Pertussis symptoms in adolescents and children versus infants: the influence of vaccination and age

Cough Sound Detection and Diagnosis Using Artificial Intelligence Techniques: Challenges and Opportunities

Coughing is a common symptom of several respiratory diseases. The sound and type of cough are useful features to consider when diagnosing a disease. Respiratory infections pose a significant risk to human lives worldwide as well as a significant economic downturn, particularly in countries with limited therapeutic resources. In this study we reviewed the latest proposed technologies that were used to control the impact of respiratory diseases. Artificial Intelligence (AI) is a promising technology that aids in data analysis and prediction of results, thereby ensuring people's well-being. We conveyed that the cough symptom can be reliably used by AI algorithms to detect and diagnose different types of known diseases including pneumonia, pulmonary edema, asthma, tuberculosis (TB), COVID19, pertussis, and other respiratory diseases. We also identified different techniques that produced the best results for diagnosing respiratory disease using cough samples. This study presents the most recent challenges, solutions, and opportunities in respiratory disease detection and diagnosis, allowing practitioners and researchers to develop better techniques.

Role of Evolutionary Selection Acting on Vaccine Antigens in the Re-Emergence of Bordetella Pertussis

Pertussis (“whooping cough”) is a re-emerging disease with increasing incidence among fully vaccinated individuals. We explored the genetic diversity of five Bordetella pertussis proteins used to generate the subunit vaccine across ancestral and newly emergent strains using immunoinformatics and evolutionary selection measurements. The five subunits of pertussis toxin (Ptx1–Ptx5) were highly conserved with regard to sequence, predicted structure, predicted antigenicity, and were under purifying selection. In contrast, the adhesin proteins pertactin (Prn) and filamentous hemagglutinin (FHA) were under statistically significant (p < 0.01) diversifying selection. Most heavily diversified sites of each protein fell within antigenic epitopes, and the functional adhesin motifs were conserved. Protein secondary structure was conserved despite sequence diversity for FHA but was changeable in Prn. These findings suggest that subunit vaccine-derived immunity does not impact Ptx1–Ptx5 but may apply evolutionary pressure to Prn and FHA to undergo diversifying selection. These findings offer further insight into the emergence of vaccine-resistant strains of B. pertussis.

Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S

INTRODUCTION

It is recommended that all pregnant women in the U.S. receive tetanus, diphtheria, acellular pertussis (Tdap) immunization to prevent infant pertussis. This study's objective was to examine the clinical effectiveness of prenatal Tdap, and whether effectiveness varies by gestational age at immunization.

METHODS

A nationwide cohort study of pregnant women with deliveries in 2010-2014 and their infants was performed. Commercial insurance claims data were analyzed in 2016-2017 to identify Tdap receipt by the pregnant women, and hospitalizations and outpatient visits for pertussis in their infants until the infants reached 18 months of age. Pertussis occurrence was compared between infants of mothers who received prenatal Tdap (overall and stratified by gestational age at administration) and infants of unvaccinated mothers.

RESULTS

There were 675,167 mother-infant pairs in the cohort. Among infants whose mothers received prenatal Tdap, the rate of pertussis was 43% lower (hazard ratio=0.57, 95% CI=0.35, 0.92) than infants whose mothers did not receive prenatal or postpartum Tdap; this reduction was consistent across pertussis definitions (hazard ratio for inpatient-only pertussis=0.32, 95% CI=0.11, 0.91). Pertussis rates were also lower for infants whose mothers received Tdap during the third trimester. Infants whose mothers received Tdap at <27 weeks of gestation did not experience reductions in pertussis rates (hazard ratio for pertussis=1.10, 95% CI=0.54, 2.25).

CONCLUSIONS

Infants of mothers who received prenatal Tdap experienced half the rate of pertussis as compared with infants of unimmunized mothers. These results do not provide evidence to support changing the currently recommended timing of Tdap administration in pregnancy.

Factors Associated with Time to Appropriate Treatment in Pertussis Cases in Georgia, 2009 to 2013

Pertussis is endemic in the United States, with periodic epidemics that continue to highlight its importance as a public health issue. The clinical presentation of pertussis can vary by age and vaccination status. However, little is known about the factors that affect time to antibiotic treatment of pertussis cases. We analyzed 5 years of data from the Georgia Department of Public Health to understand how factors such as age, symptoms, and vaccination status can alter the clinical picture of pertussis and affect time to treatment. We used multivariable linear regression to assess the impact of each variable on time to antibiotic treatment. There was little consistency across age groups for symptom and demographic predictors of time to antibiotic treatment. Overall, the multivariate linear regression showed that among patients ≤18 years old, none of the variables had an impact on time to antibiotic treatment greater than -0.25 to 1.47 days. Among patients >18 years old, most variables had little impact on time to treatment, though two (paroxysmal cough in >18- to 40-year-olds and hospitalization in individuals over 40) were associated with an additional 5 days in time to treatment from cough onset. This study highlights how the difficulties in pertussis diagnosis, particularly among adults, can affect time to antibiotic treatment; adults may not begin antibiotic treatment until there is an accumulation of symptoms. Health care providers need to recognize the variety of symptoms that pertussis can present with and consider confirmatory testing early.

