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. 2025 Jun 1;44(6):489-495.
doi: 10.1097/INF.0000000000004803. Epub 2025 May 19.

Bordetella pertussis -related Respiratory Deaths in Infants From 4 Days to 6 Months of Age, Results From a 3-Year, Prospective Postmortem Surveillance Study in Lusaka, Zambia

William B MacLeod  1 , Lawrence Mwananyanda  1   2 , Geoffey Kwenda  3 , Rachel Pieciak  1 , Zachariah Mupila  2 , Caitriona Murphy  2 , Chilufya Chikoti  2 , Leah Forman  4 , Flora Berklein  4 , Rotem Lapidot  5 , Benard Ngoma  2 , Anna Larson-Williams  1 , James Lungu  2 , Ruth Nakazwe  2 , Dianna Nzara  2 , Barron Yankonde  2 , Donald M Thea  1 , Christopher J Gill  1
Affiliations

Bordetella pertussis -related Respiratory Deaths in Infants From 4 Days to 6 Months of Age, Results From a 3-Year, Prospective Postmortem Surveillance Study in Lusaka, Zambia

William B MacLeod et al. Pediatr Infect Dis J. .

Abstract

Background: Since the 1990s, a remarkable decline in infant and child mortality has occurred. Continued progress in reducing mortality will need to focus on early infant and neonatal mortality and on less common diseases than pneumonia, diarrhea and malnutrition. One of the candidate diseases for focus is Bordetella pertussis , the principal cause of "whooping cough."

Methods: We conducted a study to measure the burden of deaths and calculate the population-attributable fraction of deaths due to B. pertussis . We collected postmortem nasopharyngeal swabs from subjects who died at the University Teaching Hospital or in the community and were brought to the University Teaching Hospital morgue 4 days to < 6 months of age. Infection with B. pertussis was determined with polymerase chain reaction testing. We assigned respiratory cause of death from the medical record or from a verbal autopsy collected from caregivers.

Results: From August 2017 to August 2020, we collected nasopharyngeal samples from 2236 deceased subjects. Respiratory deaths were assigned to 29.0% of the deaths; 39.5% of community deaths were attributed to respiratory causes. Using 2 definitions of polymerase chain reaction positivity, the prevalence of B. pertussis in infant deaths was between 5.69 per 1000 deaths (95% confidence interval, 2.57-8.80) and 25.81 per 1000 deaths (95% confidence interval, 19.24-32.38). Pertussis accounted for between 0.22% and 0.81% of all infant deaths.

Conclusions: In this population of infants, B. pertussis was a minor source of all-cause infant mortality. Our analysis does not support the need for further steps for population-level preventive strategies for the control of B. pertussis .

Keywords: infants; mortality; postmortem; surveillance.

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Conflict of interest statement

W.B.M., C.J.G. and L.M. report grants from the US National Institutes of Health and from Merck, paid to Boston University. W.B.M. reports receiving fees for participating on a data monitoring committee for Hillevax outside the submitted work. C.J.G. also reports receiving fees for participation on data safety and monitoring boards for Takeda, Moderna, Hillevax and CureVac, all outside the submitted work. L.M. reports receiving financial support from the Bill & Melinda Gates Foundation to attend meetings on respiratory syncytial virus. R.L. reports research awards from Pfizer, paid to her institution, and honoraria for participation in pneumococcal advisory boards and consulting fees from Pfizer, paid to her, outside the submitted work. AL reports employment with Manpower Professional Services, which was contracted by Merck to complete work for the Global Vaccines Public Policy & Partnerships team, and fees from Merck for consultancy services, outside the submitted work. The other authors have no conflicts of interest to disclose.

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