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Evaluation of Pertussis Disease in Young Infants in India: A Hospital-Based Multicentric Observational Study
Varinder Singh1, Balasubramanian S2, Sanjay Lalwani3
1Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.
Insights
Laboratory-confirmed pertussis (LCP) incidence was 8.5% in Indian infants hospitalized with respiratory infections. Infants under vaccination age require careful monitoring for pertussis complications.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Infections
- Vaccinology
Background:
- Pertussis (whooping cough) remains a significant public health concern globally.
- Infants, especially those too young for vaccination, are at high risk for severe pertussis complications.
- Limited data exists on pertussis incidence in India based on current diagnostic criteria.
Purpose of the Study:
- To determine the incidence of laboratory-confirmed pertussis (LCP) in infants hospitalized with acute respiratory infections (ARIs).
- To assess pertussis prevalence among infants meeting the Centers for Disease Control and Prevention (CDC)-recommended clinical case definition.
- To characterize clinical features and outcomes of pertussis in hospitalized infants in India.
Main Methods:
- Active surveillance was conducted in seven Indian centers from January 2020 to April 2022.
- Infants aged ≤6 months hospitalized with ARIs and suspected pertussis were screened.
- Reverse transcription-polymerase chain reaction (RT-PCR) was used for Bordetella pertussis detection in nasopharyngeal swabs.
Main Results:
- Of 1102 screened infants, 400 met the CDC pertussis case definition.
- Laboratory-confirmed pertussis (LCP) was diagnosed in 8.5% (34/400) and probable pertussis (PP) in 11.5% (46/400).
- Prolonged cough (≥2 weeks) was more common in PP (74%) than LCP (9%); 32% had other respiratory pathogens detected.
Conclusions:
- The incidence of LCP among hospitalized infants meeting CDC criteria in India was 8.5%.
- Prolonged cough was not a predominant feature of LCP in this cohort.
- Infants below vaccination age are vulnerable to severe pertussis requiring hospitalization and ventilation; maternal immunization warrants consideration.
Objectives:
To evaluate the incidence of laboratory-confirmed pertussis (LCP) among infants hospitalized with acute respiratory infections (ARIs) and meeting the Centers for Disease Control and Prevention (CDC)-recommended clinical case definition.
Methods:
An investigator-initiated active surveillance for clinically suspected cases (CSCs) of pertussis screened infants aged ≤6 mo hospitalized with ARIs during January 2020-April 2022 at seven centers across India. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect Bordetella pertussis in nasopharyngeal swabs. Infants were classified as having 'LCP' or 'probable pertussis' (PP).
Results:
Among 1102 screened infants, 400 participants met the CDC-2020 clinical case definition for pertussis. Of these, 34/400 (8.5%) had LCP and 46/400 (11.5%) had PP. The proportion of participants with LCP and PP was similar among infants aged 0-3 and 4-6 mo [LCP: 0-3 mo, 21/248 (~9%); 4-6 mo, 13/152 (~9%); PP: 0-3 mo, 30/248 (~12%); 4-6 mo, 16/152 (~11%)]. Cough illness lasted ≥2 wk in 3/34 (~9%) and 34/46 (~74%) participants with LCP and PP, respectively. Notably, 80% CSCs had neither LCP nor PP, and a respiratory pathogen apart from B. pertussis was detected in ~32%. Ventilation was required in 12 participants with LCP/PP.
Conclusions:
In this first study from India based on revised CDC guidelines, the incidence of LCP was 8.5%; cough illness was not a predominant feature. Infants below the age appropriate for vaccination are prone to pertussis-related hospital admissions, ICU care, and ventilation. Maternal immunization may be evaluated for neonatal protection, in addition to other strategies, to decrease disease burden in this highly vulnerable group.
Clinical Trial Registration Number:
CTRI/2019/12/022449.
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