Risk factors for Bordetella pertussis disease in hospitalized children.

<h4>Introduction</h4>Despite a resurgence of disease, risk factors for pertussis in children in low and middle-income countries are poorly understood. This study aimed to investigate risk factors for pertussis disease in African children hospitalized with severe LRTI.<h4>Methods<...

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Main Authors: Rudzani Muloiwa, Felix S Dube, Mark P Nicol, Gregory D Hussey, Heather J Zar
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2020-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0240717
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spelling doaj-7e6ae28eb00f49f9a3291c74f454b84f2021-03-04T11:10:09ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-011510e024071710.1371/journal.pone.0240717Risk factors for Bordetella pertussis disease in hospitalized children.Rudzani MuloiwaFelix S DubeMark P NicolGregory D HusseyHeather J Zar<h4>Introduction</h4>Despite a resurgence of disease, risk factors for pertussis in children in low and middle-income countries are poorly understood. This study aimed to investigate risk factors for pertussis disease in African children hospitalized with severe LRTI.<h4>Methods</h4>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.<h4>Results</h4>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]).<h4>Conclusions</h4>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 infants. Completed primary vaccination was protective. There is an urgent need to improve primary pertussis vaccine coverage in low and middle-income countries. Pertussis vaccination of pregnant women, especially those with HIV infection should be prioritized.https://doi.org/10.1371/journal.pone.0240717
collection DOAJ
language English
format Article
sources DOAJ
author Rudzani Muloiwa
Felix S Dube
Mark P Nicol
Gregory D Hussey
Heather J Zar
spellingShingle Rudzani Muloiwa
Felix S Dube
Mark P Nicol
Gregory D Hussey
Heather J Zar
Risk factors for Bordetella pertussis disease in hospitalized children.
PLoS ONE
author_facet Rudzani Muloiwa
Felix S Dube
Mark P Nicol
Gregory D Hussey
Heather J Zar
author_sort Rudzani Muloiwa
title Risk factors for Bordetella pertussis disease in hospitalized children.
title_short Risk factors for Bordetella pertussis disease in hospitalized children.
title_full Risk factors for Bordetella pertussis disease in hospitalized children.
title_fullStr Risk factors for Bordetella pertussis disease in hospitalized children.
title_full_unstemmed Risk factors for Bordetella pertussis disease in hospitalized children.
title_sort risk factors for bordetella pertussis disease in hospitalized children.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2020-01-01
description <h4>Introduction</h4>Despite a resurgence of disease, risk factors for pertussis in children in low and middle-income countries are poorly understood. This study aimed to investigate risk factors for pertussis disease in African children hospitalized with severe LRTI.<h4>Methods</h4>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.<h4>Results</h4>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]).<h4>Conclusions</h4>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 infants. Completed primary vaccination was protective. There is an urgent need to improve primary pertussis vaccine coverage in low and middle-income countries. Pertussis vaccination of pregnant women, especially those with HIV infection should be prioritized.
url https://doi.org/10.1371/journal.pone.0240717
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