博茨瓦纳婴儿百日咳相关性肺炎的流行情况和临床特征。
The prevalence and clinical characteristics of pertussis-associated pneumonia among infants in Botswana.
机构信息
Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
出版信息
BMC Pediatr. 2019 Nov 16;19(1):444. doi: 10.1186/s12887-019-1820-0.
BACKGROUND
There are scant data on the prevalence and clinical course of pertussis disease among infants with pneumonia in low- and middle-income countries. While pertussis vaccination coverage is high (≥90%) among infants in Botswana, human immunodeficiency virus (HIV) infection affects nearly one-third of pregnancies. We aimed to evaluate the prevalence and clinical course of pertussis disease in a cohort of HIV-unexposed uninfected (HUU), HIV-exposed uninfected (HEU), and HIV-infected infants with pneumonia in Botswana.
METHODS
We recruited children 1-23 months of age with clinical pneumonia at a tertiary care hospital in Gaborone, Botswana between April 2012 and June 2016. We obtained nasopharyngeal swab specimens at enrollment and tested these samples using a previously validated in-house real-time PCR assay that detects a unique sequence of the porin gene of Bordetella pertussis.
RESULTS
B. pertussis was identified in 1/248 (0.4%) HUU, 3/110 (2.7%) HEU, and 0/33 (0.0%) HIV-infected children. All pertussis-associated pneumonia cases occurred in infants 1-5 months of age (prevalence, 1.0% [1/103] in HUU and 4.8% [3/62] in HEU infants). No HEU infants with pertussis-associated pneumonia were taking cotrimoxazole prophylaxis at the time of hospital presentation. One HUU infant with pertussis-associated pneumonia required intensive care unit admission for mechanical ventilation, but there were no deaths.
CONCLUSIONS
The prevalence of pertussis was low among infants and young children with pneumonia in Botswana. Although vaccination against pertussis in pregnancy is designed to prevent classical pertussis disease, reduction of pertussis-associated pneumonia might be an important additional benefit.
背景
在中低收入国家，有关肺炎婴儿百日咳病的患病率和临床病程的数据很少。虽然博茨瓦纳婴儿的百日咳疫苗接种率很高（≥90%），但人类免疫缺陷病毒（HIV）感染几乎影响了三分之一的妊娠。我们旨在评估博茨瓦纳未感染 HIV 的未暴露婴儿（HUU）、暴露于 HIV 但未感染的婴儿（HEU）和感染 HIV 的婴儿与肺炎相关的百日咳病的患病率和临床病程。
方法
我们在博茨瓦纳哈博罗内的一家三级保健医院招募了 1-23 个月龄有临床肺炎的儿童，在 2012 年 4 月至 2016 年 6 月期间进行了研究。我们在入组时获得了鼻咽拭子标本，并使用之前经过验证的内部实时 PCR 检测法检测了这些样本，该检测法检测到百日咳博德特氏菌的外膜蛋白基因的独特序列。
结果
在 248 例 HUU 中发现了 1 例（0.4%）、110 例 HEU 中发现了 3 例（2.7%）、33 例 HIV 感染儿童中未发现 B. pertussis。所有百日咳相关肺炎病例均发生在 1-5 个月龄婴儿中（HUU 中为 1.0%[103 例中的 1 例]，HEU 婴儿中为 4.8%[62 例中的 3 例]）。在入院时，没有患百日咳相关肺炎的 HEU 婴儿正在服用复方磺胺甲噁唑预防。1 例 HUU 婴儿患有百日咳相关肺炎，需要机械通气入住重症监护病房，但无死亡病例。
结论
博茨瓦纳肺炎婴儿和幼儿百日咳的患病率较低。虽然孕期接种百日咳疫苗旨在预防典型的百日咳病，但减少百日咳相关肺炎可能是一个重要的额外获益。
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