Jordan Ellis
Whooping cough, also known as pertussis, is a highly contagious and serious infection that spreads easily from person to person. It is most dangerous for infants under 1 year old, with the highest mortality rate in infants under 3 months of age. The mortality rate for severe pertussis is very high in developed countries, ranging from 19.7% to 31%. In this paragraph, we will discuss the number of infants hospitalized by pertussis and explore the associated risks and impacts.
| Characteristics | Values |
|---|---|
| Number of infants hospitalized by pertussis | 144 between January 2016 and December 2019 in Guangzhou, China |
| Median age of hospitalized infants | 2 months |
| Percentage of patients under 6 months | 90.3% |
| Percentage of patients under 3 months | 56.9% |
| Percentage of patients admitted to the ICU | 26.4% (38 patients) |
| Percentage of patients who died | 9.0% (13 patients) |
| Percentage of deaths under 6 weeks | 76.9% |
| Highest risk factors for death | WBC > 70.0 × 109/L, pulmonary hypertension |
| Number of infant pertussis deaths in California between 1998 and 2014 | 53 |
| Number of nonfatal hospitalized cases in California between 1998 and 2014 | 183 |
| Number of pertussis cases in the US in 2024 | More than six times the number in 2023 |
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What You'll Learn
Risk factors for infant deaths from pertussis
Pertussis, commonly known as whooping cough, is a highly contagious and serious infection that spreads easily from person to person through coughing and sneezing. It is most dangerous for infants, with the highest incidence in those under 1 year old. The mortality rate for infants with severe pertussis is estimated to be between 19.7% and 34.2%, with the majority of deaths occurring in infants under 3 months old.
Several risk factors have been identified that increase the likelihood of infant death from pertussis. These factors include:
- Age: Infants under 3 months of age are at the greatest risk of dying from pertussis. The risk decreases with increasing age, but infants under 1 year old still have a significantly higher risk compared to older children and adults.
- Vaccination status: Infants who are too young to be vaccinated or who have not received the recommended vaccinations are at a higher risk of developing severe pertussis and dying from the disease.
- Birth weight and gestational age: Infants with fatal pertussis have been found to have significantly lower birth weights and younger gestational ages.
- Early-onset of cough: Infants who develop a cough at a younger age are more likely to succumb to the disease.
- Peak white blood cell (WBC) count: Higher WBC counts are associated with an increased risk of death. In particular, extreme leukocytosis (a high WBC count) has been identified as a strong risk factor for death in infants with pertussis.
- Lymphocyte count: Higher lymphocyte counts, specifically lymphocytosis, are linked to a higher risk of death.
- Pulmonary hypertension: The development of pulmonary hypertension is a significant risk factor for death in infants with severe pertussis.
- Other medical conditions: Fatal cases of pertussis in infants are associated with the development of additional medical conditions such as pneumonia, seizures, encephalitis, and apnea.
- Treatment factors: Infants who received steroids, nitric oxide, or required specific medical procedures such as exchange transfusion, extracorporeal membrane oxygenation, or intubation were more likely to have fatal outcomes.
It is important to note that the risk factors for infant deaths from pertussis are complex and vary on a case-by-case basis. The best way to prevent pertussis in infants is through vaccination. Pregnant women, adults, and adolescents in close contact with infants should receive the Tdap vaccine to help protect newborns and young infants who are too young to be vaccinated.
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Mortality rates of infants with pertussis
Pertussis, also known as whooping cough, is a highly contagious and serious infection that spreads easily from person to person through coughing and sneezing. It causes severe coughing spells that can make it hard to breathe, eat, or sleep. It can even lead to cracked ribs, pneumonia, or hospitalization. Infants under 1 year old, especially those younger than 3 months, are at the highest risk of contracting pertussis.
The mortality rate of infants with pertussis varies across different regions and years. In a 2015 case-control study, 53 fatal infant pertussis cases were identified and compared with 183 non-fatal hospitalized pertussis cases. Another case-control study conducted in the United States from 1999 to 2004 reported 91 infant deaths with pertussis as the cause. All infants were 7 months or younger, with 58% under the age of 2 months. The average annual infant mortality rate attributed to pertussis was 3.8 per 1,000,000 live births, and it increased to 13.1 per 1,000,000 live births for infants under 2 months.
