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Predictors of disease severity in children hospitalized for pertussis during an epidemic

Marshall, Helen, Clarke, Michelle, Rasiah, Kavita, Richmond, Peter, Buttery, Jim, Reynolds, Graham, Andrews, Ross M., Nissen, Michael D., Wood, Nick and McIntyre, Peter (2015). Predictors of disease severity in children hospitalized for pertussis during an epidemic. The Pediatric Infectious Disease Journal,34(4):339-345.

Document type: Journal Article
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IRMA ID 75039815xPUB925
Title Predictors of disease severity in children hospitalized for pertussis during an epidemic
Author Marshall, Helen
Clarke, Michelle
Rasiah, Kavita
Richmond, Peter
Buttery, Jim
Reynolds, Graham
Andrews, Ross M.
Nissen, Michael D.
Wood, Nick
McIntyre, Peter
Journal Name The Pediatric Infectious Disease Journal
Publication Date 2015
Volume Number 34
Issue Number 4
ISSN 0891-3668   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84937642483
Start Page 339
End Page 345
Total Pages 7
Place of Publication United States
Publisher Lippincott Williams & Wilkins
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
Abstract Background: Australia recently experienced its worst pertussis epidemic since introduction of pertussis vaccine into the National Immunisation Program. This study aimed to determine factors associated with severe pertussis in hospitalized children during an epidemic using a novel pertussis severity scoring (PSS) system.

Methods:
This prospective, observational, multicenter study enrolled children hospitalized with laboratory confirmed pertussis from 8 tertiary pediatric hospitals during a 12 month period (May 2009-April 2010). Variables assessed included demographics, clinical symptoms and relevant medical and immunization history. Cases were scored using objective clinical findings with cases classified as either severe (PSS > 5) or not severe (PSS <= 5). Logistic regression models were used to predict variables associated with severe disease.

Results: One hundred twenty hospitalized children 0-17 years of age were enrolled with a median PSS of 5 (interquartile range 3-7). Most (61.7%) were classified as not severe with 38.3% (46/120) severe. Most severe cases (54.3%) were <2 months of age. Presence of coinfection [odds ratio (OR): 4.82, CI: 1.66-14.00], <2 months old (OR: 4.76, CI: 1.48-15.32), fever >37.5[degrees]C (OR: 5.97, CI: 1.19-29.96) and history of prematurity (OR: 5.00, CI: 1.27-19.71) were independently associated with severe disease. A total of 70 cases in children >=2 months of age, almost a third (n = 23) had not received pertussis vaccine.

Conclusions:
Most severe pertussis occurred in young, unimmunized infants, although severe disease was also observed in children >12 months of age and previously vaccinated children. Children admitted with pertussis with evidence of coinfection, history of prematurity or fever on presentation need close monitoring.
Keywords pertussis
hospitalization
children
pertussis scoring system
DOI http://dx.doi.org/10.1097/INF.0000000000000577   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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