Predictors of death in infants hospitalized with pertussis: A case-control study of 16 pertussis deaths in Canada

Objectives: To describe the clinical course of fatal cases of pertussis and identify predictors of death at the time of presentation for medical care. Methods: Case-control study of 16 deaths from pertussis identified by the Immunization Monitoring Program, Active (IMPACT) surveillance network (January 1991 - December 2001) matched with 32 nonfatal cases by age, date, and geography. Differences were compared by Fisher exact test and logistic regression. A multivariate model was developed using stepwise logistic regression. Results: All 16 fatal cases were less than or equal to 6 months old; 13 were < 2 months old. Fatal cases were less likely to have had cough complications during pregnancy (48% vs 14%; P = .046) and more likely to have pneumonia (63% vs 16%; P = .0024) before hospital admission and more likely to have seizures, pneumonia, leukocytosis, and hypoxemia after admission (P < .001 for all comparisons). White blood cell count and pneumonia were independent predictors of fatal outcome in the multivariate model. Conclusions: Infants too young to have begun their immunizations are at highest risk of fatal pertussis infection. Leukocytosis and pneumonia are predictors of a poor outcome; however, rapid progression of the disease may make interventions difficult.