Department of Paediatrics & Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa.
PLoS One. 2020 Oct 15;15(10):e0240717. doi: 10.1371/journal.pone.0240717. eCollection 2020.
Despite a resurgence of disease, risk factors for pertussis in children in low and middle-income countries are poorly understood. This study aimed to investigate risk factors for pertussis disease in African children hospitalized with severe LRTI.
A prospective study of children hospitalized with severe LRTI in Cape Town, South Africa was conducted over a one-year period. Nasopharyngeal and induced sputum samples from child and nasopharyngeal sample from caregiver were tested for Bordetella pertussis using PCR (IS481+/hIS1001). History and clinical details were documented.
460 children with a median age of 8 (IQR 4-18) months were enrolled. B. pertussis infection was confirmed in 32 (7.0%). The adjusted risk of confirmed pertussis was significantly increased if infants were younger than two months [aRR 2.37 (95% CI 1.03-5.42]), HIV exposed but uninfected (aRR 3.53 [95% CI 1.04-12.01]) or HIV infected (aRR 4.35 [95% CI 1.24-15.29]). Mild (aRR 2.27 [95% CI 1.01-5.09]) or moderate (aRR 2.70 [95% CI 1.13-6.45]) under-nutrition in the children were also associated with higher risk. The highest adjusted risk occurred in children whose caregivers had B. pertussis detected from nasopharyngeal swabs (aRR 13.82 [95% CI 7.76-24.62]). Completion of the primary vaccine schedule (three or more doses) was protective (aRR 0.28 [95% CI 0.10-0.75]).
HIV exposure or infection, undernutrition as well as detection of maternal nasal B. pertussis were associated with increased risk of pertussis in African children, especially in young infants. Completed primary vaccination was protective. There is an urgent need to improve primary pertussis vaccine coverage in low and middle-income countries. Pertussis vaccination of pregnant women, especially those with HIV infection should be prioritized.
尽管疾病有所反弹，但中低收入国家儿童百日咳的风险因素仍知之甚少。本研究旨在调查南非开普敦因严重下呼吸道感染住院的非洲儿童百日咳的风险因素。
对南非开普敦因严重下呼吸道感染住院的儿童进行为期一年的前瞻性研究。使用 PCR（IS481+/hIS1001）对儿童鼻咽抽吸物和诱导痰样本以及照顾者的鼻咽样本进行百日咳博德特氏菌检测。记录病史和临床详细信息。
共纳入 460 名中位年龄为 8（IQR 4-18）个月的儿童。32 例（7.0%）证实存在百日咳感染。如果婴儿小于两个月（aRR 2.37（95%CI 1.03-5.42））、HIV 暴露但未感染（aRR 3.53（95%CI 1.04-12.01））或 HIV 感染（aRR 4.35（95%CI 1.24-15.29）），则确诊百日咳的调整风险显著增加。儿童轻度（aRR 2.27（95%CI 1.01-5.09））或中度（aRR 2.70（95%CI 1.13-6.45））营养不良也与更高的风险相关。如果照顾者的鼻咽拭子检测到百日咳博德特氏菌（aRR 13.82（95%CI 7.76-24.62）），则风险最高。完成初级疫苗接种计划（三剂或更多剂）具有保护作用（aRR 0.28（95%CI 0.10-0.75））。
HIV 暴露或感染、营养不良以及母亲鼻拭子中百日咳博德特氏菌的检测与非洲儿童百日咳风险增加相关，尤其是在婴儿中。完成初级百日咳疫苗接种具有保护作用。迫切需要提高中低收入国家的初级百日咳疫苗覆盖率。应优先为孕妇，尤其是 HIV 感染者接种百日咳疫苗。
