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Pertussis Update 2013

Mel Herbert, MD MBBS FAAEM and Sukhjit "Sarge" Takhar, MD
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19:30
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No me gusta!

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Don't call it a comeback. But its back and getting bigger all the time. 

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Sarge -

Hi Mel,
Let me clarify a couple of questions about age and pertussis vaccination. Tdap is made by two companies. It was first studied in adults under 65 years of age and thus approved for adults under 65. This number still floats around and people are hesitant on giving Tdap. Another company received FDA approval for older adults.

In 2012 ACIP voted to recommend Tdap in adults aged 65 and older (either Boostrix or Adacel is fine). Here are two links to the CDC sites that may help clarify if people still have questions.

Tdap is recommended in all adults aged 65 and older.

Hope that helps,
Sarge

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6125a4.htm

http://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/dtap-td-dt/tdap.htm

Eric S., P.A. -

Mel and Sukhjit,
After listening the review, which was very well done, I was wondering how good the data is backing up the guidelines on patients not being infectious after 5 days of appropriate antibiotic therapy? Is this something that has been well proven or more GOBSAT ("good ol' boys sitting around a table")? Only reason I ask is because I recently had a kid come back + for pertussis after being exposed to a child who was diagnosed. Only thing was my patient's source had finished a Z-pak for suspected "bronchitis" prior to his exposure. Also, the kid had only been coughing for about 6 hours prior to the ER visit, was vaccinated, and looked great. So I swabbed him, didn't start any post exposure prophylaxis, and informed the parents of the high unlikelihood that he could have contracted pertussis from such a scenario. Needless to say, the kiddo's parents were not so happy when the test result was positive. So is this something I can firmly hang my hat on or still consider prophylaxis in such a situation.

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Episode 140 Full episode audio for MD edition 238:22 min - 100 MB - M4AResumen Mayo 2013 en español Español 80:43 min - 28 MB - MP3EM:RAP 2013 May MP3 81 MB - ZIPEM:RAP May 2013 Written Summmary 857 KB - PDFEM:RAP May 2013 Board Review Questions 635 KB - PDFEM:RAP May 2013 Board Review Questions:Answer Sheet 661 KB - PDF

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