Duration in days. fRespiratory rate > 60 breaths/minute if aged <2 months, > 50 breaths/minute if aged 25 months. gA child was considered to be hypoxic if (1) a room air pulse oximetry reading indicated oxygen saturation <90% at the 2 sites at elevation (Zambia and South Africa) or <92% at all other sites, or (2) a room air oxygen saturation reading was not available and the child was on oxygen. hMedian pertussis PCR log copies/mL not significantly different comparing pertussis-positive cases to pertussis-positive controls (P=. 07, KruskalWallis test). *P. 05. We also performed case-case comparisons at the African sites to identify factors that might distinguish pertussis-positive from negative cases of severe or very severe pneumonia. to vomit (aOR, 2 . 6), to Rabbit Polyclonal to TRADD cough 14 days (aOR, 6. 3), to have leukocyte counts > 20 000 cells/L (aOR, 4. 6), and to have lymphocyte counts > 10 000 cells/L (aOR, 7. 2) (allP. 05). The case fatality ratio of pertussis-infected pneumonia cases 15 months of age was 12. 5% (95% confidence interval, 4. 2%26. 8%; 5/40); pertussis was identified in 3. 7% of 137 in-hospital deaths among African cases in this age group. Conclusions. IQ-R In the postneonatal period, pertussis causes a small fraction of hospitalized pneumonia cases and deaths; however , case fatality is substantial. The propensity to infect unvaccinated infants and those at risk intended for insufficient immunity (too young to be vaccinated, premature, HIV-infected/exposed) suggests that the role intended for maternal vaccination should be considered along with efforts to reduce exposure to risk factors and to optimize childhood pertussis vaccination coverage. Keywords: pertussis, infant, pneumonia, whooping cough, vaccination Most deaths from pertussis occur in developing countries and among children during the first weeks or months of life [1]. The World Health Organization (WHO) estimated that in 2013, Bordetella pertussiscaused approximately 60 257 deaths in children <5 years of age [2]. However , there is uncertainty regarding these estimates, largely due to the paucity of data from the areas where most deaths occur. The variable clinical presentation of pertussis, especially in young infants, and the cost and complexity of diagnostic assays compound the difficulty in ascertaining accurate estimates. Protecting young infants from pertussis is considered a priority [3]. To achieve this goal, robust data on pertussis case-fatality and risk factors are needed to guide prioritization of control strategies and public health interventions. The Pneumonia Etiology Research for Child Health (PERCH) Study, described in detail elsewhere [4], provided an opportunity to examine the clinical and epidemiologic characteristics of pertussis among infants and young children hospitalized with WHO-defined severe and very severe pneumonia in 7 developing countries. Here we report the pertussis findings among all PERCH-enrolled children, with more detailed analyses of those most at risk for pertussis, infants <6 months of age. == METHODS == == Participants == Between August 2011 and January 2014, each site enrolled children 159 months old into PERCH during 24 consecutive months. Study sites included Dhaka and Matlab, Bangladesh; Basse, The Gambia; Kilifi, Kenya; Bamako, Mali; Soweto, South Africa; Sa Kaeo and Nakhon Phanom, Thailand; and Lusaka, Zambia. Sites, selected to represent pneumonia epidemiology in low- and middle-income settings, contained a mix of urban and rural populations, high and low human immunodeficiency virus (HIV) prevalence rates, and varying infant mortality [4]. Identification and enrollment of cases hospitalized with severe and very severe pneumonia have been described [5]. Severe pneumonia was defined as presence of cough or difficulty breathing plus lower chest wall indrawing; very severe pneumonia was defined as cough or difficulty breathing, plus at least 1 danger sign (ie, central cyanosis, difficulty breastfeeding/drinking, vomiting everything, convulsions, lethargy, reduced consciousness, or head nodding) [6]. Cases were excluded if they were hospitalized within the previous 14 days, discharged as a PERCH case within the past 30 days, did not reside in the study catchment area, or recovered from lower chest wall indrawing following bronchodilator therapy for those with wheeze. Control children were enrolled year round, randomly selected from the community serving as the catchment area intended for cases, and frequency-matched to cases by enrollment date and age within the following strata: 28 days to 5 months, 611 months, 1223 months, and 2459 months, as described [5]. Those found to have WHO-defined severe or very severe pneumonia were ineligible and referred intended for medical care; those with nonsevere respiratory illness were eligible for enrollment. The IQ-R study protocol was approved by the institutional review board or ethical review committee overseeing each site and at the Johns Hopkins Bloomberg School of Public Health. Parents or guardians of participants provided written informed consent. == Data Collection == Cases and controls underwent a standardized clinical assessment that included review of pertinent medical history, respiratory findings, WHO danger signs, comorbidities, and possible risk factors (eg, lack of immunization and breastfeeding). Height, weight, and pulse oximetry were measured during a focused physical examination. Thirty days after enrollment, cases were reevaluated to ascertain vital status IQ-R and clinical outcomes. We defined underweight as weight for age at enrollment <2 SD on the median age- and sex-specific WHO reference point; prematurity seeing that gestational time.