Related Experiment Videos
Early infantile pertussis; increasingly prevalent and potentially fatal
1Paediatric Intensive Care Unit, University Hospital, Queens Medical Centre, Nottingham, UK.
Insights
Severe pertussis in infants under 7 weeks presents atypically and is difficult to manage. This resurgence highlights the need to protect vulnerable infants before immunization.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Pertussis (whooping cough) is a highly contagious respiratory infection.
- Infants less than 7 weeks old are particularly vulnerable due to their immature immune systems and pre-vaccination status.
Observation:
- Nine cases of severe early pertussis in infants under 7 weeks were reported.
- Clinical presentations were atypical, mimicking common infant illnesses like bronchiolitis.
- Infants required significant medical intervention, including ventilation for apnea and respiratory failure.
Findings:
- Complications were frequent and severe, including hypotension, seizures, pneumothoraces, and co-infections.
- Two infants required extracorporeal membrane oxygenation (ECMO).
- Six out of nine infants (67%) died from the infection.
Implications:
- The findings suggest a concerning resurgence of pertussis in a highly vulnerable population.
- Urgent review of infant immunization schedules and strategies to prevent secondary transmission are necessary.
- Protecting pre-immunized infants from pertussis is critical to reduce mortality and morbidity.
Unlabelled:
We report nine cases of severe early pertussis in infants less than 7 weeks of age. Clinical features at this age are atypical and may be confused with more common illnesses such as bronchiolitis. All were very difficult to manage. Ventilation was required for apnoeas in five cases, seizures in two or respiratory failure in two. Complications included hypotension in seven cases, pulmonary hypertension in one, pneumothoraces in two, seizures in five and co-infection in five. Two cases were referred for extracorporeal membrane oxygenation and six died. Infection was confirmed either at post mortem or by culture from pernasal swabs. The mother or other close family members were symptomatic at the time and thought to be the source of infection.
Conclusion:
The nine cases suggest a significant resurgence of the infection, which may be fatal in early life. If reporting continues to increase, the immunisation schedule will need to be reviewed and secondary transmission prevented where possible, to protect this vulnerable pre-immunisation group.