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Survey of Household Contacts of Infants With Laboratory-confirmed Pertussis Infection During a National Pertussis Outbreak in England and Wales

Kara, Edna O. MD; Campbell, Helen MSc; Ribeiro, Sonia BA; Fry, Norman K. PhD; Litt, David PhD; Eletu, Seyi PhD; Amirthalingam, Gayatri MFPH

The Pediatric Infectious Disease Journal: February 2017 - Volume 36 - Issue 2 - p 140–145
doi: 10.1097/INF.0000000000001378
Original Studies

Background: Highest rates of pertussis occur in infants <3 months of age, too young to be fully vaccinated. The 2012 national outbreak provided a valuable opportunity to study sources of infection for these infants at highest risk of severe complications and death.

Methods: Households of infants <3 months of age with laboratory-confirmed pertussis between August 2012 and October 2013 were invited to complete a questionnaire with information on household members’ demographics, relationship with the infant, chronology of cough onset where relevant and vaccination history. Contacts were also invited to provide an oral fluid sample for antipertussis toxin IgG testing. Individuals with laboratory evidence of infection and cough onset up to 3 months before infant onset were considered probable sources of infection.

Results: In total, 220 contacts from 63 families were included in the analysis. In 86% of households (54/63), at least one positive result was found with 44% (97/220) of all contacts testing positive. Around 29% (31/108) of noncoughers tested positive. A probable source of infection was found for 46% (29/63) of infant cases. Mothers were the probable source in 38% of cases, followed by siblings (31%) and fathers (10%).

Conclusion: Household contacts play an important role in the transmission of pertussis to infants and when identified, mothers were the main sources of infection. Immunization during pregnancy has a key role in preventing infant disease through passive protection from birth and reduced maternal exposure.

From the *Immunisation, Hepatitis and Blood Safety Department, and Respiratory and Vaccine Preventable Bacteria Reference Unit, Bacteriology Reference Department, Public Health England, Colindale, London, United Kingdom.

Accepted for publication June 27, 2016.

The Immunisation, Hepatitis and Blood Safety Department has provided GSK with postmarketing surveillance reports on certain infections in which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy but does not include pertussis. A cost recovery charge is made for these reports.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Edna O. Kara, MD, Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue. London. NW9 5EQ. E-mail:

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