A 4-year-old girl is diagnosed with Bordetella pertussis infection after an outbreak at her day care center. She has paroxysmal coughing fits and is prescribed a course of macrolide antibiotics. The patient lives with her 30-year-old parents and 1-year-old sister. Her family members have up-to-date immunizations and are asymptomatic. Which of the following is the most appropriate way to limit the immediate risk of infection in household contacts?

Question

A 4-year-old girl is diagnosed with Bordetella pertussis infection after an outbreak at her day care center.  She has paroxysmal coughing fits and is prescribed a course of macrolide antibiotics.  The patient lives with her 30-year-old parents and 1-year-old sister.  Her family members have up-to-date immunizations and are asymptomatic.  Which of the following is the most appropriate way to limit the immediate risk of infection in household contacts?

Quizplus · Accepted Answer

11ec25c8_d6cc_427a_bc81_7f4d4f6ca009_MD0003_00 Pertussis is a highly contagious disease transmitted through respiratory droplets. Patients have mild cough and rhinorrhea for 1-2 weeks (ie, catarrhal stage) before developing a characteristic whooping cough (ie, paroxysmal stage). Although patients are most contagious during the catarrhal stage, disease can spread up to 3 weeks after the onset of paroxysmal coughing spells. First-line treatment is with a macrolide antibiotic (eg, azithromycin, clarithromycin). Treatment during the catarrhal stage may shorten the course of illness; treatment in the later stage does not shorten symptom duration but reduces the risk of transmission. Vaccination prevents most pertussis cases. However, immunity can wane over time and some immunized, exposed household contacts can develop disease. Therefore, a macrolide antibiotic is recommended for postexposure prophylaxis to reduce the immediate risk of contracting pertussis (see table). Antibiotic indications depend on exposure history regardless of vaccination status. (Choices A and B) Postexposure vaccination does not lessen the immediate risk of infection. Contacts who are not fully immunized should receive the pertussis vaccination according to the recommended immunization schedule: primary series at 2, 4, 6, and 15-18 months and at 4-6 years, with booster doses in adolescence and adulthood. (Choices D and E) Antibiotic prophylaxis should be prescribed for all household contacts. Educational objective: Macrolides (eg, azithromycin) are the first-line medications for pertussis treatment and postexposure prophylaxis. All close and high-risk contacts should be given prophylaxis regardless of immunization status. References: Postexposure prophylaxis for common infectious diseases. (http://www.ncbi.nlm.nih.gov/pubmed/23939603)

A 4-Year-Old Girl Is Diagnosed with Bordetella Pertussis Infection After