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Hospital-Diagnosed Pertussis Infection in Children and Long-term Risk of Epilepsy
Morten Olsen1, Sandra K Thygesen1, John R Østergaard2
1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Insights
Children diagnosed with pertussis (whooping cough) have an increased risk of developing epilepsy later in life. However, the overall risk of epilepsy following pertussis remains low.
Area of Science:
- Pediatric infectious diseases
- Neurology
- Epidemiology
Background:
- Pertussis (whooping cough) is known to cause acute neurological complications like encephalopathy and seizures in infants.
- The long-term risk of developing epilepsy after a pertussis infection in childhood has not been well-established.
Purpose of the Study:
- To investigate the association between pertussis infection and the subsequent risk of developing epilepsy in children.
- To quantify the long-term risk of epilepsy in individuals with a history of pertussis.
Main Methods:
- Utilized Danish population-based medical registries and the Civil Registration System for data linkage.
- Identified a cohort of patients diagnosed with pertussis (1978-2011) and matched them with 10 controls from the general population.
- Followed cohorts through 2011 to ascertain hospital-based epilepsy diagnoses, adjusting for potential confounders.
Main Results:
- The study identified 4700 patients with pertussis and 90 cases of epilepsy during follow-up.
- The cumulative incidence of epilepsy by age 10 was 1.7% in the pertussis cohort versus 0.9% in the control cohort.
- An adjusted hazard ratio of 1.7 indicated an increased risk of epilepsy in children with pertussis.
Conclusions:
- Hospital-diagnosed pertussis in childhood is associated with an elevated risk of epilepsy.
- Despite the increased risk, the absolute risk of developing epilepsy following pertussis infection is low.
Importance:
Pertussis is associated with encephalopathy and seizures in infants. However, the risk of childhood epilepsy following pertussis is unknown.
Objective:
To examine whether pertussis is associated with the long-term risk of epilepsy.
Design, Setting, And Participants:
We used individually linked data from population-based medical registries covering all Danish hospitals to identify a cohort of all patients with pertussis born between 1978 and 2011, followed up through 2011. We used the Civil Registration System to identify 10 individuals from the general population for each patient with pertussis, matched on sex and year of birth.
Exposures:
Inpatient or hospital-based outpatient diagnosis of pertussis.
Main Outcomes And Measures:
Cumulative incidence and hazard ratio of time to hospital-based epilepsy diagnosis (pertussis cohort vs general population cohort), adjusted for birth year, sex, maternal history of epilepsy, presence of congenital malformations, and gestational age. Unique personal identifiers permitted unambiguous data linkage and complete follow-up for death, emigration, and hospital contacts.
Results:
We identified 4700 patients with pertussis (48% male), of whom 90 developed epilepsy during the follow-up. The cumulative incidence of epilepsy at age 10 years was 1.7% (95% CI, 1.4%-2.1%) for patients with pertussis and 0.9% (95% CI, 0.8%-1.0%) for the matched comparison cohort. The corresponding adjusted overall hazard ratio was 1.7 (95% CI, 1.3-2.1).
Conclusions And Relevance:
In Denmark, risk of epilepsy was increased in children with hospital-diagnosed pertussis infections compared with the general population; however, the absolute risk was low.
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