Pertussis-Associated Pneumonia in Infants and Children From Low- and Middle-Income Countries Participating in the PERCH Study.


Barger-Kamate, B; Deloria Knoll, M; Kagucia, EW; Prosperi, C; Baggett, HC; Brooks, WA; Feikin, DR; Hammitt, LL; Howie, SR; Levine, OS; Madhi, SA; Scott, JA; Thea, DM; Amornintapichet, T; Anderson, TP; Awori, JO; Baillie, VL; Chipeta, J; DeLuca, AN; Driscoll, AJ; Goswami, D; Higdon, MM; Hossain, L; Karron, RA; Maloney, S; Moore, DP; Morpeth, SC; Mwananyanda, L; Ofordile, O; Olutunde, E; Park, DE; Sow, SO; Tapia, MD; Murdoch, DR; O'Brien, KL; Kotloff, KL; Pneumonia Etiology Research for Child Health (PERCH) Study Group, ; , COLLABORATORS; Ashraf, H; Ahmed, D; Endtz, H; Jahan, Y; Zaman, K; Adrian, PV; Mudau, A; Kuwanda, L; Groome, MJ; Antonio, M; Ebruke, BE; Mackenzie, G; McLellan, J; Machuka, EM; Shamsul, A; Zaman, SM; Fu, W; Li, M; Bunthi, C; Sawatwong, P; Akarasewi, P; Rhodes, J; Thamthitiwat, S; Duncan, J; Mwansa, J; Somwe, SW; Kazungu, S; Kamau, A; Kwenda, G; Onwuchekwa, U; Tamboura, B; Sylla, M; Seidenberg, P; Zeger, S; (2016) Pertussis-Associated Pneumonia in Infants and Children From Low- and Middle-Income Countries Participating in the PERCH Study. Clinical infectious diseases , 63 (suppl 4). S187-S196. ISSN 1058-4838 DOI: 10.1093/cid/ciw546

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Abstract

 Few data exist describing pertussis epidemiology among infants and children in low- and middle-income countries to guide preventive strategies.  Children 1-59 months of age hospitalized with World Health Organization-defined severe or very severe pneumonia in 7 African and Asian countries and similarly aged community controls were enrolled in the Pneumonia Etiology Research for Child Health study. They underwent a standardized clinical evaluation and provided nasopharyngeal and oropharyngeal swabs and induced sputum (cases only) for Bordetella pertussis polymerase chain reaction. Risk factors and pertussis-associated clinical findings were identified.  Bordetella pertussis was detected in 53 of 4200 (1.3%) cases and 11 of 5196 (0.2%) controls. In the age stratum 1-5 months, 40 (2.3% of 1721) cases were positive, all from African sites, as were 8 (0.5% of 1617) controls. Pertussis-positive African cases 1-5 months old, compared to controls, were more often human immunodeficiency virus (HIV) uninfected-exposed (adjusted odds ratio [aOR], 2.2), unvaccinated (aOR, 3.7), underweight (aOR, 6.3), and too young to be immunized (aOR, 16.1) (all P ≤ .05). Compared with pertussis-negative African cases in this age group, pertussis-positive cases were younger, more likely to vomit (aOR, 2.6), to cough ≥14 days (aOR, 6.3), to have leukocyte counts >20 000 cells/µL (aOR, 4.6), and to have lymphocyte counts >10 000 cells/µL (aOR, 7.2) (all P ≤ .05). The case fatality ratio of pertussis-infected pneumonia cases 1-5 months of age was 12.5% (95% confidence interval, 4.2%-26.8%; 5/40); pertussis was identified in 3.7% of 137 in-hospital deaths among African cases in this age group.  In the postneonatal period, pertussis causes a small fraction of hospitalized pneumonia cases and deaths; however, case fatality is substantial. The propensity to infect unvaccinated infants and those at risk for insufficient immunity (too young to be vaccinated, premature, HIV-infected/exposed) suggests that the role for maternal vaccination should be considered along with efforts to reduce exposure to risk factors and to optimize childhood pertussis vaccination coverage.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 27838672
Web of Science ID: 392714700011
URI: http://researchonline.lshtm.ac.uk/id/eprint/3093670

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