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

Abstract

Background. Few data exist describing pertussis epidemiology among infants and children in low- and middle-income countries to guide preventive strategies.Methods. 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.Results. 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.Conclusions. 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.

Suspension microarray-based comparison of oropharyngeal swab and bronchoalveolar lavage fluid for pathogen identification in young children hospitalized with respiratory tract infection

“…In this study, we detected Bordetella pertussis in 5 young children. Identification of Bordetella pertussis in BALF or OPS specimens may provide predictive value for the outcome of respiratory illness at the individual case level [23]. In terms of some pathogens such as influenza A, adenovirus, Mycoplasma pneumoniae and Streptococcus pneumoniae, relatively low concordance between BALF and OPS specimens for them may reflect different cell tropisms for different parts of the respiratory tract.…”

Advances in the diagnosis of pneumonia in children

“…In a multicenter case-control study of children in hospital for severe or very severe pneumonia, the use of induced sputum samples increased the detection of B pertussis using PCR by 48% compared with the use of a combined nasopharyngeal and oropharyngeal swab. 87 Two South African studies also found an increased yield of B pertussis on PCR with induced sputum, 11 88 although no difference was shown in another hospital based study. 89 Several studies have shown good agreement between PCR testing of induced sputum and nasopharyngeal swabs for viruses; the yield is highest when both sample types are tested.…”

Pertussis in the Association of Southeast Asian Nations: epidemiology and challenges

“…Nine studies containing descriptive epidemiology data from ASEAN countries were identified: two hospital-based studies of children with severe pertussis (Kowalzik et al, 2007;Sadiasa et al, 2017), two hospital-based studies of adults with prolonged cough (Siriyakorn et al, 2016;Koh et al, 2016), two seroepidemiology surveys (Wanlapakorn et al 2016;Son et al 2018), and three studies of multiple etiologies of respiratory illness (Wertheim et al 2015;Barger-Kamate et al 2016;Lau et al 2018) (Table 3). Pertussis disease in ASEAN countries is poorly characterized, partly demonstrated by the fact that only six out of ten countries are represented by these nine studies.…”

“…No pertussis-specific symptoms or vaccine status was reported. The Pneumonia Etiology Research for Child Health Study was a multinational, prospective, hospitalbased and community control study which included Thai infants aged 1-59 months presenting with pneumonia between 2011 and 2014 (Barger-Kamate et al, 2016). None of the 224 pneumonia cases tested positive for pertussis by PCR while three (0.34%) cases (two clinically and one PCR-confirmed case) were found in the control group.…”