Sex: U
Vaccine: TDAP
Symptoms: Cough, Culture positive, Death, Encephalopathy, Mechanical ventilation
Clinical narrative: Suspected vaccination failure; Pertussis; Pneumonia; Sepsis; Encephalopathy; Cough; Respiratory Failure; This case was reported in a literature article and described the occurrence of vaccination failure in a 48-year-old patient who received DTPa (Reduced antigen) (dTpa vaccine) for prophylaxis.   Concurrent medical conditions included hiv infection.   On an unknown date, the patient received dTpa vaccine at an unknown dose. On an unknown date, more than a week after receiving dTpa vaccine, the patient experienced vaccination failure (serious criteria death, hospitalization and GSK medically significant), pertussis (serious criteria death, hospitalization and GSK medically significant), pneumonia (serious criteria death, hospitalization and GSK medically significant), sepsis (serious criteria death, hospitalization and GSK medically significant), encephalopathy (serious criteria death, hospitalization and GSK medically significant), cough (serious criteria death and hospitalization) and respiratory failure (serious criteria death and GSK medically significant). On an unknown date, the outcome of the vaccination failure, pertussis, pneumonia, sepsis, encephalopathy, cough and respiratory failure were fatal. The reported cause of death was pertussis, pneumonia, sepsis, encephalopathy, respiratory failure, vaccination failure and cough.   It was unknown if the reporter considered the vaccination failure, pertussis, pneumonia, sepsis, encephalopathy, cough and respiratory failure to be related to dTpa vaccine.  Additional details were provided as follows: This case was reported in a literature article and described the suspected vaccination failure, sever pertussis infection, pneumonia, sepsis, encephalopathy in an adult patient of 48-year-old of unspecified gender who was vaccinated with unspecified tetanus, diphtheria & acellular pertussis (Tdap) vaccine (manufacturer unknown) for prophylaxis. This case corresponds to result section reported in this literature article. The patient was the part of the Enhanced Pertussis Surveillance (EPS) as part of the Emerging Infections Program Network. The aim of the study was to characterize severe pertussis cases, defined as those that require hospitalization, and compare hospitalized and non-hospitalized pertussis patients, identify risk factors for hospitalization, and describe the clinical course and underlying health conditions of hospitalized pertussis patients. The patient had a concurrent history of human immunodeficiency virus infection. No information on patient's family history or concomitant medication. On unspecified date, at least 14 days prior to cough onset, the patient had received unspecified tetanus, diphtheria & acellular pertussis (Tdap) vaccine (administration route and site unspecified, dosage unknown; batch number not provided). The age of vaccination was not provided. [In this study, 15942 cases of pertussis were reported in the surveillance area, patients aged more or equal to 12 years were considered up to date if they had received Tdap. For this analysis, only documented vaccine doses administered at least 14 days prior to cough onset. Fewer hospitalized patients were up to date on pertussis-containing vaccines]. On unspecified date in between 1st January 2011 and 31st December 2015, at least 14 days after vaccination, the patient had the onset of cough and was admitted. The patient had an infection which was laboratory confirmed by culture or polymerase chain reaction (PCR). During the admission, the patient had diagnosed with the pneumonia, sepsis (not further described), and encephalopathy. The patient had the normal white blood cell (WBC) of 8.71 × 109/L. The patient had a respiratory failure that required mechanical ventilation. On an unspecified date, the hospitalized pertussis patients died from their infection. It was unknown, whether the autopsy was performed or not. [In this study, pertussis cases were classified according to the Council of State and Territorial Epidemiologists case definition. For hospitalized pertussis patients, defined as those admitted to an inpatient care facility, observation unit, or emergency department for more or equal to 24 hours as a result of pertussis infection. Among these cases, 15 427 occurred in patients treated as an outpatient and 515 occurred in patients who were hospitalized; 107 hospitalized patients required admission to the intensive care unit (ICU). Overall, the most common hospital admission diagnoses included cough, "pertussis", respiratory distress and or failure, bronchiolitis or bronchitis, and pneumonia. Among all hospitalized patients (515), the median length of time from onset to hospitalization was 11 days, ranging from 7 days in infants aged less than 2 months to 17 days in persons aged equal or more than 65 years. The median length of hospital stay was 3 (1.7-6.9 days) and ICU stay was 4 (2-9 days). The hospitalized patients received a macrolide antibiotic within 14 days of symptom onset, and had an infection that was laboratory confirmed by culture or polymerase chain reaction (PCR). Traditional pertussis clinical symptoms were more commonly reported in hospitalized patients symptoms included paroxysmal cough, post-tussive vomiting, whoop, cyanosis and apnea. Among patients who were tested during their hospitalization, 31 of 350 had a maximum white blood cell (WBC) count that surpassed 30 × 109/L (previously associated with an increased risk of pertussis-related infant deaths and 54 of 271 had a viral codetection (diagnosed through PCR, direct fluorescent antibody testing, culture, or rapid antigen tests). Overall, 127 of hospitalized pertussis patients developed pneumonia, developed new-onset seizures, and developed encephalopathy]. This case was considered as suspected vaccination failure as the vaccination schedule and time to onset were unknown. This case was considered as serious due to suspected vaccination failure and death. The author commented, "Pertussis vaccination according to Advisory Committee on Immunization Practices (ACIP) recommendations is not only effective at preventing disease but has also been shown to reduce the clinical severity of pertussis illness. Although high amounts of missing vaccination information in adolescents and adults precluded our ability to fully assess this association in older age groups, a recent publication suggested that adolescents and adults vaccinated with Tdap have reduced incidence of post-tussive vomiting, a marker of more clinically significant illness. Thus, although vaccinated persons may still remain at risk for pertussis infection, these data highlight the role that pertussis vaccination plays in the prevention of severe and potentially life-threating infections, suggesting an added benefits of vaccination that goes beyond disease prevention. We are unable to determine whether certain underlying conditions are risk factors for severe pertussis or, rather, whether persons with these conditions are hospitalized at greater rates due to a perception of increased risk for severe disease". The author concluded, "Our analysis shows that severe pertussis infections that require hospitalization are not limited to infants; certain risk factors, such as key underlying medical conditions, may predispose an individual to more severe infections. Continued monitoring of pertussis hospitalizations through enhanced surveillance systems such as EPS will help better define populations at increased risk of severe disease in order to appropriately target and prioritize current and future pertussis prevention and control strategies. Individuals at the extreme ends of life may be the most vulnerable to severe pertussis infections, though hospitalization was reported across all age groups. Continued monitoring of severe pertussis infections will be important to help guide prevention, control, and treatment options".      Lab Comments: Lab test done on an unspecified date between 1st January 2011 and 31st December 2015.  The patient had an infection which was laboratory confirmed by culture or polymerase chain reaction (PCR).; Reported Cause(s) of Death: Pertussis; Pneumonia; sepsis (not further described); Encephalopathy; Respiratory failure; Suspected Vaccination failure; Cough