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ELECTRONIC ARTICLE:
Scott A. Halperin, R. Bortolussi, Joanne M. Langley, Brian J. Eastwood, and Gaston De Serres
A Randomized, Placebo-Controlled Trial of Erythromycin Estolate Chemoprophylaxis for Household Contacts of Children With Culture-Positive Bordetella pertussis Infection
Pediatrics 1999; 104: e42 [Abstract] [Full text] [PDF]
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Ulrich Heininger   (8 December 1999)
[Read P3R] Response to Dr. Heininger
Scott A Halperin   (17 December 1999)

Untitled 8 December 1999
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Ulrich Heininger,
Assistant Professor for Pediatrics
University Children's Hospital Basel, Switzerland

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Ulrich.Heininger{at}unibas.ch Ulrich Heininger

I would like to congratulate the authors on their interesting findings and share a few comments. The secondary attack rate in household members treated with placebo after exposure to children with pertussis was only 5.1%-6.6%. This suggests a high level of immunity, either by previous natural infection (as the authors discuss) but also possibly by immunization (what the authors do not mention). Information on the pertussis immunization status is missing in the paper but would have been of substantial interest. Could this be provided? Furthermore, the analysis of clinical efficacy of erythromycin prophylaxis presented in Table 4 does not take the patients' compliance into account. It would be interesting to see a separate analysis restricted to erythromycin recipients with what the authors considered "excellent compliance". This might demonstrate a possible effect of erythromycin more clearly. Best regards, Ulrich Heininger

Response to Dr. Heininger 17 December 1999
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Scott A Halperin,
Professor of Pediatrics
Dalhousie University

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Re: Response to Dr. Heininger

shalperin{at}iwkgrace.ns.ca Scott A Halperin

We thank Dr. Heininger for his comments about our study. We agree that the low secondary attack rate could have been due to either previous natural infection or immunization. The effect of immunization was assessed but was hampered by the lack of reliable immunization records for nearly half of the household contacts (mostly adults). Of those household members for whom immunization status was known, all bacteriological chemoprophylaxis failures in both the placebo and the erythromycin groups occurred in individuals who had received at least four doses of pertussis vaccine. There was no effect on the clinical efficacy according to immunization status. Although there was an effect of compliance with medication on bacteriological efficacy (as reported in the manuscript), there was no effect of patient compliance on the clinical efficacy presented in Table 4.