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

Abstract

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.

Risk factors for pertussis among hospitalized children in a high HIV prevalence setting, South Africa

“…Pertussis was detected in 7% of infants hospitalized for lower respiratory tract infections in Cape Town and was detected slightly more (10.9%) in HEU infants (Muloiwa et al, 2016). The incidence of pertussis in infants in Johannesburg was lower at 2.8% of those admitted with pneumonia (Soofie et al, 2016). Most pertussis cases in these studies were in children younger than 3 months of age and in incompletely vaccinated children (Muloiwa et al, 2016;Soofie et al, 2016).…”

“…Recent hospital-based South African studies evaluating pertussis in HEU children have been inconclusive (Muloiwa et al, 2016;Nunes et al, 2016;Soofie et al, 2016). Pertussis was detected in 7% of infants hospitalized for lower respiratory tract infections in Cape Town and was detected slightly more (10.9%) in HEU infants (Muloiwa et al, 2016).…”

Clinical characteristics of pediatric pertussis cases, Quebec 2015–2017

“…The Modified Preziosi Scale (MPS) (22) was used to assess disease severity. Severe pertussis was defined by MPS score greater or equal to seven (23,24). Microsoft Excel 2016 (Redmond, Washington, US) was used to generate proportions and IQR.…”

Experience and challenges on influenza and pertussis vaccination in pregnant women

“…42 , 43 The need for a maternal pertussis vaccine strategy is based on the recognition that immunization of infants and children, including when using an accelerated vaccine schedule starting as early as 6 weeks of age, is suboptimal for protecting against the majority of severe pertussis disease and death which occur mainly (>80%) in the first 2 months of life, including in high-income countries. 41 , 44 , 45 …”