J Korean Med Sci.  2014 Sep;29(9):1232-1239. 10.3346/jkms.2014.29.9.1232.

Epidemiological Aspects of Pertussis among Adults and Adolescents in a Korean Outpatient Setting: A Multicenter, PCR-Based Study

• Park S
• Lee SH
• Seo KH
• Shin KC
• Park YB
• Lee MG
• Yoo KH
• Kim HJ
• Park JS
• Cho JH
• Ko Y
• Lee SK
• Cheon KT
• Kim DI
• Ha JW
• Lee JM
• Suhr JW
• Jeong EH
• Jung KS

• KMID: 1794601
• DOI: http://doi.org/10.3346/jkms.2014.29.9.1232

Abstract

Epidemiological data of Bordetella pertussis infection among adolescents and adults are limited in Korea. Patients (> or = 11 yr of age) with a bothersome cough for less than 30 days were enrolled during a 1-yr period at 22 hospitals in Korea. Nasopharyngeal swabs were collected for polymerase chain reaction (PCR) and for bacteriologic culture. In total, 490 patients were finally enrolled, and 34 (6.9%) patients tested positive for B. pertussis; cough duration (14.0 days [7.0-21.0 days]) and age distribution were diverse. The incidence was the highest in secondary referral hospitals, compared to primary care clinics or tertiary referral hospitals (24/226 [10.6%] vs. 3/88 [3.4%] vs. 7/176 [4.0%], P = 0.012), and the peak incidence was observed in February and August (15.8% and 15.9%), with no confirmed cases between March and June. In the multivariate analysis, post-tussive vomiting was significantly associated with pertussis (odds ratio, 2.508; 95% confidence interval, 1.146-5.486) and secondary referral hospital showed a borderline significance. In conclusion, using a PCR-based method, 6.9% of adolescent and adult patients with an acute cough illness had pertussis infection in an outpatient setting. However, hospital levels and seasonal trends must be taken into account to develop a better strategy for controlling pertussis.

Keyword

Pertussis; Adult; Hospitals; Incidence; Seasons

MeSH Terms

Adolescent
Adult
Bordetella pertussis/*genetics
Child
DNA, Bacterial/*analysis
Demography
Female
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Odds Ratio
*Polymerase Chain Reaction
Republic of Korea/epidemiology
Seasons
Vomiting/etiology
Whooping Cough/*epidemiology/microbiology/pathology
Young Adult
DNA, Bacterial

Figure

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  Fig. 1 Six provinces and numbers of participating hospitals. In total, 22 hospitals (or clinics) participated in this study; numbers in parenthesis refer to those of participating primary, secondary, and tertiary hospitals, respectively.

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  Fig. 2 Flow diagram of enrolled patients. PCR, polymerase chain reaction.

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  Fig. 3 Incidence of pertussis by hospital levels. The incidence was the highest in secondary referral hospitals compared to tertiary or primary care hospitals (P = 0.012).

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  Fig. 4 Seasonal trends of the incidence of pertussis. Peak incidences were observed in February and August; no pertussis cases were identified between March and June.

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  Fig. 5 Incidence of pertussis by provinces. The incidence rates range from 3.8% to 8.0% among the six provinces and the two southern provinces (Gyeongsang-do and Jeolla-do) show the lowest rates, with no statistical significance.

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  Fig. 6 Incidence of pertussis by age group. The age distribution of the confirmed cases was diverse (P > 0.05 by chi-square test).

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