Pertussis Prevalence and Its Determinants among Children with Persistent Cough in Urban Uganda

Kayina, Vincent; Kyobe, Samuel; Katabazi, Fred Ashaba; Kigozi, Edgar; Okee, Moses; Odongkara, Beatrice; Babikako, Harriet; Whalen, Christopher C.; Joloba, Moses; Musoke, Philippa; Mupere, Ezekiel

doi:10.1371/journal.pone.0123240

Cited by 22 publications

(22 citation statements)

References 26 publications

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“…The prevalence of B. pertussis identification was 3.0-fold (95% CI, 1.1- to 8.3-fold) greater among infants <23 months of age than children aged 24–59 months [12]. In contrast, a study conducted over 5 months in a national hospital in Niger that enrolled children <5 years of age with clinical suspicion of pertussis reported a prevalence of 0.82% for identifying Bordetella species [37].…”

Section: Discussionmentioning

confidence: 99%

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The Burden of Pertussis Hospitalization in HIV-Exposed and HIV-Unexposed South African Infants

et al. 2016

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Background. There are limited data on pertussis in African children, including among human immunodeficiency virus (HIV)–exposed infants. We conducted population-based hospital surveillance to determine the incidence and clinical presentation of Bordetella pertussis–associated hospitalization in perinatal HIV-exposed and -unexposed infants.Methods. Children <12 months of age hospitalized with any sign or symptom of respiratory illness (including suspected sepsis or apnea in neonates) were enrolled from 1 January 2015 to 31 December 2015. Detailed clinical and demographic information was recorded and respiratory samples were tested by polymerase chain reaction (PCR).Results. The overall B. pertussis PCR positivity was 2.3% (42/1839), of which 86% (n = 36) occurred in infants <3 months of age. Bordetella pertussis was detected in 2.1% (n = 26/1257) of HIV-unexposed and 2.7% (n = 16/599) of HIV-exposed infants. The incidence (per 1000) of B. pertussis–associated hospitalization was 2.9 (95% confidence interval [CI], 1.8–4.5) and 1.9 (95% CI, 1.3–2.6) in HIV-exposed and HIV-unexposed infants, respectively (P = .09). The overall in-hospital case fatality ratio among the cases was 4.8% (2/42), both deaths of which occurred in HIV-exposed infants <3 months of age. Among cases, presence of cough ≥14 days (20.5%) and paroxysmal coughing spells (33.3%) at diagnosis were uncommon. Only 16 (38%) B. pertussis–associated hospitalizations fulfilled the Centers for Diseases Control and Prevention case definition of “definite” pertussis.Conclusions. Bordetella pertussis contributed to a modest proportion of all-cause respiratory illness hospitalization among black-African children, with a trend for higher incidence among HIV-exposed than HIV-unexposed infants. Maternal vaccination of pregnant women should be considered to reduce the burden of pertussis hospitalization in this population.

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Section: Discussionmentioning

confidence: 99%

“…Recently, there has reportedly been a reemergence of pertussis in high-income countries [3, 8–12]. This could be due to more sensitive diagnostic tools such as molecular assays for detection of Bordetella pertussis rather than reliance on culture, heightened physician awareness of the disease, and lower threshold for investigating.…”

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confidence: 99%

The Burden of Pertussis Hospitalization in HIV-Exposed and HIV-Unexposed South African Infants

et al. 2016

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“…Research leads from microbiology, public health, and vaccinology highlight at least six avenues of research in pertussis (Table 8). While animal models for pertussis have been instrumental in increasing our understanding of pertussis pathogenesis, multidisciplinary collaborations will be essential to identify host-pathogen and other factors that drive evolution of B. pertussis strains circulating in populations around the world (572)(573)(574). Such studies may identify environmental, ecological, and human-related factors (e.g., biofilms, use of antibiotics, vaccines, immunity, or behaviors) that are associated with B. pertussis disease and strain emergence (133,135).…”

Section: Future Research Avenuesmentioning

confidence: 99%

Pertussis: Microbiology, Disease, Treatment, and Prevention

et al. 2016

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SUMMARYPertussis is a severe respiratory infection caused byBordetella pertussis, and in 2008, pertussis was associated with an estimated 16 million cases and 195,000 deaths globally. Sizeable outbreaks of pertussis have been reported over the past 5 years, and disease reemergence has been the focus of international attention to develop a deeper understanding of pathogen virulence and genetic evolution ofB. pertussisstrains. During the past 20 years, the scientific community has recognized pertussis among adults as well as infants and children. Increased recognition that older children and adolescents are at risk for disease and may transmitB. pertussisto younger siblings has underscored the need to better understand the role of innate, humoral, and cell-mediated immunity, including the role of waning immunity. Although recognition of adult pertussis has increased in tandem with a better understanding ofB. pertussispathogenesis, pertussis in neonates and adults can manifest with atypical clinical presentations. Such disease patterns make pertussis recognition difficult and lead to delays in treatment. Ongoing research using newer tools for molecular analysis holds promise for improved understanding of pertussis epidemiology, bacterial pathogenesis, bioinformatics, and immunology. Together, these advances provide a foundation for the development of new-generation diagnostics, therapeutics, and vaccines.

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“…Other than research studies undertaken in small, intensively studied populations, such as Senegal [23], many published studies report pertussis prevalence in hospitalized patients or patients with persistent cough, unlikely to accurately estimate pertussis prevalence in the whole population [27–29]. In Senegal, as EPI coverage increased from 13% in 1986 to 82%–84% after 1990, cases in infants aged <2 months decreased from around 200 per 1000 to around 56 per 1000 [23].…”

Section: Discussionmentioning

confidence: 99%

Influence of Population Demography and Immunization History on the Impact of an Antenatal Pertussis Program

et al. 2016

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Background. Antenatal pertussis vaccination is being considered as a means to reduce the burden of infant pertussis in low- and middle-income countries (LMICs), but its likely impact in such settings is yet to be quantified.Methods. An individual-based model was used to simulate the demographic structure and dynamics of a population with characteristics similar to those of LMICs. Transmission of pertussis within this population was simulated to capture the incidence of infection in (1) the absence of vaccination; (2) with a primary course only (three doses of diphtheria, tetanus, and pertussis vaccines [DTP3] commencing in 1985, 1995, or 2005 at 20%, 50%, or 80% coverage); and (3) with the addition of an antenatal pertussis program.Results. Modeled annual incidence averaged over the period 2015–2024 reduced with increasing DTP3 coverage, regardless of the year childhood vaccination commenced. Over the same period, the proportion of infants born with passive protection did not change substantially compared with the prevaccination situation, regardless of DTP3 coverage and start year. We found minimal impact of antenatal vaccination on infection in all infants when mothers were eligible for a single antenatal dose. When mothers were eligible for multiple antenatal doses, incidence in infants aged 0–2 months was reduced by around 30%. This result did not hold for the full 0- to 1-year age group, for whom antenatal vaccination did not reduce infection levels.Conclusions. While antenatal vaccination could potentially reduce infant mortality in LMICs, broader gains at the population level are likely to be achieved by focusing efforts on increasing DTP3 coverage.

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Pertussis Prevalence and Its Determinants among Children with Persistent Cough in Urban Uganda

Cited by 22 publications

References 26 publications

The Burden of Pertussis Hospitalization in HIV-Exposed and HIV-Unexposed South African Infants

The Burden of Pertussis Hospitalization in HIV-Exposed and HIV-Unexposed South African Infants

Pertussis: Microbiology, Disease, Treatment, and Prevention

Influence of Population Demography and Immunization History on the Impact of an Antenatal Pertussis Program

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