The Burden of Pertussis Hospitalization in HIV-Exposed and HIV-Unexposed South African Infants

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Abstract
There are limited data on pertussis in African children, including among human immunodeficiency virus (HIV)–exposed infants. We conducted population-based hospital surveillance to determine the incidence and clinical presentation of Bordetella pertussis–associated hospitalization in perinatal HIV-exposed and -unexposed infants. Children B. pertussis PCR positivity was 2.3% (42/1839), of which 86% (n = 36) occurred in infants Bordetella pertussis was detected in 2.1% (n = 26/1257) of HIV-unexposed and 2.7% (n = 16/599) of HIV-exposed infants. The incidence (per 1000) of B. pertussis–associated hospitalization was 2.9 (95% confidence interval [CI], 1.8–4.5) and 1.9 (95% CI, 1.3–2.6) in HIV-exposed and HIV-unexposed infants, respectively (P = .09). The overall in-hospital case fatality ratio among the cases was 4.8% (2/42), both deaths of which occurred in HIV-exposed infants B. pertussis–associated hospitalizations fulfilled the Centers for Diseases Control and Prevention case definition of “definite” pertussis. Bordetella pertussis contributed to a modest proportion of all-cause respiratory illness hospitalization among black-African children, with a trend for higher incidence among HIV-exposed than HIV-unexposed infants. Maternal vaccination of pregnant women should be considered to reduce the burden of pertussis hospitalization in this population.
Funding Information
  • Bill & Melinda Gates Foundation (OPP1114622)
  • South African Research Chairs Initiative
  • Department of Science and Technology
  • National Research Foundation in Vaccine Preventable Diseases
  • Medical Research Council Respiratory and Meningeal Pathogens Research Unit

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