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Risk Factors Associated With Bordetella pertussis Among Infants ≤4 Months of Age in the Pre-Tdap Era: United States, 2002–2005

Curtis, Christine Robinette MD, MPH*†‡; Baughman, Andrew L. PhD, MPH§; DeBolt, Chas RN, MPH¶‖; Goodykoontz, Susan BA**; Kenyon, Cynthia MPH††; Watson, Barbara MBChB‡‡; Cassiday, Pamela K. MS§§; Miller, Claudia MS††; Pawloski, Lucia C. PhD§§; Tondella, Maria-Lucia C. PhD§§; Bisgard, Kristine M. DVM, MPH‡¶¶

Pediatric Infectious Disease Journal: August 2017 - Volume 36 - Issue 8 - p 726–735
doi: 10.1097/INF.0000000000001528
Original Studies

Background: In the United States, infants have the highest reported pertussis incidence and death rates. Improved understanding of infant risk factors is needed to optimize prevention strategies.

Methods: We prospectively enrolled infants ≤4 months of age with incident-confirmed pertussis from 4 sites during 2002–2005 (preceding pertussis antigen-containing vaccination recommendations for adolescents/adults); each case-patient was age and site matched with 2 control subjects. Caregivers completed structured interviews. Infants and their contacts ≥11 years of age were offered serologic testing for IgG; being seropositive was defined as ≥94 antipertussis toxin IgG enzyme-linked immunosorbent assay units per milliliter.

Results: Enrolled subjects (115 case-patients; 230 control subjects) had 4396 contacts during incubation periods; 83 (72%) case-patients had ≥1 contact with prolonged (≥5 days) new cough in primary or secondary households. In multivariable analysis, the odds for pertussis were higher for infants with primary/secondary household contacts who had a prolonged new cough, compared with infants who did not. These contacts included mother [adjusted matched odds ratio (aMOR), 43.8; 95% confidence interval (CI), 6.45–298.0] and ≥1 nonmother contact (aMOR, 20.1; 95% CI, 6.48–62.7). Infants receiving breast milk with 0–1 formula feedings daily had decreased pertussis odds (aMOR, 0.27; 95% CI, 0.08–0.89), compared with those receiving more formula. Of 41 tested case-patients, 37 (90%) were seropositive.

Conclusions: Pertussis in infants was associated with prolonged new cough (≥5 days) in infants’ household contacts. Findings suggest that breastfeeding protects against pertussis and warrants recommendation with pertussis prevention strategies, which currently include pertussis vaccination of pregnant mothers and infants’ close contacts.

From the *Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Preventive Medicine Residency, Population Health Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service Program, Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; §Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Washington State Department of Health, Shoreline, Washington; Public Health—Seattle & King County, Seattle, Washington; **Arizona Department of Health Services, Phoenix, Arizona; ††Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, St. Paul, Minnesota; ‡‡City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania; §§Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and ¶¶ Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia.

Accepted for publication November 30, 2016.

This activity was supported by the National Vaccine Program Office and the Centers for Disease Control and Prevention, respectively. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest to disclose.

Address for correspondence: Christine Robinette Curtis, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop A-30, Atlanta, GA 30329. E-mail: rcurtis@cdc.gov.

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