title: Population-Based Pertussis Incidence and Risk Factors in Infants Less Than 6 Months in Nepal.
abstract: Pertussis is estimated to cause 2 percent of childhood deaths globally and is a growing public health problem in developed countries despite high vaccination coverage. Infants are at greatest risk of morbidity and mortality. Maternal vaccination during pregnancy may be effective to prevent pertussis in young infants, but population-based estimates of disease burden in infants are lacking, particularly in low-income countries. The objective of this study was to estimate the incidence of pertussis in infants less than 6 months of age in Sarlahi District, Nepal.
  Nested within a population-based randomized controlled trial of influenza vaccination during pregnancy, infants were visited weekly from birth through 6 months to assess respiratory illness in the prior week. If any respiratory symptoms had occurred, a nasal swab was collected and tested with a multitarget pertussis polymerase chain reaction (PCR) assay. The prospective cohort study includes infants observed between May 2011 and August 2014.
  The incidence of PCR-confirmed Bordetella pertussis was 13.3 cases per 1000 infant-years (95% confidence interval, 7.7-21.3) in a cohort of 3483 infants with at least 1 day of follow-up.
  In a population-based active home surveillance for respiratory illness, a low risk for pertussis was estimated among infants in rural Nepal. Nepal's immunization program, which includes a childhood whole cell pertussis vaccine, may be effective in controlling pertussis in infants.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Disease Epidemiology and Control, Baltimore, Maryland.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Hughes
authors.affiliation: University of Washington, Seattle Children's Hospital.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
authors.affiliation: University of Washington, Molecular Virology Laboratory, Seattle.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: George Washington University Milken Institute School of Public Health, Department of Global Health, Washington, District of Columbia.
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
authors.affiliation: Nepal Nutrition Intervention Project-Sarlahi, Kathmandu.
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.affiliation: Tribhuvan University Teaching Hospital, Department of Paediatrics, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
authors.forename: Laxman
authors.initials: L
authors.lastname: Shrestha
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Disease Epidemiology and Control, Baltimore, Maryland.|Nepal Nutrition Intervention Project-Sarlahi, Kathmandu.
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.affiliation: Cincinnati Children's Hospital and Medical Center, Global Health Center, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Steinhoff
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Disease Epidemiology and Control, Baltimore, Maryland.
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
mesh_terms: D015331:Cohort Studies; D003906:Developing Countries; D060740:Disease Eradication; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D009390:Nepal; D016133:Polymerase Chain Reaction; D011156:Population Density; D011159:Population Surveillance; D014917:Whooping Cough / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission
chemical_list: D022542:Measles-Mumps-Rubella Vaccine
keywords: Nepal; epidemiology; incidence; infants; pertussis.