title: Pertussis-Associated Pneumonia in Infants and Children From Low- and Middle-Income Countries Participating in the PERCH Study.
abstract: BACKGROUND
  Few data exist describing pertussis epidemiology among infants and children in low- and middle-income countries to guide preventive strategies.
  
  
  METHODS
  Children 1-59 months of age hospitalized with World Health Organization-defined severe or very severe pneumonia in 7 African and Asian countries and similarly aged community controls were enrolled in the Pneumonia Etiology Research for Child Health study. They underwent a standardized clinical evaluation and provided nasopharyngeal and oropharyngeal swabs and induced sputum (cases only) for Bordetella pertussis polymerase chain reaction. Risk factors and pertussis-associated clinical findings were identified.
  
  
  RESULTS
  Bordetella pertussis was detected in 53 of 4200 (1.3%) cases and 11 of 5196 (0.2%) controls. In the age stratum 1-5 months, 40 (2.3% of 1721) cases were positive, all from African sites, as were 8 (0.5% of 1617) controls. Pertussis-positive African cases 1-5 months old, compared to controls, were more often human immunodeficiency virus (HIV) uninfected-exposed (adjusted odds ratio [aOR], 2.2), unvaccinated (aOR, 3.7), underweight (aOR, 6.3), and too young to be immunized (aOR, 16.1) (all P ≤ .05). Compared with pertussis-negative African cases in this age group, pertussis-positive cases were younger, more likely to vomit (aOR, 2.6), to cough ≥14 days (aOR, 6.3), to have leukocyte counts >20 000 cells/µL (aOR, 4.6), and to have lymphocyte counts >10 000 cells/µL (aOR, 7.2) (all P ≤ .05). The case fatality ratio of pertussis-infected pneumonia cases 1-5 months of age was 12.5% (95% confidence interval, 4.2%-26.8%; 5/40); pertussis was identified in 3.7% of 137 in-hospital deaths among African cases in this age group.
  
  
  CONCLUSIONS
  In the postneonatal period, pertussis causes a small fraction of hospitalized pneumonia cases and deaths; however, case fatality is substantial. The propensity to infect unvaccinated infants and those at risk for insufficient immunity (too young to be vaccinated, premature, HIV-infected/exposed) suggests that the role for maternal vaccination should be considered along with efforts to reduce exposure to risk factors and to optimize childhood pertussis vaccination coverage.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.|Spokane Emergency Physicians, Washington.
authors.forename: Breanna
authors.initials: B
authors.lastname: Barger-Kamate
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Maria
authors.initials: M
authors.lastname: Deloria Knoll
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: E Wangeci
authors.initials: EW
authors.lastname: Kagucia
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Christine
authors.initials: C
authors.lastname: Prosperi
authors.affiliation: Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi.|Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Baggett
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab.
authors.forename: W Abdullah
authors.initials: WA
authors.lastname: Brooks
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Hammitt
authors.affiliation: Medical Research Council Unit, Basse, The Gambia.|Department of Paediatrics, University of Auckland.|Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: Stephen R C
authors.initials: SR
authors.lastname: Howie
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Orin S
authors.initials: OS
authors.lastname: Levine
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.|Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.|London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Massachusetts.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.affiliation: Sa Kaeo Provincial Hospital, Thailand Ministry of Health, Sa Kaeo.
authors.forename: Tussanee
authors.initials: T
authors.lastname: Amornintapichet
authors.affiliation: Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.
authors.forename: Trevor P
authors.initials: TP
authors.lastname: Anderson
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.
authors.forename: Juliet O
authors.initials: JO
authors.lastname: Awori
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.|Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Vicky L
authors.initials: VL
authors.lastname: Baillie
authors.affiliation: Department of Paediatrics and Child Health, University of Zambia School of Medicine.|University Teaching Hospital, Lusaka, Zambia.
authors.forename: James
authors.initials: J
authors.lastname: Chipeta
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Department of Epidemiology.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: DeLuca
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Driscoll
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab.
authors.forename: Doli
authors.initials: D
authors.lastname: Goswami
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Higdon
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab.
authors.forename: Lokman
authors.initials: L
authors.lastname: Hossain
authors.affiliation: Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Karron
authors.affiliation: Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi.|Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Susan
authors.initials: S
authors.lastname: Maloney
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit.|Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: David P
authors.initials: DP
authors.lastname: Moore
authors.affiliation: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.|London School of Hygiene and Tropical Medicine, United Kingdom.|Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Morpeth
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Massachusetts.|University Teaching Hospital, Lusaka, Zambia.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mwananyanda
authors.affiliation: Medical Research Council Unit, Basse, The Gambia.
authors.forename: Ogochukwu
authors.initials: O
authors.lastname: Ofordile
authors.affiliation: Medical Research Council Unit, Basse, The Gambia.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Olutunde
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington D.C.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Park
authors.affiliation: Centre pour le Développement des Vaccins, Bamako, Mali.
authors.forename: Samba O
authors.initials: SO
authors.lastname: Sow
authors.affiliation: Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore.
authors.forename: Milagritos D
authors.initials: MD
authors.lastname: Tapia
authors.affiliation: Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.|Department of Pathology, University of Otago, Christchurch, New Zealand.
authors.forename: David R
authors.initials: DR
authors.lastname: Murdoch
authors.affiliation: Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: O'Brien
authors.affiliation: Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Kotloff
mesh_terms: D001886:Bordetella pertussis / Q000235:genetics; D016022:Case-Control Studies; D060085:Coinfection; D003906:Developing Countries; D005260:Female; D015658:HIV Infections; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D011159:Population Surveillance; D012307:Risk Factors; D063189:Symptom Assessment; D014611:Vaccination; D014917:Whooping Cough / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control
keywords: infant; pertussis; pneumonia; vaccination; whooping cough