Performance of the new clinical case definitions of pertussis in pertussis suspected infection and other diagnoses similar to pertussis

Abstract

Background: In an effort to improve the pertussis diagnosis, the Global Pertussis Initiative (GPI) proposed an algorithm of the signs/symptoms of pertussis for three age groups: 0-3 months, 4 months to 9 years, and ≥10 years of age.

Methods: We evaluated the accuracy of the clinical case definitions for pertussis proposed by the GPI using laboratory-confirmed pertussis as a reference standard for four groups: clinically suspected pertussis without comorbidity; asthma exacerbation; allergic constitution, and other diagnoses (bronchitis, bronchiolitis, laryngitis, and tracheitis). We included only patients who fulfilled one or more criteria of clinical case definitions for the age groups (0-3 months, 4 months-9 years, and ≥10 years of age). The data for this prospective epidemiological study were collected between 1st January 2013-31st December 2016 at the outpatients and inpatients health care settings in the South Bačka District of Autonomous Province of Vojvodina, Serbia. We evaluated accuracy of the certain sign and symptom combinations of GPI case definitions based on their sensitivity, specificity, and likelihood ratios.

Results: A total of 1043 participants were included, with 306 (29.3%) laboratory-confirmed pertussis cases. In patients aged 0-3 months, whoop and apnoea associated with laboratory confirmation of pertussis. In patients aged 4 months-9 years with a pertussis suspicion infection or with one of the other diagnoses, the highest accuracy was found for whoop combined with apnoea or post-tussive emesis. In patients aged 10 years and older, several different sign and symptom combinations were associated with an increased risk of pertussis among all enrolment diagnoses. There were fewer hospitalizations among the fully vaccinated children than in partly or unvaccinated children aged 4 months to 6 years (20.7% vs. 60.0%, p = 0.017).

Conclusions: The numerous sign and symptom combinations in the observed case definitions were good predictors for laboratory-confirmed pertussis among all enrolment diagnoses, therefore suggesting the necessity for increased awareness of possibility for pertussis in patients with certain pertussis-like medical conditions.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Algorithm for the surveillance and laboratory diagnosis of pertussis.

a Clinical case definition and procedures for laboratory confirmation in accordance with the recommendations of the Global Pertussis Initiative (GPI) (Cherry at all, Clinical Definitions of Pertussis: Summary of a Global Pertussis Initiative Roundtable Meeting, February 2011. Clinical Infectious Diseases Advance Access published May 4, 2012); b Other diagnoses included bronchitis, bronchiolitis, laryngitis or tracheitis. PCR: polymerase chain reaction; IgG: immunoglobin G; PT: pertussis toxin.