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High pertussis circulation among infants, children and adolescents in Abidjan, Côte d'Ivoire
Man Koumba Soumahoro1, Gaëlle Noel2, Florence Campana3
1Epidemiology Unit, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire.
Insights
Pertussis (whooping cough) is circulating widely in Abidjan, particularly among infants. Addressing barriers to booster vaccinations and enhancing laboratory capacity are crucial for effective pertussis surveillance and control.
Area of Science:
- Medical Microbiology
- Epidemiology
- Public Health
Background:
- Pertussis, caused by Bordetella pertussis (BP) and B. parapertussis (BPP), is a severe, contagious childhood illness with high mortality in Africa.
- A hospital-based prospective study (PS) with household contact investigations (CCS) and a sero-epidemiological cross-sectional study (SECS) were conducted to assess pertussis circulation in Abidjan.
Purpose of the Study:
- To evaluate the circulation of Bordetella pertussis and B. parapertussis in infants and the wider community.
- To identify risk factors for pertussis infection in infants.
- To assess the seroprevalence of pertussis in children and adolescents and identify potential transmission dynamics within households.
Main Methods:
- Prospective study enrolled infants ≤6 months with cough and pertussis-like symptoms, using qPCR for Bordetella diagnostics.
- Household contact investigations involved qPCR and serology for all household members.
- Cross-sectional study assessed pertussis serology in children aged 3-15 years who had received primary immunization.
Main Results:
- In the prospective study, 22.5% of infants were positive for BP/BPP; younger age (<3 months), low BMI, apnea, and inclusion period were risk factors.
- Household contact investigations revealed a 49.0% infection rate, with 81% of households having at least one positive case; mothers and siblings were common sources/contacts.
- Serology in children aged 3-15 years showed 21.7% had positive pertussis serology, with low booster uptake.
Conclusions:
- Pertussis is highly prevalent in Abidjan, indicating significant ongoing transmission.
- Barriers to accessing recommended pertussis boosters must be addressed to improve population immunity.
- Strengthening laboratory capabilities is essential for individual diagnosis and establishing a robust surveillance system.
Background:
Whooping cough due to Bordetella pertussis (BP) and/or B. parapertussis (BPP) is a highly contagious infection sometimes fatal for infants. Africa accounts for the largest share of cases and deaths worldwide. To evaluate pertussis circulation, we conducted a hospital-based prospective study (PS) including household contact-cases investigation (CCS) and a sero-epidemiological cross-sectional study (SECS).
Methods:
The PS, in which Bordetella diagnostics (qPCR) were performed, included infants aged ≤6 months presenting with ≥5 days of cough associated with one pertussis-like symptom. CCS was performed using qPCR and serology regardless of clinical signs. In the SECS, serology was performed in children aged 3-15 years with primary pertussis immunization.
Results:
Study took place in Abidjan between April 2019 and July 2021. In the PS, 187 infants with median age of 2.8 months were enrolled. A total of 42 (22.5%) were confirmed as positive, including 29 (15.5%), 4 (2.1%) and 9 (4.8%) of BP, BPP and BP/BPP coinfections respectively. Age <3 months, low BMI, apnea and inclusion period were identified as risk factors of infection. In the CCIS, 36 households were investigated, representing 158 people with median age of 21.4 years. BP and/or BPP infection was confirmed for 77/157 (49.0%). Twenty-nine households (81%) had at least one positive case. Sixty-seven (42.7%) contact cases were categorized as possibly contaminated, mainly siblings older than five years (25.4%). Twenty-seven contact cases were considered as possible contaminators, primarily mothers (26%). In the SECS, 444 people were enrolled. Two hundred and thirty-eight (53.6%) and nine (2.0%) children had received one and two boosters, respectively. A positive serology was observed in 96 (21.7%) of children and adolescents.
Conclusion:
Our study highlighted high circulation of pertussis. Barriers to accessing boosters recommended by WHO need to be overcome. Laboratory capacities are key at individual level and to build an effective surveillance system.
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