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

J Pediatr. 2003 Nov;143(5):576-81. doi: 10.1067/S0022-3476(03)00365-2.


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 < or =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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Feeding / statistics & numerical data
  • Canada / epidemiology
  • Case-Control Studies
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Pertussis Vaccine / administration & dosage
  • Prospective Studies
  • Survival Rate
  • Vaccination / statistics & numerical data
  • Whooping Cough / mortality*
  • Whooping Cough / prevention & control


  • Pertussis Vaccine