Neonatal Pertussis, an Under-Recognized Health Burden and Rationale for Maternal Immunization: A Systematic Review of South and South-East Asian Countries

Abstract

Pertussis is an under-recognized cause of neonatal morbidity and mortality. To review information on the epidemiology and disease burden of neonatal pertussis in South and Southeast Asian countries, a systematic literature review of three bibliographic databases was undertaken. Peer-reviewed original studies on neonatal pertussis epidemiology and burden published since 2000, with a geographical scope limited to South and Southeast Asian countries, were included. Data were systematically extracted based on parameters defined a priori. Our findings show that the burden of neonatal pertussis and its complications is substantial. An increase in the number of pertussis cases has been noted since early 2000, ranging from 61 to 92.9% in infants 0–3 months old. The most common symptoms an infant is likely to present with are cough with or without paroxysms, cyanosis, apnea, tachypnea, difficulty in breathing and leukocytosis. In addition, it can lead to hospitalization (length of stay: 5–7 days), complications (e.g., pneumonia, seizures) and mortality ranging from 5.6 to 14.7%. Other observations indicate that diagnosis is challenging because of non-specific clinical symptoms. Specifically, for obstetricians and gynecologists, the information available for making informed decisions on the prevention of neonatal pertussis is unreliable. Maternal immunization against pertussis during late stages of pregnancy has proven to be efficacious and well tolerated. A high burden of neonatal pertussis, as well as its complications, is observed in South and Southeast Asian countries. There is a need to intensify efforts to protect this vulnerable population with maternal vaccination. Funding : GlaxoSmithKline Biologicals SA Plain Language Summary : Plain language summary available for this article. Please see Fig. 1 and the following link: https://doi.org/10.6084/m9.figshare.7951187 .

Use of a Neonatal-Mouse Model to Characterize Vaccines and Strategies for Overcoming the High Susceptibility and Severity of Pertussis in Early Life

“…Within the current epidemiologic context of pertussis, many countries in which the number of cases have increased in mainly newborns and infants not receiving primary doses because of age (Fabricius et al, 2018;Agrawal et al, 2019) have once again begun discussion on neonatal vaccination and its possible implementation (Lumbreras Areta et al, 2019). Neonatal immunization would provide an early protection for newborns and infants, thus narrowing the critical period of vulnerability intrinsic to routine vaccination schedules that start later in life.…”

Etiologies of Hospitalized Acute Bronchiolitis in Children 2 Years of Age and Younger: A 3 Years' Study During a Pertussis Epidemic

“…Studies suggested that early identification and treatment of B. pertussis could shorten the duration of paroxysmal cough (27,28), and antibiotics against pertussis could limit the severity of disease if started in the catarrhal phase (27,29). In addition, several systematic reviews confirmed the safety and effectiveness of maternal pertussis vaccination during pregnancy (30)(31)(32). Therefore, it is important to early recognize and initiate treatment.…”

Maternal immunization: trends in South and Southeast Asian countries

“…The disease is still endemic worldwide and can have severe complications in young infants [36]. Review of epidemiological data on neonatal pertussis published between 2000 and 2018 has shown that the burden of neonatal pertussis and related complications is high in South and Southeast Asia [37]. The number of pertussis cases observed per year has increased in infants younger than three months old.…”

“…The number of pertussis cases observed per year has increased in infants younger than three months old. Indeed, infant mortality rates due to pertussis ranges between 5.6% and 14.7% in the region [37]. In India, review of 36 pertussis cases admitted to the pediatric intensive care unit showed that 27.7% of those infected were infants below six weeks of age, the youngest age to receive the first dose of the tetanus-diphtheria-pertussis vaccine [36,38].…”