高艾滋病毒流行地区住院儿童百日咳的危险因素，南非。

Risk factors for pertussis among hospitalized children in a high HIV prevalence setting, South Africa.

机构信息

Department of Paediatrics, Kalafong Provincial Tertiary Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

Division of Public Health Surveillance and Response, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.

出版信息

Int J Infect Dis. 2018 Mar;68:54-60. doi: 10.1016/j.ijid.2018.01.010. Epub 2018 Feb 2.

DOI:10.1016/j.ijid.2018.01.010

PMID:29410230

Abstract

BACKGROUND

In low- and middle-income countries, including South Africa, the epidemiology of pertussis in relation to immunization, nutritional, and HIV status is poorly described. This article reports on risk factors in South African children hospitalized with pertussis.

METHODS

A prospective, hospital-based, sentinel surveillance programme for pertussis was conducted in Gauteng Province, South Africa. Hospitalized children (≤10 years) meeting the surveillance criteria for clinically suspected pertussis were screened and enrolled. Nasopharyngeal specimens were collected for real-time multiplex PCR and culture of Bordetella species.

RESULTS

Bordetella pertussis was detected in 6.2% (61/992) of children. Pertussis was significantly more prevalent in infants younger than 3 months (9.8%; 38/392) and in young children between the ages of 5 and 9 years (12%; 4/34) (p=0.0013). Of the 61 confirmed pertussis cases, 17 were too young for vaccination. Of the remaining 44 infants, vaccination DTP1 was administered in 73% (32/44) of pertussis-confirmed patients who were eligible, DTP2 in 50% (16/32), DTP3 in 54% (14/26), and DTP4 in 56% (5/9) of vaccine-eligible cases at 18 months of age. B. pertussis infection was less likely in children immunized at least once (5%, 32/692) than in unvaccinated children (10%, 24/230) (p=0.0001). HIV exposure and infection status were determined in 978 (99%) patients: 69% (678/978) were HIV-unexposed and uninfected and 31% (300/978) were HIV-exposed. Of these HIV-exposed patients, 218 (22%) were proven HIV-exposed and uninfected and 82 patients were HIV-infected (8.4%, 82/978). HIV prevalence was similar in pertussis-positive (6%, 5/82) and pertussis-negative (6%, 55/896) children (p=0.90). B. pertussis infection was unrelated to poor nutritional status.

CONCLUSIONS

In South Africa, B. pertussis poses a greater risk to infants who are too young for the first vaccine dose, those who are not vaccinated in a timely manner, and those who do not receive all three primary doses. HIV infection and HIV exposure were not associated with pertussis infection.

摘要

背景

在包括南非在内的低收入和中等收入国家，与免疫、营养和 HIV 状况相关的百日咳流行病学情况描述得还不够完善。本文报告了南非因百日咳住院的儿童的风险因素。

方法

在南非豪登省开展了一项前瞻性、基于医院的百日咳哨点监测规划。对符合临床疑似百日咳监测标准的住院儿童进行筛查和登记。采集鼻咽拭子，进行实时多重 PCR 和博德特氏菌属培养。

结果

992 名儿童中，有 6.2%（61/992）检测出了百日咳鲍特菌。3 个月以下的婴儿（9.8%；38/392）和 5-9 岁的幼儿（12%；4/34）中百日咳的发病率明显更高（p=0.0013）。61 例确诊百日咳病例中，有 17 例因年龄太小而无法接种疫苗。在其余 44 例婴儿中，44 例符合接种条件的患儿中，有 73%（32/44）接种了 DTP1，50%（16/32）接种了 DTP2，54%（14/26）接种了 DTP3，56%（5/9）接种了 DTP4，接种时间均为 18 个月。至少接种过一次疫苗的儿童（5%，32/692）中，B. pertussis 感染的可能性低于未接种疫苗的儿童（10%，24/230）（p=0.0001）。978 名（99%）患者确定了 HIV 暴露和感染状况：69%（678/978）为未暴露和未感染 HIV，31%（300/978）为 HIV 暴露。在这些 HIV 暴露的患者中，218 名（22%）证实 HIV 暴露但未感染，82 名感染 HIV（8.4%，82/978）。百日咳阳性（6%，5/82）和阴性（6%，55/896）儿童的 HIV 患病率相似（p=0.90）。B. pertussis 感染与营养不良状况无关。