Pertussis in infants: an underestimated disease

Vittucci, Anna Chiara; Spuri Vennarucci, Valentina; Grandin, Annalisa; Russo, Cristina; Lancella, Laura; Tozzi, Albero Eugenio; Bartuli, Andrea; Villani, Alberto

Although the duration of symptoms in BP+ patients was longer than in the other diagnoses, 40 patients (75.5 %) of 53 BP+ showed cough for less than 14 days. According to the clinical case definition of CDC, WHO [33] and ECDC [26] , none of those patients should have been reported. Similar observations were reported also by others [25, 34] . The case definitions and classifications played an important role in improving the sensitivity of pertussis diagnosis in epidemiological surveys. But if these criteria are used purely clinically to select pertussis cases for confirmation in this age group, this may result in considerable under-diagnosis of pertussis. The clinical suspicion does not always meet all the clinical criteria. Therefore, the current clinical criteria of pertussis are all based on paroxysmal cough, but as van den Brink et al have previously demonstrated, it is not a good predictor in atypical pertussis infections [34] . The development of an age-related case definition, as suggested by the GPI [33] , may be important to better assess the real burden of pertussis in infants.