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Influencing factors for severe pertussis among Chinese children: A meta-analysis
Yingying Yang1, Yaning Zhuo2, Xinren Che1
1Department of Immunization Program, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution), Hangzhou, Zhejiang, China.
Insights
Severe pertussis in children is linked to lung consolidation, concave signs, high C-reactive protein, and lack of DTP vaccination. Early detection and increased vaccination rates are key to reducing severe pertussis cases.
Area of Science:
- Pediatric Infectious Diseases
- Public Health
- Epidemiology
Background:
- Pertussis, or whooping cough, remains a significant public health concern globally.
- Severe pertussis in children can lead to serious complications and mortality.
- Understanding risk factors is crucial for effective prevention and management strategies.
Purpose of the Study:
- To systematically evaluate factors associated with severe pertussis in Chinese children.
- To provide scientific evidence to inform prevention and treatment guidelines.
- To identify key indicators for early recognition of severe pertussis.
Main Methods:
- A meta-analysis was conducted on 24 studies involving 839 severe and 4,280 non-severe pertussis cases in China.
- Literature search included major databases (PubMed, Embase, Web of Science, CNKI, Wanfang) up to September 30, 2025.
- Data were combined using fixed or random effect models to determine odds ratios and weighted mean differences.
Main Results:
- Severe pertussis was strongly associated with lung consolidation/atelectasis (OR: 15.44), three concave sign (OR: 12.91), and unvaccinated status for DTP vaccine (OR: 4.00).
- Elevated C-reactive protein (OR: 5.33) and higher white blood cell counts (WMD: 16.42 × 10^9/L) were also significant indicators.
- These factors demonstrated statistically significant associations with disease severity.
Conclusions:
- Early identification of specific clinical and laboratory factors can aid in recognizing severe pertussis.
- Strengthening DTP vaccination coverage is a critical public health intervention to reduce severe pertussis.
- Integrated strategies focusing on early detection and vaccination are essential for mitigating severe pertussis burden.
Abstract:
This study systematically evaluates factors influencing severe pertussis in Chinese children, providing scientific evidence for its prevention and treatment. A comprehensive search of PubMed, Embase, Web of Science, CNKI, and Wanfang identified literature on factors influencing severe pertussis in Chinese children up to September 30, 2025. We conducted a meta-analysis, and data were combined using either fixed or random models. A total of 24 studies included 839 severe pertussis cases and 4,280 non-severe cases. Severe pertussis was significantly associated with several factors, with the top five strongest associations being: lung consolidation or atelectasis (OR: 15.44; 95%CI: 9.06-26.31), three concave sign (OR: 12.91; 95%CI: 5.46-30.53), elevated C-reactive protein (OR: 5.33; 95%CI: 3.00-9.49), unvaccinated with DTP vaccine (OR: 4.00; 95%CI: 2.86-5.58), and white blood cell count (WMD: 16.42 × 109/L; 95%CI: 9.49-23.36). Early identification of these factors and timely intervention, along with strengthening vaccination efforts for children, can help effectively reduce severe cases.
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