Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia.
Hospital Likas, Sabah, Malaysia.
Vaccine. 2022 Aug 19;40(35):5241-5247. doi: 10.1016/j.vaccine.2022.07.019. Epub 2022 Aug 2.
The case fatality rate and the risk of complications due to pertussis is very high in infants. Asia has the second highest childhood pertussis burden. The study aimed to assess the prevalence, clinical complications, and mortality rates of pertussis disease requiring hospitalization among young infants in Malaysia.
The study was a one-year, hospital-based, multi-site surveillance of infants less than six months of age with symptoms consistent with pertussis and a cross-sectional analysis of their mothers for recent pertussis infection. Information was obtained from medical records and interviews with the parents. Pertussis diagnosis was confirmed for all infants through serum anti-PT titration test or PCR test.
441 possible cases of pertussis were included in this study. Of these, 12.7 % had laboratory confirmation of pertussis. Infants with confirmed pertussis had significantly higher rates of cyanosis (37.5 % vs 8.6 %; p < 0.0001) and apnea (12.5 % vs 3.9 %; p = 0.027) than test-negative infants. Most infants from both groups were in recovery/recovered at discharge. Those with confirmed pertussis had higher case fatality rate than test-negative cases (5.4 % vs 1.0 %; p = 0.094), but the difference did not reach significance. The majority of confirmed pertussis cases (89.3 %) occurred in infants too young to be fully vaccinated or under-vaccinated for their age. Both test-negative and confirmed pertussis resulted in work-day losses and incurred costs for both parents.
A high pertussis disease burden persists in infants less than six months of age, especially among those un- and under-vaccinated. Maternal and complete, on-time infant vaccination is important to reduce disease burden.
百日咳的病死率和并发症风险在婴儿中非常高。亚洲是儿童百日咳负担第二高的地区。本研究旨在评估马来西亚 6 月龄以下婴幼儿因百日咳住院的患病率、临床并发症和死亡率。
该研究为为期一年的、基于医院的、多地点的婴儿百日咳监测，纳入了症状符合百日咳的 6 月龄以下婴儿，并对其母亲进行了近期百日咳感染的横断面分析。信息来自病历和对父母的访谈。所有婴儿的百日咳诊断均通过血清抗-PT 滴度试验或 PCR 试验得到确认。
本研究共纳入了 441 例可能的百日咳病例。其中，12.7%的病例有实验室确诊的百日咳。确诊百日咳的婴儿出现发绀（37.5%比 8.6%；p<0.0001）和呼吸暂停（12.5%比 3.9%；p=0.027）的比率显著更高。两组的大多数婴儿在出院时都在康复中。确诊百日咳的婴儿病死率高于阴性检测婴儿（5.4%比 1.0%；p=0.094），但差异无统计学意义。大多数确诊的百日咳病例（89.3%）发生在未完全接种或未按年龄接种疫苗的婴儿中。阴性检测和确诊的百日咳都会导致父母的工作日损失和花费。
6 月龄以下婴儿的百日咳疾病负担仍然很高，尤其是在未接种和未完全接种疫苗的婴儿中。母亲和婴儿的完全、按时接种疫苗对于降低疾病负担很重要。
