In typical pertussis in young infants, the child will appear deceptively well; he or she will have coryza, sneezing, and a mild cough. There is no fever. This progresses to gagging, gasping, eye bulging, bradycardia, cyanosis, and vomiting. There is leukocytosis with lymphocytosis and apneic episodes. Deaths relate to leukocytosis, pulmonary hypertension, and pneumonia. The source of pertussis in young infants is most often a family member with cough illness that is not recognized as pertussis. Diagnosis is based on culture/polymerase chain reaction and leukocytosis with lymphocytosis. Treatment depends on macrolide antibiotic therapy and intubation, with assisted ventilation and oxygen. Prevention is based on prophylactic macrolide treatment, immunization starting at 6 weeks of age, and immunization of all pregnant women in the second or third trimester.

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Pertussis in Young Infants Throughout the World.

In the last few years, pertussis has re-emerged worldwide. The aim of this article is to study how the incidence of the disease has evolved in Barcelona city over a 16-year period, and determine which factors are associated with the evolution of the disease. We discuss the causes of the observed changes considering different possibilities such as vaccination coverage, vaccine effectiveness, increased surveillance or the effect of the current economic recession. We performed a cross-sectional, observational, population-based descriptive study using data for the 2000–2015 period from the notifiable diseases register maintained by Barcelona Public Health Agency. We used Poisson regression to compute adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI). A total of 1791 cases were registered. The incidence of the disease increased throughout the city from 2011 onwards. While children under 1 year of age had the highest-incidence and were the most at risk (aOR = 27.18, CI:23.51–31.44), we found that the age of affected children was higher in the last years. Incidence proportion (PRR) was lower among foreign-born children than native children (PRR = 0.43 CI:0.32–0.58). In the whole-cell vaccine period (2000–2004), the percentage of cases under 1 year of age who received the vaccine was lower than in 2005–2015 when the acellular vaccine was used (p = 0.01), suggesting a lower efficacy of the acellular vaccine. However, vaccination coverage in children under 6 years remained high (~ 90%), and there were no significant year-to-year variations (p = 0.757). Moreover, there did not appear to be any significant restrictions in medical care. According to the index of disposable household income (DHI), pertussis incidence increased from 2011 onwards in all neighbourhoods and remained higher in those with lower DHI. The noteworthy increase in pertussis incidence does not seem to be due to the economic recession, but to other factors here described.

/pdf/does-the-economic-recession-influence-the-incidence-of-45faruegpl.pdf

Does the economic recession influence the incidence of pertussis in a cosmopolitan European city

Aim Pertussis is a respiratory tract infection, the vaccine for which was introduced in the Expanded Programme on Immunization (EPI) in Guizhou Province of China (hereafter referred as Guizhou) in the 1980s. This vaccine rapidly decreased incidence rates of pertussis in the province, however, despite the wide high coverage of the diphtheria, tetanus and acellular pertussis (DTaP) combined vaccine, there has been a resurgence of pertussis since 2014. Even with this recent increase in disease transmission, risk factors for pertussis infection have not been evaluated in Guizhou. We aimed to provide information on pertussis risk factors and insight on designing targeted pertussis control policies and measures through this study. Methods A 1∶2 matched retrospective case-control study was conducted between 2016 and 2017, involving infants and children younger than 6 years old and parents of the participants. The enrolled cases included clinical and laboratory confirmed pertussis cases according to the WHO-recommended pertussis definition. Controls were selected from children in the same neighborhood who were not diagnosed with pertussis prior to our investigation and did not exhibit any clinical manifestations of pertussis. Results The household size [Matched odds ratio (ORm) = 1.4, 95% confidence interval (CI): 1.1–1.7] and household members with antecedent cough (ORm = 3.6, 95% CI: 1.8–7.2) were significantly associated with their child’s pertussis onset. The parents’ occupations were significantly associated with their child’s pertussis onset (ORm = 9.4, 95% CI: 1.6–54.8, for mother side; ORm = 4.5, 95% CI: 1.2–16.5, for father side), when they worked in the business and/or service industry. Having family members with a history of cough was an independent risk factor for pertussis [Adjusted odds ratio (AOR) = 43.6, 95% CI: 2.7–694.0]. Besides, the parents' demographic characteristics and DTaP doses were not found to be independent factors. Conclusion Household exposure is an important risk factor for pertussis infection in infants and young children and should therefore be considered as a major factor during formulation of pertussis control policies and measures.