A more recent study from 2021 evaluated the medical records of 144 hospitalized children with severe pertussis at the Guangzhou Women and Children's Medical Centre between 2016 and 2019. The median age of the patients was 2 months, with 90.3% of the patients under 6 months old and 56.9% under 3 months. The mortality rate of severe pertussis in this study was 34.2%, with patients younger than 6 weeks accounting for 76.9% of the deaths.
The World Health Organization (WHO) estimates that pertussis affects nearly 240,000,000 children under the age of 5 years annually, resulting in approximately 160,700 deaths. The overall mortality rate in this age group is estimated at 4%, but it increases to 70% and higher for infants younger than 6 weeks.
It is important to note that the mortality rate of pertussis in infants can be influenced by various factors, including early recognition and treatment with appropriate antibiotics, birth weight, gestational age, age at cough onset, and WBC count. Additionally, vaccination plays a crucial role in preventing pertussis and reducing mortality rates in infants.
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Pertussis prevention methods for infants
Pertussis, commonly known as whooping cough, is a highly contagious and severe respiratory infection that can be life-threatening, especially for infants. The disease is characterised by violent coughing fits, which can cause difficulty in breathing, eating, and sleeping. The coughing spells are followed by a high-pitched "whoop" sound when the person breathes in. The infection is caused by the Bordetella pertussis bacteria, which spreads through respiratory droplets transmitted by coughing and sneezing.
Due to the high risk associated with pertussis for infants, it is crucial to implement preventive measures to protect them from this dangerous disease. Here are some methods to prevent pertussis in infants:
Vaccination
One of the most effective ways to prevent pertussis in infants is through vaccination. The DTaP (diphtheria, tetanus, and acellular pertussis) vaccine is recommended for children, with five doses typically administered before a child's sixth birthday. This vaccine provides critical protection against pertussis, but immunity wanes over time. Therefore, booster shots, known as Tdap, are necessary for continued protection. Adolescents aged 11 to 12 should receive a booster, and it is recommended that pregnant women receive a Tdap booster during the second half of their pregnancy, preferably in the third trimester, to protect both the mother and the newborn.
Antibiotic Prophylaxis
Antibiotics play a crucial role in preventing and treating pertussis. Early treatment with antibiotics can reduce the severity of the infection and limit its spread to others. If an infant or someone in close contact with an infant is diagnosed with pertussis, healthcare providers may recommend preventive antibiotics for those exposed to reduce the risk of infection and severe illness.
Good Hygiene Practices
Maintaining good hygiene practices is essential for preventing the spread of pertussis. This includes frequent and thorough handwashing with soap and water, especially after coughing, sneezing, or coming into contact with an infected individual. Covering the mouth and nose when coughing or sneezing and practising good respiratory etiquette can also help reduce the transmission of respiratory droplets containing the bacteria.
Social Distancing and Isolation
When an infant or a person in close contact with an infant is sick or has been exposed to pertussis, it is advisable to practise social distancing and isolation. Staying at home when sick helps prevent the spread of the disease to others. Additionally, keeping infants away from individuals with respiratory infections can reduce their risk of exposure to pertussis.
Caretaker and Family Member Vaccination
It is crucial that caretakers, family members, and anyone in close contact with infants are up to date with their pertussis vaccination. This includes older siblings, parents, and healthcare professionals. By ensuring that the people around the infant are vaccinated, the risk of transmitting pertussis to the infant is significantly reduced.
Awareness and Early Diagnosis
Awareness of the symptoms of pertussis is essential for early diagnosis and treatment. In its early stages, pertussis may resemble a common cold, but it can quickly progress to violent coughing fits. If an infant or child exhibits a persistent or severe cough, it is crucial to seek medical attention promptly. Early diagnosis can lead to timely treatment, reducing the severity of the disease and preventing potential complications.
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Treatment for infants with pertussis
Pertussis, commonly known as whooping cough, is a highly contagious and serious infection that spreads easily from person to person through coughing and sneezing. It is most dangerous for infants under 1 year old, especially those younger than 3 months. The bacteria Bordetella pertussis causes pertussis, damaging the lining of the airways, leading to swelling and thick mucus buildup, resulting in severe coughing fits.
