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Epidemiology of Pertussis Among Young Pakistani Infants: A Community-Based Prospective Surveillance Study
Saad B Omer1,2,3,4, A Momin Kazi5, Robert A Bednarczyk2,4
1Department of Global Health.
Insights
Pertussis poses a significant health risk to young infants. This study in Pakistan found a moderate burden of pertussis disease in infants, highlighting the need for further public health interventions.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health Surveillance
Background:
- Pertussis (whooping cough) is a major cause of infant illness and death, particularly in low-resource settings.
- Limited data exist on the pertussis disease burden in infants in South Asia.
Purpose of the Study:
- To determine the incidence and burden of pertussis disease in young infants in Pakistan.
- To implement active, community-based surveillance for Bordetella pertussis.
Main Methods:
- A prospective surveillance study was conducted in Karachi, Pakistan, involving two infant cohorts.
- Infants were monitored until 18 weeks of age, with nasopharyngeal swabs collected for Bordetella pertussis testing via real-time PCR.
- Pertussis incidence was calculated using protocol-defined and CDC case definitions.
Main Results:
- The incidence of protocol-defined pertussis was 3.96 cases per 1000 infants.
- CDC-defined confirmed and probable pertussis incidence rates were 2.47 and 0.99 cases per 1000 infants, respectively.
- Three severe pertussis cases were identified.
Conclusions:
- This study identified a moderate burden of pertussis in early infancy in Pakistan.
- Results underscore the importance of pertussis surveillance in developing countries.
Background:
Pertussis remains a cause of morbidity and mortality among young infants. There are limited data on the pertussis disease burden in this age group from low- and lower-middle-income countries, including in South Asia.
Methods:
We conducted an active community-based surveillance study from February 2015 to April 2016 among 2 cohorts of young infants in 4 low-income settlements in Karachi, Pakistan. Infants were enrolled either at birth (closed cohort) or at ages up to 10 weeks (open cohort) and followed until 18 weeks of age. Nasopharyngeal swab specimens were obtained from infants who met a standardized syndromic case definition and tested for Bordetella pertussis using real-time polymerase chain reaction. We determined the incidence of pertussis using a protocol-defined case definition, as well as the US Centers for Disease Control and Prevention (CDC) definitions for confirmed and probable pertussis.
Results:
Of 2021 infants enrolled into the study, 8 infants met the protocol-defined pertussis case definition, for an incidence of 3.96 (95% confidence interval [CI], 1.84-7.50) cases per 1000 infants. Seven of the pertussis cases met the CDC pertussis case definition (5 confirmed, 2 probable), for incidences of CDC-defined confirmed pertussis of 2.47 (95% CI, .90-5.48) cases per 1000 infants, and probable pertussis of 0.99 (95% CI, .17-3.27) cases per 1000 infants. Three of the pertussis cases were severe according to the Modified Preziosi Scale score.
Conclusions:
In one of the first prospective surveillance studies of infant pertussis in a developing country, we identified a moderate burden of pertussis disease in early infancy in Pakistan.
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