KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
Vaccine. 2017 Nov 7;35(47):6422-6428. doi: 10.1016/j.vaccine.2017.09.085. Epub 2017 Oct 9.
Pertussis causes the highest complication rates and deaths in the infant group. Our study explored risk factors for ICU/high dependency (HD) admissions and intubation/non-invasive ventilation (NIV).
A retrospective review of pertussis admissions over 10 years from 2007 to 2016 was done at KK Women's and Children's Hospital, Singapore. To understand risk factors for severe pertussis infection, we compared cases requiring ICU/HD care with controls admitted to the general ward. Risk factors for intubation/NIV were also studied. Vaccine efficacy for protection against ICU/HD admission or intubation/NIV was also calculated.
There were 200 pertussis patients with a median age of 2.75 months. Sixty-one % were ≤3 months and 14.5% were <6 weeks old. Majority of patients (77%) had no prior pertussis vaccination. After removing 3 patients with missing vaccination records, 20 cases were compared with 177 controls. On univariate analysis, risk factors for ICU/HD admission comprised: Age ≤3 months, contact history, underlying co-morbidity, prematurity, absent DTaP vaccination, lymphocytosis, hyperleukocytosis (wbc ≥50×10/L), thrombocytosis (platelet ≥500×10/L), and pneumonia. Multivariate analysis revealed that age ≤3 months (OR 40, 95% CI 4.57-1111.11, p=.007), co-morbidity (OR 8.46 (95% CI 1.47-56.89, p=.019), pneumonia (OR 18.08, 95% CI 3.22-132.15, p=.002), white cell count (OR 1.07, 95% CI 1.01-1.14, p=.023) and cyanosis (OR 5.09, 95% CI 1.31-24.71, p=.026) were risk factors for ICU/HD admission. Prior DTaP vaccination had a vaccine effectiveness of 86.5% in preventing ICU/HD admission and 82.1% in preventing intubation/NIV.
As the majority of pertussis patients were infants ≤3 months old who are at high risk for ICU/HD admission and intubation/NIV, prevention is key to reducing pertussis morbidity. Even though not statistically significant, DTaP vaccination had a role in preventing ICU/HD admission and intubation/NIV.
百日咳会导致婴儿群体出现最高的并发症发生率和死亡率。我们的研究探讨了 ICU/高依赖（HD）入院和插管/无创通气（NIV）的风险因素。
对 2007 年至 2016 年期间在新加坡 KK 妇女儿童医院接受百日咳治疗的 200 例患者进行了回顾性分析。为了了解严重百日咳感染的风险因素，我们将需要 ICU/HD 护理的病例与普通病房入院的对照组进行了比较。还研究了插管/NIV 的风险因素。还计算了疫苗对预防 ICU/HD 入院或插管/NIV 的功效。
有 200 例百日咳患者，中位年龄为 2.75 个月。61%的患者年龄≤3 个月，14.5%的患者年龄<6 周。大多数患者（77%）没有接受过百日咳疫苗接种。在排除 3 例疫苗接种记录缺失的患者后，将 20 例患者与 177 例对照组进行比较。在单变量分析中，ICU/HD 入院的危险因素包括：年龄≤3 个月、接触史、合并症、早产、未接种 DTaP 疫苗、淋巴细胞增多、白细胞增多（白细胞≥50×10/L）、血小板增多（血小板≥500×10/L）和肺炎。多变量分析显示，年龄≤3 个月（OR 40，95%CI 4.57-1111.11，p=.007）、合并症（OR 8.46（95%CI 1.47-56.89，p=.019）、肺炎（OR 18.08，95%CI 3.22-132.15，p=.002）、白细胞计数（OR 1.07，95%CI 1.01-1.14，p=.023）和发绀（OR 5.09，95%CI 1.31-24.71，p=.026）是 ICU/HD 入院的危险因素。先前的 DTaP 疫苗接种在预防 ICU/HD 入院方面的疫苗有效性为 86.5%，在预防插管/NIV 方面的疫苗有效性为 82.1%。
由于大多数百日咳患者为≤3 个月的婴儿，他们有较高的 ICU/HD 入院和插管/NIV 风险，因此预防是降低百日咳发病率的关键。尽管没有统计学意义，但 DTaP 疫苗接种在预防 ICU/HD 入院和插管/NIV 方面发挥了作用。
