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Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection.
Pediatr Infect Dis J. 2016 06; 35(6):611-6.PI

Abstract

BACKGROUND

The incidence of pertussis in children in low- and middle-income countries is poorly described. This study aimed to prospectively investigate the incidence of pertussis in South African children hospitalized with lower respiratory tract infection (LRTI).

METHODS

Children hospitalized with LRTI in Cape Town, South Africa were enrolled over 1 year. Clinical data were collected. A nasopharyngeal (NP) swab and induced sputum (IS) were taken, and polymerase chain reaction specific for Bordetella pertussis (IS481+/hIS1001-) and Bordetella parapertussis (IS1001+) was performed.

RESULTS

A total of 460 children with median age 8 [interquartile range (IQR), 4-18] months were studied. B. pertussis was detected in 17 (3.7%) while total Bordetella spp. were identified on 23 (5.0 %) of 460 NP. Adding IS testing increased the identification of B. pertussis to 32 of 460 cases (7.0%; 95% confidence interval, 4.8%-9.7%); P = 0.028 and total Bordetella to 41 of 460 (8.9%; 95% confidence interval, 4-10%); P = 0.020. Shorter duration of symptoms [median 2 (IQR, 2-3) days versus 5 (IQR, 3-7) days; P = 0.0008] was associated with detection of B. pertussis on IS versus NP. B. pertussis was detected in 15.8% (n=3/19) of HIV-infected children, 10.9% (n = 10/92) of HIV exposed uninfected and 5.4% (n = 19/349) of HIV-unexposed uninfected children. Risk of B. pertussis decreased with each additional dose of diphtheria, tetanus and acellular pertussis vaccine [0 doses = 17.9%; 1 dose = 7.0%; 2 doses = 6.9%; and >3 doses = 6.2%].

CONCLUSIONS

Pertussis is common in South African children hospitalized with LRTI particularly if HIV exposed or infected but decreases sequentially with vaccination doses. Polymerase chain reaction on IS specimen provides confirmation earlier than NP while increasing overall diagnostic yield.

Authors+Show Affiliations

From the *Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; †MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; and ‡Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; §National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa; ¶Institute of Infectious Disease and Molecular Medicine and ||Vaccines for Africa Initiative, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26967813

Citation

Muloiwa, Rudzani, et al. "Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection." The Pediatric Infectious Disease Journal, vol. 35, no. 6, 2016, pp. 611-6.
Muloiwa R, Dube FS, Nicol MP, et al. Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection. Pediatr Infect Dis J. 2016;35(6):611-6.
Muloiwa, R., Dube, F. S., Nicol, M. P., Zar, H. J., & Hussey, G. D. (2016). Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection. The Pediatric Infectious Disease Journal, 35(6), 611-6. https://doi.org/10.1097/INF.0000000000001132
Muloiwa R, et al. Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection. Pediatr Infect Dis J. 2016;35(6):611-6. PubMed PMID: 26967813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection. AU - Muloiwa,Rudzani, AU - Dube,Felix S, AU - Nicol,Mark P, AU - Zar,Heather J, AU - Hussey,Gregory D, PY - 2016/3/12/entrez PY - 2016/3/12/pubmed PY - 2017/4/20/medline SP - 611 EP - 6 JF - The Pediatric infectious disease journal JO - Pediatr Infect Dis J VL - 35 IS - 6 N2 - BACKGROUND: The incidence of pertussis in children in low- and middle-income countries is poorly described. This study aimed to prospectively investigate the incidence of pertussis in South African children hospitalized with lower respiratory tract infection (LRTI). METHODS: Children hospitalized with LRTI in Cape Town, South Africa were enrolled over 1 year. Clinical data were collected. A nasopharyngeal (NP) swab and induced sputum (IS) were taken, and polymerase chain reaction specific for Bordetella pertussis (IS481+/hIS1001-) and Bordetella parapertussis (IS1001+) was performed. RESULTS: A total of 460 children with median age 8 [interquartile range (IQR), 4-18] months were studied. B. pertussis was detected in 17 (3.7%) while total Bordetella spp. were identified on 23 (5.0 %) of 460 NP. Adding IS testing increased the identification of B. pertussis to 32 of 460 cases (7.0%; 95% confidence interval, 4.8%-9.7%); P = 0.028 and total Bordetella to 41 of 460 (8.9%; 95% confidence interval, 4-10%); P = 0.020. Shorter duration of symptoms [median 2 (IQR, 2-3) days versus 5 (IQR, 3-7) days; P = 0.0008] was associated with detection of B. pertussis on IS versus NP. B. pertussis was detected in 15.8% (n=3/19) of HIV-infected children, 10.9% (n = 10/92) of HIV exposed uninfected and 5.4% (n = 19/349) of HIV-unexposed uninfected children. Risk of B. pertussis decreased with each additional dose of diphtheria, tetanus and acellular pertussis vaccine [0 doses = 17.9%; 1 dose = 7.0%; 2 doses = 6.9%; and >3 doses = 6.2%]. CONCLUSIONS: Pertussis is common in South African children hospitalized with LRTI particularly if HIV exposed or infected but decreases sequentially with vaccination doses. Polymerase chain reaction on IS specimen provides confirmation earlier than NP while increasing overall diagnostic yield. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/26967813/Incidence_and_Diagnosis_of_Pertussis_in_South_African_Children_Hospitalized_With_Lower_Respiratory_Tract_Infection_ L2 - https://doi.org/10.1097/INF.0000000000001132 DB - PRIME DP - Unbound Medicine ER -