Clinical Complications

Infants and Children

Pertussis can cause serious and potentially life-threatening complications in infants and young children who are not fully vaccinated.

In infants younger than 12 months of age who get pertussis, more than half must be hospitalized. Hospitalization is most common in infants younger than 6 months of age. Of those infants who are hospitalized with pertussis approximately:

• 50% will have apnea
• 20% get pneumonia
• 1% will have seizures
• 1% will die
• 0.3% will have encephalopathy (as a result of hypoxia from coughing or possibly from toxin)

Of those infants younger than 12 months of age who die:

• Refractory pulmonary hypertension is a common, severe complication that contributes to death
• Encephalopathy occurs in approximately 20% of cases

Other complications can include anorexia, dehydration, difficulty sleeping, epistaxis, hernias, otitis media, and urinary incontinence. More severe complications can include pneumothorax, rectal prolapse, and subdural hematomas.

Adolescents and Adults

Adolescents and adults can also develop complications from pertussis, but they are usually less severe in this older age group, especially in those who have been vaccinated.

In one study, hospitalization rates were 0.8% for adolescents and 3% for adults with confirmed pertussis. Pneumonia was diagnosed in 2% of each group. The most common complications in another study of adults with pertussis were:

• Weight loss (33%)
• Urinary incontinence (28%)
• Syncope (6%)
• Rib fractures from severe coughing (4%)

Other complications can include anorexia, dehydration, epistaxis, hernias, and otitis media. More severe complications can include encephalopathy as a result of hypoxia from coughing or possibly from toxin, pneumothorax, rectal prolapse, subdural hematomas, and seizures.

References

• Cortese MM, Bisgard KM. Pertussis. In: Wallace RB, Kohatsu N, Kast JM, ed. Maxcy-Rosenau-Last Public Health & Preventive Medicine, Fifteenth Edition. The McGraw-Hill Companies, Inc.; 2008:111-14.
• Tanaka M, Vitek CR, Pascual FB, Bisgard KM, Tate JE, Murphy TV. Trends in pertussis among infants in the United States, 1980-1999. JAMA. 2003;290:2968-75.

 

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