title: The Burden of Pertussis Hospitalization in HIV-Exposed and HIV-Unexposed South African Infants.
abstract: BACKGROUND
  There are limited data on pertussis in African children, including among human immunodeficiency virus (HIV)-exposed infants. We conducted population-based hospital surveillance to determine the incidence and clinical presentation of Bordetella pertussis-associated hospitalization in perinatal HIV-exposed and -unexposed infants.
  
  
  METHODS
  Children <12 months of age hospitalized with any sign or symptom of respiratory illness (including suspected sepsis or apnea in neonates) were enrolled from 1 January 2015 to 31 December 2015. Detailed clinical and demographic information was recorded and respiratory samples were tested by polymerase chain reaction (PCR).
  
  
  RESULTS
  The overall B. pertussis PCR positivity was 2.3% (42/1839), of which 86% (n = 36) occurred in infants <3 months of age. Bordetella pertussis was detected in 2.1% (n = 26/1257) of HIV-unexposed and 2.7% (n = 16/599) of HIV-exposed infants. The incidence (per 1000) of B. pertussis-associated hospitalization was 2.9 (95% confidence interval [CI], 1.8-4.5) and 1.9 (95% CI, 1.3-2.6) in HIV-exposed and HIV-unexposed infants, respectively (P = .09). The overall in-hospital case fatality ratio among the cases was 4.8% (2/42), both deaths of which occurred in HIV-exposed infants <3 months of age. Among cases, presence of cough ≥14 days (20.5%) and paroxysmal coughing spells (33.3%) at diagnosis were uncommon. Only 16 (38%) B. pertussis-associated hospitalizations fulfilled the Centers for Diseases Control and Prevention case definition of "definite" pertussis.
  
  
  CONCLUSIONS
  Bordetella pertussis contributed to a modest proportion of all-cause respiratory illness hospitalization among black-African children, with a trend for higher incidence among HIV-exposed than HIV-unexposed infants. Maternal vaccination of pregnant women should be considered to reduce the burden of pertussis hospitalization in this population.
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
authors.forename: Nasiha
authors.initials: N
authors.lastname: Soofie
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
authors.forename: Marta C
authors.initials: MC
authors.lastname: Nunes
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
authors.forename: Prudence
authors.initials: P
authors.lastname: Kgagudi
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
authors.forename: Nadia
authors.initials: N
authors.lastname: van Niekerk
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
authors.forename: Tselane
authors.initials: T
authors.lastname: Makgobo
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
authors.forename: Yasmeen
authors.initials: Y
authors.lastname: Agosti
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
authors.forename: Cleopas
authors.initials: C
authors.lastname: Hwinya
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
authors.forename: Jayani
authors.initials: J
authors.lastname: Pathirana
authors.affiliation: Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.|Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.|National Institute for Communicable Diseases, National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
mesh_terms: D001886:Bordetella pertussis / Q000235:genetics; D060085:Coinfection; D017281:Cost of Illness; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009026:Mortality; D011247:Pregnancy; D013019:South Africa / Q000453:epidemiology; D063189:Symptom Assessment; D014611:Vaccination; D014917:Whooping Cough / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control
keywords: Bordetella pertussis; HIV-exposed; incidence; infants; neonates