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Clinical and Epidemiologic Characteristics of Pertussis in Hospitalized Children: A Prospective and Standardized
Jana Zumstein1, Ulrich Heininger1,2,
1From the Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland.
Insights
Pertussis (whooping cough) remains a significant threat to infants, with most severe cases and fatalities occurring in those under six months. Vaccination during pregnancy has shown promise, but challenges in vaccine uptake persist.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Public Health Surveillance
Background:
- Pertussis (whooping cough) surveillance is crucial for evaluating vaccination program effectiveness and guiding public health strategies.
- Switzerland reinstated nationwide reporting of pertussis hospitalizations in children in 2013 to assess the impact of maternal immunization programs.
Purpose of the Study:
- To analyze the incidence, clinical characteristics, and outcomes of pertussis hospitalizations in children under 16 in Switzerland.
- To evaluate the effectiveness of the pertussis immunization in pregnancy program introduced in 2013.
Main Methods:
- A nationwide surveillance system collected data on children hospitalized with suspected or confirmed pertussis from 2013 to 2019.
- Data included clinical and epidemiological characteristics, laboratory confirmation, and vaccination status.
- Standardized case definitions were applied to reported cases.
Main Results:
- Of 294 reported cases, 213 were confirmed pertussis cases, with 79% occurring in infants under 6 months.
- Hospitalization duration averaged 8 days, with complications like cyanosis and dyspnea common in infants.
- The overall case fatality rate was 1.4%, rising to 8.7% in neonates. Maternal vaccination rates during pregnancy were low (2%).
Conclusions:
- Despite a decrease in pertussis cases following the introduction of maternal immunization, disease control remains a challenge.
- Failure to achieve adequate vaccination coverage, rather than vaccine failure, is the primary obstacle to pertussis control.
Background:
Surveillance of incidence and severity of pertussis is key to control success and shortcomings of vaccination programs followed by adaptations of recommendations if necessary. In Switzerland, nationwide reporting of hospitalizations due to pertussis in children has a long tradition and resumed in 2013 to evaluate the effects of pertussis immunization in pregnancy introduced in 2013.
Methods:
Since 2013, all patients <16 years of age hospitalized with suspected or proven pertussis have been reported to the Swiss Pediatric Surveillance Unit. Patient data comprising clinical and epidemiologic characteristics and laboratory confirmation were assessed in a standardized fashion, and case definitions were applied to all cases reported until the end of 2019.
Results:
Two hundred thirteen of 294 cases were valid cases of pertussis. Of these, 168 (79%) occurred in <6-month-old infants. Mean duration of hospitalization was 8 days (median 5, range 2-47) overall and highest in neonates (14.2 days); 85% of all patients had ≥1 complication, most commonly cyanosis and dyspnea, especially in infants. Overall, case fatality rate was 1.4% (8.7% in neonates). Only 4 (2%) of 168 mothers of infants <6 months had been vaccinated during pregnancy; 14 (12%) of 112 patients with precise records of immunization had completed their primary series and were up-to-date for age.
Conclusions:
Despite a decline of cases associated with the introduction of immunization against pertussis in pregnancy, control of the disease remains challenging, mainly due to failure to vaccinate rather than vaccine failure.
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