Reactions 1487, p17 - 8 Feb 2014

SDTaP vaccine

Vaccine failure leading to pertussis: case reportA 43-year-old man developed pertussis despite receiving

DTaP vaccine.The man presented to the emergency department with

shortness of breath, and a 2-week history of low-grade feverand a nonproductive cough without whoop. He had receivedDTaP vaccination a year earlier [route and dosage not stated].He had been seen by a physician prior to presentation; heinitially also had a sore throat. A viral upper respiratoryinfection was suspected; he was given supportive care. A weeklater, he had been treated with salbutamol [albuterol] andprednisone for putative bronchospastic complications.However, his symptoms had failed to improve. He washospitalised at the current presentation. Examination revealedhypoxia, with dry rales and end-expiratory wheezing. Anatypical infection was suspected. Serological testing revealedelevated Bordetella IgM and IgG titres, indicating vaccinefailure.

The man was successfully treated with azithromycin.Author comment: "In this case, despite a recent well-

publicized outbreak less than 20 miles away, providers didnot consider a vaccination failure . . . resulting in significantmorbidity requiring hospitalization. Therefore, although rare,pertussis vaccination failure does occur, and should beconsidered in the workup for a coughing illness lasting morethan 5 days, even without the classic "whoop"."Schmidt TR, et al. Whoops! Pertussis after vaccination failure. Journal of GeneralInternal Medicine 27 (Suppl.): S506 abstr. 1304413, No. 2, Jul 2012 -USA 803099084

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