Risk factors for pertussis among children hospitalized for pertussis during 2016–2017, in Guizhou Province of China: a case-control study

Pertussis is a highly contagious disease with clinical features ranging from mild to severe and various complications. Hematological examination, especially the leukocyte count, can predict the possibility of clinical deterioration with several complications, such as pneumonia. This case study aimed to assess whether leukocytosis could indicate the clinical worsening of pertussis in children. This research method is a systematic review on a case study. The subject of this case study is a child with pertussis experiencing clinical deterioration. Prominent laboratory data in this case study includes leukocytosis. This systematic review aims to analyze the association between leukocytosis and the clinical deterioration of this case study. Literature search procedure using PubMed, Cochrane, and Google Scholar search instruments. The keywords used are "pertussis," "risk factor," and "and children." Using the limitations of randomized controlled clinical trials, systematic reviews, meta-analyses, cohorts, and cross-sectional or case series, the language of instruction is English, and publications within the last 20 years. Overall, 16,666 articles were obtained, consisting of 43 pieces from PubMed; only two papers were valid. Of the 3,123 articles on the Cochrane, only two are valid. Likewise, out of 13,500 articles on Google Scholar, only two are valid. Furthermore, it was traced based on the aspect of duplication, then three papers were found, which were cohort studies. It was concluded that leukocytosis predicts clinical deterioration and complications in children with pertussis.

/pdf/leukocytosis-as-a-predictor-of-clinical-worsening-and-1ib540ng.pdf

Leukocytosis as a Predictor of Clinical Worsening and Complications in Children with Pertussis: A Systematic Review of Case Study

Objectives Hispanic infants are at greater risk of pertussis compared with other racial/ethnic groups. Studies have shown that the source of Bordetella pertussis infection for most infants is household members. Using a case-control study, we examined risk markers for pertussis among Hispanic and non-Hispanic infants and evaluated whether maternal parity, a proxy for household size, contributes to the ethnic disparity. Methods We evaluated infants born in California during 2013-2014; cases were infants reported to California Department of Public Health with pertussis occurring before 4 months of age, and controls were infants who survived to at least 4 months of age without pertussis. Bivariate comparisons and multivariate logistic regression models were used to identify risk markers for pertussis in Hispanic and non-Hispanic infants. Results Increased maternal parity was associated with greater risk of pertussis, with a clear dose response observed with increasing risk for additional prior births. Teenage mothers were more likely to have infants with pertussis. These were both independent risk factors across all racial/ethnic groups, even when adjusting for important covariates. Preterm birth and Medicaid insurance were also identified as independent risk markers among Hispanic infants only. Conclusions Infants of all races/ethnicities with older siblings or born to younger mothers are at increased risk of pertussis. Among Hispanic infants, prematurity and Medicaid insurance were independent risk markers for pertussis. These factors highlight the need to ensure prompt immunization of pregnant women with Tdap at the earliest opportunity starting at 27 weeks gestation.

Risk Markers for Pertussis Among Infants <4 Months of Age: Understanding the Hispanic Disparity.

Background In 2012, Oregon observed its highest numbers of reported pertussis cases since 1953. The greatest morbidity occurred among infants Methods An analysis was conducted among infants 4 or ≤4 persons), pertussis vaccination status (upto-date or not up-to-date for age), child care center attendance (yes or no), infant birth weight ( Results Eighty-two infants 4 persons. Univariate analysis showed Hispanic infants had approximately 2.3 times the risk for pertussis, compared with non-Hispanic infants, and infants living in households >4 persons had approximately 2.4 times the risk for illness, compared with those in households with Conclusions A household size of >4 persons is a potential risk factor for pertussis; the magnitude of this risk is similar for Hispanic and non-Hispanic infants.

/pdf/risk-factors-for-pertussis-among-hispanic-infants-13zgbx7blx.pdf

Risk Factors for Pertussis Among Hispanic Infants: Metropolitan Portland, Oregon, 2010-2012.

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Risk Factors for Pertussis Among Hispanic Infants: Metropolitan Portland, Oregon, 2010-2012.