Epidemiological Profile of Children Infected with Bordetella pertussis at Varela Santiago Children’s Hospital: a Retrospective Study

Abstract

BackgroundPertussis, also called whooping cough, is an acute infectious disease of high transmissibility transmitted through aerosol particles released during the catarrhal phase and paroxysmal cough. Since the 1990s its incidence has increased and atypical clinical forms have been identified, mainly in newborns and adults. We hypothesized that there is a relationship between the high incidence of pertussis infection in children up to 6 months of age and genetic changes in the circulating strains of B. pertussis leading to inefficacy of diphtheria, tetanus, and pertussis vaccine (DTP).MethodsData were obtained from the medical records of hospitalized patients at the Varela Santiago Children’s Hospital in Brazil from January 1, 2013 to December 31, 2013.ResultsA total of 33 cases of pertussis hospitalizations were found, where 75.7% (25/33) of the patients were 6 months of age or younger (6 patients were 30 days old or younger while 19 ranged in age from 31 days to 6 months). Of these, 54.5% (14/25) were in exclusive breastfed children. Only 18.2% (6/33) of the patients had the appropriate administration of DTP doses according to their age. Signs and symptoms were: cough 100%, cyanosis 63.6%, fever 48.5% and inspiratory winch 33.3%. Azithromycin was used as monotherapy in 90% (30/33) of the cases and the mean time of hospitalization was 9.48 days ranging from 6 to 30 days. No patient died.ConclusionWe identified a high prevalence (75.7%) of B. pertussis infection in children up to 6 months of age. This is likely explained by the low vaccination rate (18.2%) and the low percentage of exclusive breastfeeding of the studied population. The low rate of vaccination is unexpected, given that there has been greater access to vaccination in recent decades in Brazil. In addition, the cases evolved with an atypical clinical presentation, since the classic symptoms of the catarrhal stage were absent or had a such short duration that such symptoms were no longer present at the time of hospitalization. Our study does not exclude the possibility that genetic changes are occurring in the circulating strains of B. pertussis and that DTP seems to have less efficacy on these new strains, but future studies will be needed to specifically test this hypothesis.Disclosures All authors: No reported disclosures.