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Finding the Key to Prevention
Clinical Study to Determine Prevalence and Long Term Affects of Pertussis (aka Whooping Cough)

CHORI clinical scientist Heidi Flori, MD, is leading Children Hospital & Research Center Oakland's participation in the highly competitive National Institute for Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN) as part of a large cohort study intended to assess the acute course of critical pertussis in the United States for the first time.

"Understanding the prevalence and impacts of severe pertussis will help generate adequate data to determine national prevention strategies, generate next step research hypotheses, and prioritize research."

More commonly called whooping cough, because of the deep and 'whooping' breath of air required after a long cough spasm, pertussis is one of the more common infections that both adults and children can acquire. The most severe problems occur in babies, however, because they are the most vulnerable population.

"Pertussis is included in the vaccine series that are normally given to infants and children beginning at two months of age," explains Dr. Flori. "During those first two months before the vaccines can begin, infants are particularly vulnerable."

In older adults, the infection tends to persist for a very long time, beginning with a runny nose and then escalating to a deep cough forceful enough to cause vomiting. It eventually subsides overtime. As Dr. Flori explains, it doesn't usually result in a critical illness in adults that would bring them to the emergency room or urgent care to get treatment, so it is likely to be under-diagnosed in the community.
"This is an important part of the problem. It's very contagious, and many adults have it and are spreading it around the community, so there is a large reservoir of infection for other people to get."
As Dr. Flori explains, "This includes particularly the more vulnerable newborns and any immune-compromised patients."

In unprotected children younger than 2 months, the infection can be very severe and potentially life-threatening. It can cause fatal pneumonia and pulmonary hypertension, as well as sudden infant death syndrome, or SIDS.

Pertussis is one of the least understood infections, however, which is where Dr. Flori's grant comes in. A multi-center study, the investigation will utilize large pediatric care units across the country and will follow pediatric patients with suspected or confirmed pertussis while they are in intensive care for treatment and up to one year after discharge.
"What we're trying to do is figure out the impact that the disease has on children. We recognize that over the last 20 or 30 years, we've done a much better job of keeping children alive with our aggressive and sometimes invasive therapies, but what we'd like to know is what the end result of that is - how these children are affected in the long term from having had the infection," Dr. Flori explains.

Potential long-term affects include problems potentially associated with how low the blood oxygen levels can get during a bout of the coughs associated with pertussis.

"The coughing fits last for so long that the child has trouble breathing - they cough until there is no more air left in the body, and then have to take in such a long breath to make up for it. We're not really sure when kids have these spasms for weeks and weeks, what impacts these continued periods of reduced oxygen might have on them," says Dr. Flori. "We want to take all these patients together, find out how pertussis affects them over time, and try to figure out if there is a special group that might be at a higher risk for more long term affects."

Solutions for helping prevent pertussis may be as simple as requiring a second vaccination booster for adults, where the contagion is greatest. Eliminating the highest reservoir of the disease would eliminate the potential for exposure. In the mean time, however, Dr. Flori hopes to gather enough data in the next 2 years of the study to fully understand the acute and long-term implications of the disease.


Tuesday, May 17, 2011 8:19 AM

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