Severe Pertussis Infections in the United States, 2011–2015

Abstract

Background The incidence of pertussis in the United States has increased in recent years. While characteristics of severe pertussis infection have been described in infants, fewer data are available in older children and adults. In this analysis, we characterize pertussis infections in hospitalized patients of all ages. Methods Cases of pertussis with cough onset from 1 January 2011 through 31 December 2015 from 7 US Emerging Infections Program Network states were reviewed. Additional information on hospitalized patients was obtained through abstraction of the inpatient medical record. Descriptive and multivariable analyses were conducted to characterize severe pertussis infection and identify potential risk factors. Results Among 15942 cases of pertussis reported, 515 (3.2%) were hospitalized. Three hospitalized patients died. Infants aged <2 months accounted for 1.6% of all pertussis cases but 29.3% of hospitalizations. Infants aged 2–11 months and adults aged ≥65 years also had high rates of hospitalization. Infants aged <2 months whose mothers received acellular pertussis during the third trimester and children aged 2 months to 11 years who were up to date on pertussis-containing vaccines had a 43%–66% reduced risk of hospitalization. Among adolescents aged 12–20 years, 43.5% had a history of asthma, and among adults aged ≥65 years, 26.8% had a history of chronic obstructive pulmonary disease. Conclusions Individuals at the extreme ends of life may be the most vulnerable to severe pertussis infections, though hospitalization was reported across all age groups. Continued monitoring of severe pertussis infections will be important to help guide prevention, control, and treatment options.

Pertussis in High Risk Groups: An Overview of the Past Quarter Century

“…Of the three hospitalized patients who died, one was an infant aged 42 days and two were adults with underlying medical conditions: one 48-yearold adult who had a history of human immunodeficiency virus and one 76-year-old adult who had a previous history of asthma and COPD. 24 Asthma Three studies have shown that individuals with underlying asthma are at increased risk of pertussis diagnosis compared to individuals without, as further illustrated by two case studies ( Figure 3). [28][29][30][31][32] A retrospective, population-based case-control study compared the history of asthma in children and adults who had pertussis (confirmed by polymerase chain reaction, PCR) with age-and sex-matched controls during a pertussis outbreak between 2004 and 2005 in California, USA.…”

“…24 Asthma (and/or COPD) exacerbations were among the most frequent diagnoses leading to pertussisrelated hospitalizations in both adolescents and adults. 24 An increased all-cause and pertussis-related hospital admission rate was also observed for pertussis patients with asthma compared to controls at 45 days, 3 months, or 6-months postpertussis diagnosis. 30 In a case-control study in Finland in 1999, involving 103 adults with stable asthma (53 mild, 50 moderate) and 30 healthy controls, B. pertussis was detected by PCR in the sputum of 28.3% of mild asthmatics, in 20.0% of moderate asthmatics, and in 16.7% of controls.…”

The unmet need for pertussis prevention in patients with chronic obstructive pulmonary disease in the Italian context

“…35 Lastly, the findings from a recent study led by authors from CDC, which evaluated severe pertussis infections across various states in the US during the period 2011-2015, showed that 14.5% of patients aged 21-64 years and 26.8% of those ≥65 years who were hospitalized for pertussis also presented with COPD indicating that underlying COPD may contribute to the clinical severity of pertussis infections. 36 Age-related changes in adaptive and humoral immunity in adults result in immunosenescence, i.e., a diminished immune response against certain diseases. 37 These changes can not only result in infections in such susceptible adults but also result in them becoming reservoirs of the causative agents, infecting those who cannot be vaccinated.…”

Severe Bordetella pertussis infection and vaccine issue in Chongqing, from 2012 to 2018

“…A total of 4477 children, who were included in our study, were diagnosed as having pertussis. The standard for clinical diagnosis of pertussis was not only based on the criteria (Mbayei et al, 2018), but also confirmed as follows: (1) Culture for B. pertussis or PCR for Bordetella-DNA from respiratory samples were positive;…”