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Clinical Characteristics of Hospitalized Infants With Laboratory-Confirmed Pertussis in Guatemala
Varun K Phadke1, John P McCracken2, Jennifer L Kriss3
1Division of Infectious Diseases, School of Medicine.
Insights
Infants under two months hospitalized with respiratory illness in Guatemala had a high rate of pertussis, leading to increased intensive care unit admissions and a higher fatality rate. This highlights the severity of Bordetella pertussis in unvaccinated infants.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Surveillance
- Microbiology
Background:
- Pertussis (whooping cough) poses a significant risk of hospitalization and mortality in infants younger than two months, who are too young for vaccination.
- Limited data exists on pertussis prevalence and characteristics in infants within Central America.
- This study aimed to characterize acute respiratory illnesses (ARIs) caused by Bordetella pertussis in Guatemalan infants.
Purpose of the Study:
- To determine the incidence and clinical features of pertussis in hospitalized infants under two months with ARIs in Guatemala.
- To compare clinical outcomes between pertussis-positive and pertussis-negative infants.
Main Methods:
- Infants under two months hospitalized with ARI in Guatemala were enrolled in a population-based surveillance study.
- Nasopharyngeal and oropharyngeal swab specimens were collected and tested for Bordetella pertussis using real-time polymerase chain reaction (PCR).
Main Results:
- Of 301 infants hospitalized with ARI, 11 (3.7%) tested positive for B. pertussis.
- Pertussis-positive infants exhibited significantly higher white blood cell counts (20900 vs 12579 cells/μl) and absolute lymphocyte counts (11517 vs 5591 cells/μl).
- A higher proportion of pertussis-positive infants required intensive care unit (ICU) admission (64% vs 35%) and had a greater case fatality rate (18% vs 3%) compared to pertussis-negative infants.
Conclusions:
- Bordetella pertussis infection in hospitalized infants under two months in Guatemala is associated with severe clinical outcomes.
- Infants with pertussis experienced higher rates of ICU admission and a significantly increased case fatality rate.
- These findings underscore the critical need for effective pertussis prevention strategies in vulnerable infant populations.
Background:
Pertussis is an important cause of hospitalization and death in infants too young to be vaccinated (aged <2 months). Limited data on infant pertussis have been reported from Central America. The aim of this study was to characterize acute respiratory illnesses (ARIs) attributable to Bordetella pertussis among infants enrolled in an ongoing surveillance study in Guatemala.
Methods:
As part of a population-based surveillance study in Guatemala, infants aged <2 months who presented with ARI and required hospitalization were enrolled, and nasopharyngeal and oropharyngeal swab specimens were obtained. For this study, these specimens were tested for B pertussis using real-time polymerase chain reaction (PCR).
Results:
Among 301 infants hospitalized with ARI, we found 11 with pertussis confirmed by PCR (pertussis-positive infants). Compared to pertussis-negative infants, pertussis-positive infants had a higher mean admission white blood cell count (20900 vs 12579 cells/μl, respectively; P = .024), absolute lymphocyte count (11517 vs 5591 cells/μl, respectively; P < .001), rate of admission to the intensive care unit (64% vs 35%, respectively; P = .054), and case fatality rate (18% vs 3%, respectively; P = .014). Ten of the 11 pertussis-positive infants had cough at presentation; the majority (80%) of them had a cough duration of <7 days, and only 1 had a cough duration of >14 days. Fever (temperature ≥ 38°C) was documented in nearly half (45%) of the pertussis-positive infants (range, 38.0-38.4°C).
Conclusions:
In this study of infants <2 months of age hospitalized with ARI in Guatemala, pertussis-positive infants had a high rate of intensive care unit admission and a higher case fatality rate than pertussis-negative infants.
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