Pertussis in children in Bloemfontein, South Africa: A 7-year retrospective review

Abstract

Background. Pertussis vaccination in the 1950s was associated with a decrease in the incidence of pertussis. A resurgence of pertussis has been documented, mainly in well-resourced countries since the 1990s. The burden of pertussis has not been well described in South Africa (SA). Epidemiological data are important for rational implementation of vaccination strategies. Objective. To describe the morbidity and mortality of children with pertussis admitted to public sector hospitals in Bloemfontein, SA. Methods. A retrospective descriptive hospital-based study of children diagnosed with pertussis by polymerase chain reaction testing from April 2008 to March 2015. Results. One hundred and eighty-three laboratory results confirmed pertussis; 105/183 children (57.4%) were <18 weeks old. Clinical data, available for 154/183 cases (84.2%), showed that 141/154 children (91.6%) were admitted to hospital, of whom one-third required intensive care. Hospital admission was associated with young age (p<0.001). The median hospital stay was 9.0 days (interquartile range 6 - 14.5), and hospital stay was longer for children aged <18 weeks than for those aged ≥18 weeks (p=0.006; 95% confidence interval 1 - 5 days). Of the 154 children, 139 (90.3%) had a cough, which lasted ≤7 days in 110/137 cases (80.3%). The total white cell count was ≥20.0 × 109/L in 58/144 cases (40.3%). Eight children (5.2%) died. Conclusions. This case series highlights the importance of pertussis as a problem in children. Most children had a history of cough lasting ≤7 days. Young infants were most severely affected, requiring prolonged hospital stay, often with admission to a paediatric intensive care unit.