Clinical characteristics of pediatric pertussis cases, Quebec 2015–2017

Abstract

Background: The introduction of the acellular pertussis vaccine may have changed the epidemiological and clinical features of pertussis in Canadian children. Objective: To describe the demographics, clinical presentation and outcomes of children and adolescents with pertussis presenting to a tertiary care hospital. Methods: Retrospective cohort of consecutive patients evaluated at the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ) and tested with a bacterial multiplex real-time polymerase chain reaction (PCR) for Bordetella pertussis or B. parapertussis between June 2015 and March 2017. Demographics, clinical presentations and outcomes were described for positive test results. The Modified Preziosi Scale was used to assess disease severity; severe disease was defined as a score ≥7. Results: The age distribution of the 144 positive patients with a clinical encounter at CHUSJ was as follows: less than three months (n=25/144, 17.4%), four months to nine years (n=63/144, 43.8%) and 10 to 18 years (n=56/144, 38.9%). The most common symptoms at presentation were paroxysmal cough (70.1%), post-tussive emesis (47.2%) and coryza (33.3%). Over 84.0% of cases in infants less than three months of age had severe pertussis (92.0% required hospitalization and 28.0 % intensive care admission). In children four months to nine years of age, 22.2% had severe pertussis and 11.1% required hospitalization. Only two (3.6%) children greater than 10 years had severe disease. Conclusion: Pertussis still affects children of all ages in Quebec. In older children, it tends to be a milder disease. When it affects infants, who do not yet have full protection from pertussis vaccination, it often causes severe disease, especially in those less than three months of age. This evidence further supports the implementation of a pertussis vaccination program in pregnant women.

Pertussis epidemiology and effect of vaccination among diagnosed children at Vietnam, 2015‐2018

“…Many severe clinical symptoms were found in this study, including paroxysmal respiratory distress, severe cough, pneumonia and decreased oxygen saturation, and these symptoms appeared more frequently in the <2-month-old group (Table 2), similar finding as in other studies,. 20,21 The cost per pertussis patient in VNCH was about 722 USD and average duration of hospitalisation was 12.7 days. Compared to the United States, the duration of hospitalisation was similar (5-15 days).…”

Kokliušo Grėsmė Ir Kokono Strategija

“…Grėsmės. Kokliušo sukėlėjo išskiriamas toksinas gali sukelti rimtas kvėpavimo sistemos ir bendras sistemines komplikacijas, kurios pasireiškia kartu su hipoksemija, sukelta paroksizminio kosulio [7]. Komplikacijos kartais gali baigtis mirtimi kūdikiams ir mažiems vaikams, ypač neskiepytiems arba dar negalutinai paskiepytiems.…”

“…Standartinis kokliušo gydymas susideda iš viso makrolidinių antibiotikų kurso. Dažniausiai skiriamas eritromicinas, klaritromicinas arba azitromicinas [7]. Gydymas antibiotikais skiriamas remiantis klinika, nelaukiant specifinių laboratorinių tyrimų rezultatų [6].…”

“…Klaritromicino skiriama 15-20 mg/kg kas 12 valandų, 7-10 dienų. Azitromicino skiriama 10 mg/kg pirmąją dieną, o antrą-penktą dienomis skiriama po 5 mg/kg [7]. Visi trys makrolidai yra vienodo efektyvumo, jie eradikuoja B. pertussis 97 proc.…”

Association of Pertussis Toxin with Severe Pertussis Disease

“…There is a strong association between the number of circulating white blood cells and pertussis severity, with high white blood cell count (leukocytosis) and rapid progression of leukocytosis both being associated with increased risk of mortality [8,10,11,14]. In addition to increasing total white blood cell number, B. pertussis specifically elevates the number of circulating lymphocytes in infants but not older individuals [15]. Concurrent with lymphocytosis, B. pertussis also affects lymphoid organs.…”