Severe and unrecognised: pertussis in UK infants
Severe and unrecognised: pertussis in UK infants
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DOI：
10.1136/adc.88.9.802
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发表时间：
2003-09-01
影响因子：
5.2
通讯作者：
Miller, E
中科院分区：
文献类型：
--
作者：
Crowcroft, NS;Booy, R;Miller, E
目的：在伦敦的重症监护室（PICU）和一些儿科病房的儿童中，使用培养、聚合酶链反应和血清学诊断百日咳，并在其家庭接触者中确定感染源。方法：1998年至2000年间因呼吸衰竭、呼吸暂停和/或心动过缓或急性危及生命事件（ALTE）而入住伦敦PICU的< 5个月婴儿，1999年至2000年期间，在St玛丽医院和St乔治医院儿科病房住院的< 15岁儿童中，有下呼吸道感染、呼吸暂停或ALTE的儿童进行了研究。23%（33/142）的患儿有百日咳史，其中PICU为19.8%（25/126），病房为50%（8/16）。死了两个仅4%（6/142）培养阳性。在PICU和病房中，分别有28%（7/25）和75%（6/8）的婴儿在入院时被临床怀疑患有百日咳。在PICU中，患有百日咳的婴儿咳嗽时间更长，呼吸暂停更频繁，并且淋巴细胞计数高于没有百日咳的婴儿。百日咳和呼吸道合胞病毒（RSV）合并感染是常见的（11/33，33%）。百日咳在22/33（67%）的家庭中首次发病的人中得到证实。对于14/33的儿童的感染源是父母，9/33的百日咳的来源是一个年龄较大的完全接种疫苗的儿童在households.Conclusions：严重的百日咳是根据诊断。RSV诊断不排除百日咳。英国疫苗接种计划的未来变化应旨在减少父母和哥哥姐姐对幼儿的百日咳传播。
Aims: To diagnose pertussis using culture, polymerase chain reaction, and serology, in children admitted to intensive care units (PICUs) and some paediatric wards in London, and in their household contacts to determine the source of infection.Methods: Infants < 5 months old admitted to London PICUs between 1998 and 2000 with respiratory failure, apnoea and/or bradycardia, or acute life threatening episodes (ALTE), and children < 15 years admitted to paediatric wards at St Mary's and St George's Hospitals between 1999 and 2000 with lower respiratory tract infection, apnoea, or ALTE were studied.Results: Sixty seven per cent of eligible children (142/212) were recruited; 23% (33/142) had pertussis, 19.8% (25/126) on the PICU and 50% (8/16) on wards. Two died. Only 4% (6/142) were culture positive. Pertussis was clinically suspected on admission in 28% of infants (7/25) on the PICU and 75% (6/8) on the wards. Infants on PICU with pertussis coughed for longer, had apnoeas and whooped more often, and a higher lymphocyte count than infants without pertussis. Pertussis and respiratory syncytial virus (RSV) co-infection was frequent (11/33, 33%). Pertussis was confirmed in 22/33 (67%) of those who were first to become ill in the family. For 14/33 children the source of infection was a parent; for 9/33 the source of pertussis was an older fully vaccinated child in the household.Conclusions: Severe pertussis is under diagnosed. An RSV diagnosis does not exclude pertussis. Future changes to the UK vaccination programme should aim to reduce pertussis transmission to young infants by their parents and older siblings.