Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
New Mexico Department of Health, Santa Fe, NM, United States of America.
PLoS One. 2023 May 18;18(5):e0285953. doi: 10.1371/journal.pone.0285953. eCollection 2023.
Post-exposure prophylaxis (PEP) for pertussis is recommended for household contacts of pertussis cases in the United States within 21 days of exposure, but data on PEP effectiveness for prevention of secondary cases in the setting of widespread pertussis vaccination are limited. We implemented a multi-state evaluation of azithromycin PEP use and effectiveness among household contacts.
Culture- or PCR-confirmed pertussis cases were identified through surveillance. Household contacts were interviewed within 7 days of case report and again 14-21 days later. Interviewers collected information on exposure, demographics, vaccine history, prior pertussis diagnosis, underlying conditions, PEP receipt, pertussis symptoms, and pertussis testing. A subset of household contacts provided nasopharyngeal and blood specimens during interviews.
Of 299 household contacts who completed both interviews, 12 (4%) reported not receiving PEP. There was no evidence of higher prevalence of cough or pertussis symptoms among contacts who did not receive PEP. Of 168 household contacts who provided at least one nasopharyngeal specimen, four (2.4%) were culture or PCR positive for B. pertussis; three of these received PEP prior to their positive test result. Of 156 contacts with serologic results, 14 (9%) had blood specimens that were positive for IgG anti-pertussis toxin (PT) antibodies; all had received PEP.
Very high PEP uptake was observed among household contacts of pertussis patients. Although the number of contacts who did not receive PEP was small, there was no difference in prevalence of pertussis symptoms or positive laboratory results among these contacts compared with those who did receive PEP.
在美国，对于接触过百日咳病例的家庭接触者，建议在接触后 21 天内进行暴露后预防（PEP），但在广泛接种百日咳疫苗的情况下，关于 PEP 预防继发性病例的有效性的数据有限。我们对多州的阿奇霉素 PEP 使用和有效性进行了评估。
通过监测发现培养或 PCR 确诊的百日咳病例。家庭接触者在病例报告后 7 天内接受访谈，并在 14-21 天后再次接受访谈。访谈者收集有关接触、人口统计学、疫苗接种史、先前百日咳诊断、潜在疾病、PEP 接受情况、百日咳症状和百日咳检测的信息。一部分家庭接触者在访谈期间提供了鼻咽和血液标本。
在完成两次访谈的 299 名家庭接触者中，有 12 人（4%）报告未接受 PEP。未接受 PEP 的接触者咳嗽或百日咳症状的发生率没有更高。在提供了至少一份鼻咽标本的 168 名家庭接触者中，有 4 人（2.4%）培养或 PCR 对 B. pertussis 呈阳性；其中 3 人在阳性检测结果前接受了 PEP。在有血清学结果的 156 名接触者中，有 14 名（9%）血液标本 IgG 抗百日咳毒素（PT）抗体阳性；所有人都接受了 PEP。
在百日咳患者的家庭接触者中，PEP 的接种率非常高。尽管未接受 PEP 的接触者人数较少，但与接受 PEP 的接触者相比，这些接触者的百日咳症状或阳性实验室结果的发生率没有差异。
