Curtis Christine Robinette, Baughman Andrew L, DeBolt Chas, Goodykoontz Susan, Kenyon Cynthia, Watson Barbara, Cassiday Pamela K, Miller Claudia, Pawloski Lucia C, Tondella Maria-Lucia C, Bisgard Kristine M
From the *Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; †Preventive Medicine Residency, Population Health Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; ‡Epidemic Intelligence Service Program, Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; §Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; ¶Washington State Department of Health, Shoreline, Washington; ‖Public Health-Seattle & King County, Seattle, Washington; **Arizona Department of Health Services, Phoenix, Arizona; ††Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, St. Paul, Minnesota; ‡‡City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania; §§Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and ¶¶ Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia.
Pediatr Infect Dis J. 2017 Aug;36(8):726-735. doi: 10.1097/INF.0000000000001528.
In the United States, infants have the highest reported pertussis incidence and death rates. Improved understanding of infant risk factors is needed to optimize prevention strategies.
We prospectively enrolled infants ≤4 months of age with incident-confirmed pertussis from 4 sites during 2002-2005 (preceding pertussis antigen-containing vaccination recommendations for adolescents/adults); each case-patient was age and site matched with 2 control subjects. Caregivers completed structured interviews. Infants and their contacts ≥11 years of age were offered serologic testing for IgG; being seropositive was defined as ≥94 antipertussis toxin IgG enzyme-linked immunosorbent assay units per milliliter.
Enrolled subjects (115 case-patients; 230 control subjects) had 4396 contacts during incubation periods; 83 (72%) case-patients had ≥1 contact with prolonged (≥5 days) new cough in primary or secondary households. In multivariable analysis, the odds for pertussis were higher for infants with primary/secondary household contacts who had a prolonged new cough, compared with infants who did not. These contacts included mother [adjusted matched odds ratio (aMOR), 43.8; 95% confidence interval (CI), 6.45-298.0] and ≥1 nonmother contact (aMOR, 20.1; 95% CI, 6.48-62.7). Infants receiving breast milk with 0-1 formula feedings daily had decreased pertussis odds (aMOR, 0.27; 95% CI, 0.08-0.89), compared with those receiving more formula. Of 41 tested case-patients, 37 (90%) were seropositive.
Pertussis in infants was associated with prolonged new cough (≥5 days) in infants' household contacts. Findings suggest that breastfeeding protects against pertussis and warrants recommendation with pertussis prevention strategies, which currently include pertussis vaccination of pregnant mothers and infants' close contacts.
在美国，婴儿的百日咳发病率和死亡率报告最高。需要更好地了解婴儿的危险因素，以优化预防策略。
我们在2002年至2005年期间前瞻性纳入了来自4个地点的4个月及以下确诊为百日咳的婴儿（在针对青少年/成人的含百日咳抗原疫苗接种建议之前）；每个病例患者按年龄和地点与2名对照受试者匹配。照顾者完成结构化访谈。为婴儿及其年龄≥11岁的接触者提供IgG血清学检测；血清学阳性定义为每毫升抗百日咳毒素IgG酶联免疫吸附测定单位≥94。
纳入的受试者（115例病例患者；230名对照受试者）在潜伏期有4396名接触者；83例（72%）病例患者在主要或次要家庭中有≥1名接触者出现持续（≥5天）的新咳嗽。在多变量分析中，与没有新咳嗽的婴儿相比，主要/次要家庭中有持续新咳嗽的接触者的婴儿患百日咳的几率更高。这些接触者包括母亲[调整后的匹配比值比（aMOR），43.8；95%置信区间（CI），6.45 - 298.0]和≥1名非母亲接触者（aMOR，20.1；95%CI，6.48 - 62.7）。与接受更多配方奶的婴儿相比，每天接受0 - 1次配方奶喂养的母乳喂养婴儿患百日咳的几率降低（aMOR，0.27；95%CI，0.08 - 0.89）。在41例接受检测的病例患者中，37例（90%）血清学呈阳性。
婴儿百日咳与婴儿家庭接触者持续的新咳嗽（≥5天）有关。研究结果表明母乳喂养可预防百日咳，值得在百日咳预防策略中推荐，目前的预防策略包括对孕妇和婴儿密切接触者进行百日咳疫苗接种。
