Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa.
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Clin Infect Dis. 2021 Aug 2;73(3):e745-e753. doi: 10.1093/cid/ciab089.
Policy recommendations on pertussis vaccination need to be guided by data, which are limited from low- and middle-income countries. We aimed to describe the epidemiology of pertussis in South Africa, a country with high human immunodeficiency virus (HIV) prevalence and routine pertussis vaccination for 6 decades including the acellular vaccine since 2009.
Hospitalized patients of all ages were enrolled at 5 sentinel sites as part of a pneumonia surveillance program from January 2013 through December 2018. Nasopharyngeal specimens and induced sputum were tested by polymerase chain reaction (PCR) for Bordetella pertussis. In addition, demographic and clinical information were collected. Incidence rates were calculated for 2013-2016, and multivariable logistic regression performed to identify factors associated with pertussis.
Over the 6-year period 19 429 individuals were enrolled, of which 239 (1.2%) tested positive for B. pertussis. Detection rate was highest in infants aged <6 months (2.8%, 155/5524). Mean annual incidence was 17 cases per 100 000 population, with the highest incidence in children <1 year of age (228 per 100 000). Age-adjusted incidence was 65.9 per 100 000 in HIV-infected individuals compared to 8.5 per 100 000 in HIV-uninfected individuals (risk ratio 30.4, 95% confidence interval: 23.0-40.2). Ten individuals (4.2%) with pertussis died; of which 7 were infants aged <6 months and 3 were immunocompromised adults.
Pertussis continues to be a significant cause of illness and hospitalization in South Africa, despite routine vaccination. The highest burden of disease and death occurred in infants; however, HIV-infected adults were also identified as an important group at risk of B. pertussis infection.
政策建议需要以数据为指导，而来自中低收入国家的数据有限。我们旨在描述南非百日咳的流行病学情况，该国艾滋病毒（HIV）流行率高，60 年来常规接种百日咳疫苗，包括自 2009 年以来的无细胞疫苗。
作为肺炎监测计划的一部分，2013 年 1 月至 2018 年 12 月期间，在 5 个哨点医院招募了所有年龄段的住院患者。通过聚合酶链反应（PCR）检测鼻咽标本和诱导痰中的博德特氏菌百日咳。此外，还收集了人口统计学和临床信息。计算了 2013-2016 年的发病率，并进行多变量逻辑回归以确定与百日咳相关的因素。
在 6 年期间，共纳入了 19429 人，其中 239 人（1.2%）检测出博德特氏菌百日咳阳性。检测率在 <6 个月龄的婴儿中最高（2.8%，155/5524）。年平均发病率为每 100000 人 17 例，<1 岁儿童发病率最高（228/100000）。与未感染 HIV 的个体相比，感染 HIV 的个体调整年龄后的发病率为 65.9/100000，而未感染 HIV 的个体发病率为 8.5/100000（风险比 30.4，95%置信区间：23.0-40.2）。10 名（4.2%）百日咳患者死亡；其中 7 名是 <6 个月的婴儿，3 名是免疫功能低下的成年人。
尽管常规接种疫苗，但百日咳在南非仍是导致疾病和住院的重要原因。疾病和死亡负担最高的是婴儿；然而，也发现感染 HIV 的成年人是感染博德特氏菌百日咳的重要高危人群。
