Predictors of disease severity in children hospitalized for pertussis during an epidemic

Helen Marshall, Michelle Clarke, Kavita Rasiah, Peter Richmond, Jim Buttery, Graham Reynolds, Ross Andrews, Michael Nissen, Nick Wood, Peter McIntyre

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29 Citations (Scopus)

Abstract

Background: Australia recently experienced its worst pertussis epidemic since introduction of pertussis vaccine into the National Immunisation Program. This study aimed to determine factors associated with severe pertussis in hospitalized children during an epidemic using a novel pertussis severity scoring (PSS) system. Methods: This prospective, observational, multicenter study enrolled children hospitalized with laboratory confirmed pertussis from 8 tertiary pediatric hospitals during a 12 month period (May 2009-April 2010). Variables assessed included demographics, clinical symptoms and relevant medical and immunization history. Cases were scored using objective clinical findings with cases classified as either severe (PSS > 5) or not severe (PSS ≤ 5). Logistic regression models were used to predict variables associated with severe disease. Results: One hundred twenty hospitalized children 0-17 years of age were enrolled with a median PSS of 5 (interquartile range 3-7). Most (61.7%) were classified as not severe with 38.3% (46/120) severe. Most severe cases (54.3%) were <2 months of age. Presence of coinfection [odds ratio (OR): 4.82, CI: 1.66-14.00], <2 months old (OR: 4.76, CI: 1.48-15.32), fever >37.5°C (OR: 5.97, CI: 1.19-29.96) and history of prematurity (OR: 5.00, CI: 1.27-19.71) were independently associated with severe disease. A total of 70 cases in children ≥2 months of age, almost a third (n = 23) had not received pertussis vaccine. Conclusions: Most severe pertussis occurred in young, unimmunized infants, although severe disease was also observed in children >12 months of age and previously vaccinated children. Children admitted with pertussis with evidence of coinfection, history of prematurity or fever on presentation need close monitoring.

Original languageEnglish
Pages (from-to)339-345
Number of pages7
JournalPediatric Infectious Disease Journal
Volume34
Issue number4
DOIs
Publication statusPublished - 21 Apr 2015

Keywords

  • children
  • hospitalization
  • pertussis
  • pertussis scoring system

Cite this

Marshall, H., Clarke, M., Rasiah, K., Richmond, P., Buttery, J., Reynolds, G., Andrews, R., Nissen, M., Wood, N., & McIntyre, P. (2015). Predictors of disease severity in children hospitalized for pertussis during an epidemic. Pediatric Infectious Disease Journal, 34(4), 339-345. https://doi.org/10.1097/INF.0000000000000577