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Burden of pertussis among young infants in Malaysia: A hospital-based surveillance study
Thahira J Mohamed1, Siew M Fong2, Thiyagar Nadarajaw3
1Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia.
Insights
Infants face severe pertussis risks, with most cases in the unvaccinated. Early vaccination for infants and mothers is crucial to reduce this high disease burden and prevent complications.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Pertussis (whooping cough) poses a significant threat to infants, carrying a high risk of complications and mortality.
- Asia experiences the second-highest global burden of childhood pertussis.
- Malaysia, particularly, sees a substantial impact of pertussis among young infants requiring hospitalization.
Purpose of the Study:
- To determine the prevalence of pertussis in hospitalized infants under six months in Malaysia.
- To analyze the clinical complications and mortality rates associated with pertussis in this vulnerable population.
- To assess the vaccination status of infants diagnosed with pertussis.
Main Methods:
- A one-year, multi-site, hospital-based surveillance study was conducted.
- Infants under six months presenting with pertussis-like symptoms were included.
- Diagnosis was confirmed via serum anti-PT titration or PCR; maternal infection was also assessed cross-sectionally.
Main Results:
- Of 441 suspected cases, 12.7% were laboratory-confirmed pertussis.
- Confirmed pertussis cases showed significantly higher rates of cyanosis and apnea.
- While the case fatality rate was higher in confirmed cases (5.4%), it did not reach statistical significance.
- The majority (89.3%) of confirmed cases were in infants too young or incompletely vaccinated.
Conclusions:
- A substantial burden of pertussis disease continues to affect infants under six months old.
- Un- and under-vaccinated infants are disproportionately affected by pertussis.
- Maternal vaccination and timely infant immunization are vital strategies to mitigate the impact of pertussis.
Background:
The case fatality rate and the risk of complications due to pertussis is very high in infants. Asia has the second highest childhood pertussis burden. The study aimed to assess the prevalence, clinical complications, and mortality rates of pertussis disease requiring hospitalization among young infants in Malaysia.
Methods:
The study was a one-year, hospital-based, multi-site surveillance of infants less than six months of age with symptoms consistent with pertussis and a cross-sectional analysis of their mothers for recent pertussis infection. Information was obtained from medical records and interviews with the parents. Pertussis diagnosis was confirmed for all infants through serum anti-PT titration test or PCR test.
Results:
441 possible cases of pertussis were included in this study. Of these, 12.7 % had laboratory confirmation of pertussis. Infants with confirmed pertussis had significantly higher rates of cyanosis (37.5 % vs 8.6 %; p < 0.0001) and apnea (12.5 % vs 3.9 %; p = 0.027) than test-negative infants. Most infants from both groups were in recovery/recovered at discharge. Those with confirmed pertussis had higher case fatality rate than test-negative cases (5.4 % vs 1.0 %; p = 0.094), but the difference did not reach significance. The majority of confirmed pertussis cases (89.3 %) occurred in infants too young to be fully vaccinated or under-vaccinated for their age. Both test-negative and confirmed pertussis resulted in work-day losses and incurred costs for both parents.
Conclusions:
A high pertussis disease burden persists in infants less than six months of age, especially among those un- and under-vaccinated. Maternal and complete, on-time infant vaccination is important to reduce disease burden.
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