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Risk factors for Bordetella pertussis disease in hospitalized children
Rudzani Muloiwa1, Felix S Dube2,3,4, Mark P Nicol4,5
1Department of Paediatrics & Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Insights
Young African infants with HIV exposure/infection or malnutrition face higher pertussis risk. Maternal pertussis and vaccination status are key factors. Improving pertussis vaccination coverage is crucial.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Pertussis (whooping cough) is a significant concern in low and middle-income countries, with poorly understood risk factors.
- A resurgence of pertussis necessitates a deeper understanding of its epidemiology in vulnerable populations.
Purpose of the Study:
- To investigate risk factors associated with pertussis in African children hospitalized with severe lower respiratory tract infections (LRTI).
- To identify key determinants of pertussis severity and transmission in a South African pediatric cohort.
Main Methods:
- Prospective study conducted over one year in Cape Town, South Africa.
- PCR testing for Bordetella pertussis on nasopharyngeal and sputum samples from children and nasopharyngeal samples from caregivers.
- Collection of clinical history and demographic data.
Main Results:
- 32 out of 460 (7.0%) children were confirmed to have B. pertussis.
- Increased risk was observed in infants younger than two months, HIV-exposed/infected children, and those with moderate under-nutrition.
- Caregiver B. pertussis detection showed the highest adjusted risk (aRR 13.82), while completed primary vaccination was protective (aRR 0.28).
Conclusions:
- HIV exposure/infection, undernutrition, and maternal B. pertussis are significant risk factors for pertussis in African children.
- Completed primary pertussis vaccination is protective.
- Urgent improvement in primary pertussis vaccine coverage and prioritization of maternal vaccination, especially for HIV-infected pregnant women, are recommended.
Introduction:
Despite a resurgence of disease, risk factors for pertussis in children in low and middle-income countries are poorly understood. This study aimed to investigate risk factors for pertussis disease in African children hospitalized with severe LRTI.
Methods:
A prospective study of children hospitalized with severe LRTI in Cape Town, South Africa was conducted over a one-year period. Nasopharyngeal and induced sputum samples from child and nasopharyngeal sample from caregiver were tested for Bordetella pertussis using PCR (IS481+/hIS1001). History and clinical details were documented.
Results:
460 children with a median age of 8 (IQR 4-18) months were enrolled. B. pertussis infection was confirmed in 32 (7.0%). The adjusted risk of confirmed pertussis was significantly increased if infants were younger than two months [aRR 2.37 (95% CI 1.03-5.42]), HIV exposed but uninfected (aRR 3.53 [95% CI 1.04-12.01]) or HIV infected (aRR 4.35 [95% CI 1.24-15.29]). Mild (aRR 2.27 [95% CI 1.01-5.09]) or moderate (aRR 2.70 [95% CI 1.13-6.45]) under-nutrition in the children were also associated with higher risk. The highest adjusted risk occurred in children whose caregivers had B. pertussis detected from nasopharyngeal swabs (aRR 13.82 [95% CI 7.76-24.62]). Completion of the primary vaccine schedule (three or more doses) was protective (aRR 0.28 [95% CI 0.10-0.75]).
Conclusions:
HIV exposure or infection, undernutrition as well as detection of maternal nasal B. pertussis were associated with increased risk of pertussis in African children, especially in young infants. Completed primary vaccination was protective. There is an urgent need to improve primary pertussis vaccine coverage in low and middle-income countries. Pertussis vaccination of pregnant women, especially those with HIV infection should be prioritized.
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