Fever Occurrence in Pertussis Cases: Insights from US Surveillance 2015–2022
Overview
Analysis of 7,840 pertussis cases from 2015 to 2022 revealed that 10% had documented fever, challenging the traditional view that fever is uncommon in pertussis. Fever presence varied by age, ethnicity, season, and vaccination status, with notable increases in 2022.
Background
Pertussis, or whooping cough, is a contagious respiratory infection caused by Bordetella pertussis, primarily affecting infants and young children. It typically presents with severe coughing fits following cold-like symptoms. Fever is not classically associated with pertussis and is excluded from the US national case definition, complicating diagnosis especially in atypical cases. Understanding fever prevalence in pertussis can improve clinical recognition and management.
Data Highlights
Characteristic
Fever Prevalence (%)
Overall documented fever
10%
Age <2 months
6%
Age 2 months to <6 years
16%
Hispanic ethnicity (vs non-Hispanic)
1.3 times more likely
Probable vs confirmed cases
1.6 times more likely
Vaccinated vs never vaccinated
2 times more likely
Fever prevalence in 2022
20%
Temperature range among febrile cases
38°C to 41.7°C (median 38.7°C)
Key Findings
10% of pertussis cases had documented fever, with most fevers starting on or after cough onset.
Infants <2 months were less likely to have fever (6%) compared to children 2 months to <6 years (16%).
Hispanic individuals had a 1.3-fold higher likelihood of fever compared to non-Hispanics.
Probable pertussis cases were 1.6 times more likely to have fever than confirmed cases.
Vaccinated individuals were twice as likely to have fever compared to those never vaccinated.
Fever prevalence was higher in fall, winter, and spring, and peaked at 20% in 2022.
Clinical Implications
Clinicians should not exclude pertussis as a diagnosis solely based on the presence of fever, as it occurs in a significant minority of cases. Awareness of fever in pertussis, especially among vaccinated individuals and certain demographic groups, may aid in timely diagnosis and treatment. Surveillance data highlight the need to consider fever in clinical assessments despite its omission from case definitions.
Conclusion
Fever occurs in approximately 1 in 10 pertussis cases and varies by age, ethnicity, vaccination status, and season. Recognizing fever as a possible symptom can improve pertussis identification and management.
by Michelle M Hughes, Amy Rubis, Anna M Acosta, Vanessa Aden, Patricia Firmender, Kate Horn, Emma Stanislawski, Rachel Wester, Erin Youngkin, Victor Cruz, Tami H Skoff
