Pertussis in infants: how to protect the vulnerable?
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Published on: February 22, 2019
Lai-Man R Chuk1, Stephen B Lambert, Meryta L May
1Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Center, Royal Children's Hospital, Brisbane, Queensland. r.chuk@uq.edu.au
Insights
Infants are highly vulnerable to severe pertussis (whooping cough). Even vaccinated infants can require hospitalization, highlighting the importance of parental immunization to protect newborns from this serious respiratory illness.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Infants, particularly those under 3 months, face the highest risk of severe pertussis (whooping cough).
- Adult household contacts are a primary source of pertussis transmission to vulnerable infants.
- Understanding transmission and risk factors is crucial for preventing severe infant outcomes.
Purpose of the Study:
- To review exposure history, vaccination status, and outcomes of hospitalized infants with pertussis.
- To assess the accuracy of hospital discharge coding for identifying pertussis cases.
- To identify key factors contributing to severe pertussis in hospitalized infants.
Main Methods:
- Retrospective review of 55 hospitalized infants with pertussis between 1997 and 2006.
- Data sourced from hospital discharge coding and laboratory confirmation of Bordetella pertussis.
- Comparison of data completeness between the two identification sources.
Main Results:
- Infants under 3 months (64% of cases) had higher risks of ICU admission and mortality.
- Most infants admitted were not significantly overdue for routine pertussis vaccinations.
- Hospital discharge coding was more sensitive than laboratory data for case identification, though 16% had errors.
Conclusions:
- Severe pertussis requiring hospitalization can occur even in infants up-to-date with vaccinations.
- Parental immunization is a potential strategy to prevent pertussis transmission to newborns.
- Improving discharge coding accuracy is necessary for better surveillance of pertussis.
Abstract:
In terms of adverse outcomes, infants remain the group most vulnerable to severe pertussis disease. Adult household contact is thought to be the main source of transmission to infants. This study reviews exposure history, vaccination status, admission outcome and quality of discharge coding of hospitalised infants with pertussis at a tertiary paediatric hospital. We identified cases between 1997 and 2006 from 2 sources: hospital discharge coding and positive Bordetella pertussis results from the hospital laboratory database. We assessed the completeness of each of these sources, compared with the dataset of all identified cases. We identified 55 hospitalised infants with pertussis. The 35 cases (64%) less than 3 months of age had greater risk of Intensive Care Unit admission, higher mortality, and were more likely to have parents as an identified source. On admission, only 5 cases (9%) were more than 2 weeks overdue for their previous scheduled pertussis vaccination. Discharge coding was more sensitive for identifying cases than the laboratory database. Nine cases (16%) had incorrect discharge coding. Even infants up to date for pertussis vaccine can have severe disease requiring hospitalisation. Immunising parents planning to have, or who have had, a newborn baby may help to prevent pertussis in infants.
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