Responding to Infant Infectious Threats: Pertussis and Botulism
Pertussis and infant botulism are concurrently escalating threats to young infants, demanding immediate clinical and public‑health action.
With more than 25,000 pertussis cases reported nationwide in 2025 and focal spikes — including recent infant deaths in Kentucky — community risk for severe infant disease is elevated. For infants under 2 months, clinicians should raise vigilance and expedite evaluation for respiratory or feeding concerns.
Current case counts and geographic clustering increase baseline risk for infants too young to complete the primary DTaP series and therefore raise the likelihood that an exposed neonate will develop severe disease. Local media reports of infant deaths heighten concern, though primary surveillance data are needed to quantify case‑fatality. Intensify local surveillance and communicate heightened exposure risk to caregivers at well‑child contacts.
Maternal immunization provides demonstrable neonatal protection, and timely DTaP/Tdap vaccination of household contacts substantially reduces infant exposure. Optimal maternal Tdap timing is late second to third trimester (commonly cited as 27–36 weeks) to maximize transplacental antibody transfer.
Infants can deteriorate rapidly — watch for apnea, paroxysmal cough with cyanosis, feeding difficulty, and altered responsiveness; these are red flags that warrant immediate evaluation. Rapid diagnostics include nasopharyngeal PCR and culture while implementing droplet precautions and cohorting. Start empiric macrolide therapy for suspected pertussis in young infants promptly without awaiting confirmatory results, and consider hospitalization for apnea, hypoxia, or poor oral intake. Early recognition, isolation, and initiation of therapy materially improve clinical trajectories.
Key Takeaways:
- Concurrent pertussis surge and formula‑linked infant botulism increase risk for infants, especially those under 2 months.
- Maternal Tdap (optimally in late second–third trimester, ~27–36 weeks) plus timely household DTaP/Tdap reduces neonatal risk.
- Immediate steps: rapid testing, empiric macrolide therapy and isolation for suspected pertussis; stool testing, reporting, and antitoxin coordination for suspected botulism.