- Antibiotics: Erythromycin is the first-line treatment for pertussis. Alternative treatments include azithromycin and clarithromycin. Antibiotics are crucial for limiting the spread of the infection to others and may reduce the severity of symptoms. It is important to begin treatment early, before coughing fits begin, as it can shorten the amount of time the infected individual is contagious.
- Hospitalization: Infants with severe pertussis may require hospitalization, especially if they are very young. Intensive care is sometimes necessary, and in certain cases, mechanical ventilation may be required.
- Supportive care: Treatment for pertussis is largely supportive, including oxygen therapy, suctioning, hydration, and avoiding respiratory irritants.
- Post-exposure prophylaxis: Close contacts of infants with pertussis should be treated with azithromycin or erythromycin to prevent the spread of the infection.
- Vaccination: Vaccination is the best way to prevent pertussis. Pregnant women should receive a single dose of the Tdap vaccine during the third trimester to protect both the mother and the baby. Caretakers and individuals in close contact with infants should also be up to date with their whooping cough vaccination.
- Corticosteroids: Corticosteroids may be administered to critically ill infants with pertussis, although their benefit in reducing the severity of the illness is uncertain.
- Leukocytosis with lymphocytosis: Exchange blood transfusion therapy may be considered for leukocytosis with lymphocytosis, which has been associated with fatal cases of pertussis in infants.
- Isolation: Strict isolation is essential while the infant remains infectious. Isolation should be continued for at least five days after initiating antibiotic treatment.
It is important to note that pertussis cases have been increasing in the United States and worldwide, and the disease can affect individuals of all ages. Therefore, it is crucial to follow the recommended treatment guidelines and seek medical attention if pertussis is suspected.
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How infants contract pertussis
Pertussis, commonly known as whooping cough, is a highly contagious and serious infection of the respiratory system. It is caused by the Bordetella pertussis bacteria, which spreads through large respiratory droplets containing the bacteria, produced when an infected person coughs or sneezes.
Whooping cough can affect people of all ages but is most dangerous for infants under 1 year old, with a higher risk for babies younger than 6 months. The violent coughing spells associated with the illness can cause severe health complications in infants, including pneumonia, cracked ribs, and even death.
Infants typically contract pertussis from older siblings, parents, or caregivers who may not even be aware they are infected. The bacteria can spread easily to babies who have not yet completed their vaccination series. In the prevaccination era, pertussis was a leading cause of infant morbidity and mortality. Even today, with the availability of vaccines, infants remain at high risk due to their immature immune systems and the waning immunity of those around them.
The best way to protect infants from pertussis is through vaccination. The CDC and healthcare professionals recommend that infants receive the pertussis vaccine during infancy, usually in combination with vaccines against diphtheria and tetanus (DTaP). Additionally, it is crucial for pregnant women, family members, and caregivers to be up to date with their Tdap booster shots to help create a protective cocoon around the infant.
In summary, infants are highly susceptible to contracting pertussis due to their immature immune systems and close contact with potential carriers. The disease can have severe and life-threatening consequences in this vulnerable age group. Therefore, proactive measures, such as timely vaccination and ensuring up-to-date vaccinations in those around them, are critical to safeguarding infants from pertussis and its potentially devastating effects.
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Frequently asked questions
It is unclear exactly how many infants are hospitalized by pertussis each year, but the number is likely to be in the hundreds. One study in Guangzhou, China, evaluated the medical records of 144 hospitalized children with severe pertussis between January 2016 and December 2019.
Infants under 1 year old have the highest incidence of pertussis, but it is most dangerous for babies younger than 3 months.
The mortality rate of pertussis in infants varies depending on the age of the infant and the country. In developed countries, the mortality rate of severe pertussis is between 19.7% and 31%. In one study, the mortality rate of severe pertussis in infants under 6 weeks was 76.9%.
Risk factors for infant deaths from pertussis include leukocytosis with lymphocytosis, pneumonia, high white blood cell (WBC) count, female sex, low birth weight, and low maternal education.
Infant hospitalizations from pertussis can be prevented through early diagnosis and treatment with macrolides, as well as strategies that confer earlier immunity, such as vaccinating pregnant women and accelerating the first dose of the DTaP vaccine.
