Severe and unrecognised: pertussis in UK infants

Area of Science:

• Pediatric Infectious Diseases
• Microbiology
• Epidemiology

Background:

• Pertussis, commonly known as whooping cough, poses a significant threat to infants, particularly those requiring intensive care.
• Accurate and timely diagnosis of pertussis is crucial for effective patient management and public health interventions.
• Understanding the transmission dynamics within households is essential for controlling outbreaks.

Purpose of the Study:

• To investigate the diagnostic accuracy of culture, polymerase chain reaction (PCR), and serology for pertussis in hospitalized children.
• To identify the sources of pertussis infection within the households of affected children.
• To assess the clinical presentation and co-infections associated with pertussis in pediatric intensive care units (PICUs) and general pediatric wards.

Main Methods:

• A prospective study was conducted on infants admitted to London PICUs and children admitted to pediatric wards with relevant respiratory symptoms.
• Diagnostic methods included bacterial culture, PCR, and serological testing for pertussis.
• Household contacts were also evaluated to trace the origin of infection.

Main Results:

• Pertussis was diagnosed in 23% of recruited children, with a higher prevalence in ward admissions (50%) compared to PICU admissions (19.8%).
• Culture was positive in only 4% of cases, indicating low sensitivity for this diagnostic method.
• Respiratory Syncytial Virus (RSV) co-infection was common (33%), and pertussis was frequently transmitted by parents (42%) and older vaccinated children (27%) within the household.

Conclusions:

• Severe pertussis is frequently underdiagnosed, emphasizing the need for improved diagnostic approaches.
• A diagnosis of RSV does not rule out the possibility of co-existing pertussis.
• Enhancements to the UK vaccination program are recommended to reduce pertussis transmission from parents and older siblings to young infants.