Risk factors for Bordetella pertussis disease in hospitalized children

Abstract

Introduction Despite a resurgence of disease, risk factors for pertussis in children in low and middleincome countries are poorly understood. This study aimed to investigate risk factors for pertussis disease in African children hospitalized with severe LRTI. Methods A prospective study of children hospitalized with severe LRTI in Cape Town, South Africa was conducted over a one-year period. Nasopharyngeal and induced sputum samples from child and nasopharyngeal sample from caregiver were tested for Bordetella pertussis using PCR (IS481+/hIS1001). History and clinical details were documented. Results 460 children with a median age of 8 (IQR 4-18) months were enrolled. B. pertussis infection was confirmed in 32 (7.0%). The adjusted risk of confirmed pertussis was significantly increased if infants were younger than two months [aRR 2.37 (95% CI 1.03-5.42]), HIV exposed but uninfected (aRR 3.53 [95% CI 1.04-12.01]) or HIV infected (aRR 4.35 [95% CI 1.24-15.29]). Mild (aRR 2.27 [95% CI 1.01-5.09]) or moderate (aRR 2.70 [95% CI 1.13-6.45]) under-nutrition in the children were also associated with higher risk. The highest adjusted risk occurred in children whose caregivers had B. pertussis detected from nasopharyngeal swabs (aRR 13.82 [95% CI 7.76-24.62]). Completion of the primary vaccine schedule (three or more doses) was protective (aRR 0.28 [95% CI 0.10-0.75]). Conclusions HIV exposure or infection, undernutrition as well as detection of maternal nasal B. pertussis were associated with increased risk of pertussis in African children, especially in young

The burden of human coronavirus infection in children hospitalised with lower respiratory tract infection in Cape Town, South Africa

“…The risk of HCoV infection was not associated with HIV status. This contrasts with other pathogens in published studies in South Africa in which the risk of respiratory pathogens such as RSV was shown to be associated with HIV exposure among children [20,29]. It is not fully clear why this association with coronavirus as shown in our reported results is missing.…”

“…Compared to RSV and other respiratory viruses in which children younger than 6 months got severe infection, vaccines have been targeted for maternal vaccination to protect them [29]. This finding is consistent with the literature in which older children who got coronavirus were reported to be less likely to get severe respiratory illness [7].…”

“…Compared to RSV and other respiratory viruses in which children younger than 6 months got severe infection, vaccines have been targeted for maternal vaccination to protect them [29].…”

Incidence and Transmission Dynamics of Bordetella pertussis Infection in Rural and Urban Communities, South Africa, 2016‒2018

“…Assessing factors associated with B. pertussis incidence, children <5 years of age who did not receive the full schedule of pertussis vaccine for age were more likely to be infected with B. pertussis than were vaccinated children. Similarly, other studies in South Africa showed that risk for pertussis and risk for hospitalization caused by pertussis decreased when persons were vaccinated ( 9 , 14 ).…”

“…The overall household cumulative infection risk was (9,14). Data on duration of PCR-positive B. pertussis infection among persons are limited.…”