Comparing Seasonal Pattern of Laboratory Confirmed Cases of Pertussis with Clinically Suspected Cases

Objectives

During recent decades, there has been limited attention on the seasonal pattern of pertussis within a high vaccine coverage population. This study aimed to compare the seasonal patterns of clinical suspected pertussis cases with those of laboratory confirmed cases in Iran.

Methods

The current study was conducted using time series methods. Time variables included months and seasons during 2011–2013. The effects of seasons and months on the incidence of pertussis were estimated using analysis of variance or Kruskal–Wallis.

Results

The maximum average incidence of clinically confirmed pertussis was 23.3 in July (p = 0.04), but the maximum incidence of clinical suspected pertussis was 115.7 in May (p = 0.6). The maximum seasonal incidences of confirmed and clinical pertussis cases were reported in summer (average: 12, p = 0.004), and winter (average: 108.1; p = 0.4), respectively.

Conclusion

The present study showed that the seasonal pattern of laboratory confirmed pertussis cases is highly definite and different from the pattern of clinical suspected cases.

Clinical and laboratory features of pertussis in hospitalized infants with confirmed versus probable pertussis cases

BACKGROUND

The clinical presentations of pertussis infection have considerable variation. Many infections and illnesses can cause prolonged repetitive paroxysmal cough that could be confused with Bordetella pertussis infection.

AIM

This retrospective study was designed to compare the clinico-laboratory findings between two groups of hospitalized infants with confirmed, and those who have clinical pertussis disease; to identify the possible additional diagnostic clues "for the diagnosis of confirmed pertussis disease".

SUBJECTS AND METHODS

The study population consisted of infants ≤12 months of age with clinical diagnosis of pertussis that fulfilled the World Health Organization definition for pertussis or those diagnosed by physicians. Clinico-laboratory findings were compared between two groups of patients (confirmed vs. clinical cases).

RESULTS

From a total of 118 infants admitted with a clinical diagnosis of pertussis, 16% (19/118) were confirmed by laboratory to have confirmed pertussis. Twelve of 19 (63%) and 71.99% of confirmed and clinical cases were younger than 6 months of age, respectively. For most patients, the duration of symptoms before hospitalization was <14 days. There were no significant differences between two groups of patients for paroxysmal cough and facial discoloration. However, whoop and apnea were more common among confirmed pertussis cases: P = 0.01, and P = 0.02, respectively. Leukocytosis (≥16,000/ml) (P = 0.01) and lymphocytosis (≥11,000) (P = 0.02) were reported significantly more frequently in confirmed pertussis cases.

CONCLUSION

Given the unavailability of a highly sensitive diagnostic test, in every afebrile patient with paroxysmal cough lasting for ≥7 days associated with whoop and/or apnea, particularly if accompanied by leukocytosis/lymphocytosis, pertussis disease should be considered. In this situation, prompt administration of empiric treatment for cases, and providing control measures to prevent infection transmission to contacts are recommended.

Bordetella pertussis IgG and IgA antibodies seroprevalence among 1-35 y-old population: the role of subclinical pertussis infection

OBJECTIVE

To determine age-dependent pertussis specific IgG and IgA antibodies seroprevalence in apparently healthy subjects.

METHODS

A total of 595 healthy 1-35-y-old individuals divided into 5 different age groups were selected from Sari district. Antipertussis IgG and IgA antibodies levels were measured quantitatively by ELISA method. Positive sera for IgA and also IgG titer ≥150 were considered for recent pertussis infection.

RESULTS

High seroprevelence levels (72% and 71%) were observed among preschool (<7 y) children. After decreasing the seroprevelence rates significally to lowest level (54.4%) among school aged (7-11 y), the rates increased again to the highest levels of 60% and 73% at adulthood (P = 0.03 and P = 0.003). In total, 1.55% of study subjects were IgA positive, and 5.7% showed high IgG titers.

CONCLUSIONS

The present study reveals, vaccine induced immunity has decreased among school-aged children and natural pertussis infection is common among adolescent and young adults. Also, asymptomatic/sub-clinical recent pertussis infection was prevalent among studied population. These findings necessitate developing new strategies to reduce and control pertussis infection in Iran.

Contact network structure explains the changing epidemiology of pertussis

The epidemiology of whooping cough (pertussis) remains enigmatic. A leading cause of infant mortality globally, its resurgence in several developed nations--despite the availability and use of vaccines for many decades--has caused alarm. We combined data from a singular natural experiment and a detailed contact network study to show that age-specific contact patterns alone can explain shifts in prevalence and age-stratified incidence in the vaccine era. The practical implications of our results are notable: Ignoring age-structured contacts is likely to result in misinterpretation of epidemiological data and potentially costly policy missteps.