheme do not include azithromycin for pertussis. Issues regarding access to azithromycin are highlighted in a case report of pertussis exposure in a tertiary paediatric hospital.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Australia; Azithromycin; Contact Tracing; Cross Infection; Hospitals, Pediatric; Humans; Infectious Disease Transmission, Professional-to-Patient; National Health Programs; Organizational Case Studies; Whooping Cough

Topics: Acute Disease; Adolescent; Antitussive Agents; Azithromycin; Diagnosis, Differential; Humans; Male; Whooping Cough

Seven-week-old 32-week premature triplets were hospitalized because of rhinorrhea, cough with color change and posttussive emesis. One infant had a positive direct fluorescent antibody test for Bordetella pertussis, so all were treated with 5 days of azithromycin. Two of the infants were subsequently diagnosed with hypertrophic pyloric stenosis and underwent surgical pyloromyotomies 6 and 7 weeks, respectively, after the initial admission.

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Cough; Cyanosis; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Pyloric Stenosis, Hypertrophic; Rhinitis; Triplets; Vomiting; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Child, Preschool; Female; Humans; IgA Vasculitis; Whooping Cough

Topics: Anti-Bacterial Agents; Australia; Azithromycin; Drug and Narcotic Control; Humans; Infant; Infant, Newborn; Macrolides; Practice Guidelines as Topic; Roxithromycin; Whooping Cough

Hospitalized premature infants are particularly vulnerable to morbidity and mortality from pertussis. Effective prevention and investigative and control measures are not well described.. To identify the source of nosocomial pertussis in a 2-month-old premature infant in a neonatal intermediate care nursery (ICN) and to critically review the investigation and outbreak control measures.. An ICN and a neonatal intensive care unit.. We queried healthcare workers (HCWs) and family members about cough illness and contacted potentially exposed patients to determine whether they had symptoms of pertussis. Culture and polymerase chain reaction (PCR) testing for Bordetella pertussis were performed by the hospital laboratory with specimens collected from symptomatic patients and HCWs. Levels of pertussis toxin immunoglobulin G antibodies were measured in HCWs with cough of at least 14 days' duration at a public health laboratory. Extensive control measures were instituted.. Four ICN HCWs met the clinical case definition for presence of pertussis. Serologic test results were positive for 3 of the HCWs. The primary case patient was a 36-year-old HCW with a cough illness of 3-weeks' duration that was accompanied by paroxysms, whoop, posttussive emesis, and pneumothorax. Among the 4 affected HCWs, the duration of cough illness prior to identification of the infant index patient ranged from 11 to 25 days. Outbreak control measures included isolation of the infant case patient, furlough and treatment of symptomatic HCWs, administration of chemoprophylaxis to contacts, and surveillance for additional cases. Seventy-two infant patients and 72 HCWs were exposed and were given antibiotic prophylaxis. One additional case of pertussis, confirmed by PCR and culture, occurred in a resident physician who declined prophylaxis; she had cared for the index patient but had no contact with symptomatic HCWs.. HCWs or patients may serve as the source of pertussis in nosocomial outbreaks, which can result in substantial morbidity and outlay of resources for control measures. Our review suggested that a diagnosis of pertussis should be an early consideration for HCWs with cough illness. Targeted pertussis immunization of HCWs, employee health policies that provide for testing and furlough of HCWs with prolonged cough, and monitoring of HCWs for compliance with infection control measures could reduce the morbidity and costs associated with pertussis outbreaks. These measures will require evaluation of their effectiveness.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Centers for Disease Control and Prevention, U.S.; Disease Outbreaks; Disease Transmission, Infectious; Health Personnel; Humans; Infant; Infant, Newborn; Infant, Premature; Infection Control; Infectious Disease Transmission, Professional-to-Patient; Intensive Care Units, Neonatal; Kentucky; Population Surveillance; United States; Whooping Cough

The objective of the present study was to evaluate the feasibility of azithromycin prophylaxis with respect to tolerability and compliance during a pertussis outbreak among healthcare workers in a university hospital ward. Compliance with the prophylaxis regimen was 89%; compliance was 75% from intent-to-treat perspective. The rate of adverse events was 33%. Female sex was associated with reporting of adverse events. Nonstudents and healthcare workers who reported adverse events were less compliant with the prophylaxis regimen.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Disease Outbreaks; Disease Transmission, Infectious; Feasibility Studies; Female; France; Health Personnel; Hospitals, University; Humans; Male; Patient Compliance; Prospective Studies; Whooping Cough

We describe a case of nosocomial maternal transmission of Bordetella pertussis to a very-low-birth-weight (VLBW) neonate in whom treatment was unsuccessful. This case underscores the need for rapid and sensitive PCR diagnosis in VLBW neonates and in parents with clinical signs of pertussis and suggests that standard treatment may not be appropriate for VLBW neonates.

Topics: Anti-Bacterial Agents; Azithromycin; Cross Infection; Diphtheria-Tetanus-acellular Pertussis Vaccines; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Josamycin; Male; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

The recommendations in this report were developed to broaden the spectrum of antimicrobial agents that are available for treatment and postexposure prophylaxis of pertussis. They include updated information on macrolide agents other than erythromycin (azithromycin and clarithromycin) and their dosing schedule by age group.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Clarithromycin; Erythromycin; Humans; Infant; Whooping Cough

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Contact Tracing; Cough; Diagnostic Errors; Female; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Professional-to-Patient; Pertussis Vaccine; Whooping Cough

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Dexamethasone; Erythromycin; Humans; Infant; Male; Recurrence; Treatment Failure; Whooping Cough

A questionnaire regarding tolerability and adherence was administered for 5 days to hospital employees who received azithromycin prophylaxis during a hospitalwide outbreak of a pertussis-like illness. Analysis of the 239 responses from those having received prophylactic azithromycin determined that it was well tolerated and accounted for a minimal loss of days worked; 81.5% were fully adherent with the regimen.

Topics: Anti-Bacterial Agents; Azithromycin; Cross Infection; Disease Outbreaks; Drug Tolerance; Female; Humans; Male; Occupational Diseases; Patient Compliance; Personnel, Hospital; Surveys and Questionnaires; Whooping Cough

Topics: Anti-Bacterial Agents; Azithromycin; Clarithromycin; Humans; Otitis Media; Pneumonia, Bacterial; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Whooping Cough