Colby Stong
Patients aged 10 years and older with asthma or chronic obstructive pulmonary disease (COPD) have a greater pertussis risk and an increased burden of pertussis complications compared with the general population, investigators reported in Chest.
Pertussis remains endemic worldwide, with many countries — including the United States — documenting an increase in pertussis, despite the existence of a pertussis vaccine. Researchers conducted an observational, retrospective study, using data from the Optum de-identified Clinformatics DataMart Database, to compare the incidence of pertussis from 2007 through 2019 in the general population with that of patients with asthma and COPD.
Participants were aged 10 years and older from January 1, 2007, through December 31, 2019, and had 12 months of continuous health enrollment. Patients with asthma or COPD had at least 1 inpatient or at least 2 outpatient claims with a corresponding diagnosis from January 1, 2008, through December 31, 2018.
Pertussis infection incidence in the general population ranged from 5.33 per 100,000 person-years in 2007 to 13.04 per 100,000 person-years in 2012. The highest incidence of pertussis was observed in those aged 10 to 17 years for all years in the analysis. Complicated cases of pertussis ranged from 0.69 per 100,000 person-years in 2007 to 1.32 per 100,000 person-years in 2012.
The asthma group included 960,494 patients matched to 3,841,976 individuals in the general population, with 850 cases of pertussis occurring in this matched asthma cohort (incidence rate [IR], 28.80; 95% CI, 26.86-30.73 per 100,000 person-years). Patients with asthma had a 3.57-fold increased pertussis risk compared with the general population (rate ratio [RR], 3.57; 95% CI, 3.25-3.92), with the higher risk occurring in all age groups.
In the asthma cohort, 113 cases of pertussis with complications were observed, with an IR of 3.83 (95% CI, 3.12-4.53) per 100,000 person-years. Patients with asthma had an increased risk for pertussis with complications vs the general population (RR, 4.12; 95% CI, 3.16-5.38). The highest RRs were found in participants aged 18 to 44 years (RR, 8.14; 95% CI, 4.42-14.98).
The COPD group included 829,411 patients and 3,317,644 individuals in the matched general population, 97.1% of whom were aged at least 45 years. A total of 248 pertussis cases were observed in the COPD cohort, with an IR of 10.04 (95% CI, 8.79-11.28) per 100,000 person-years. Patients with COPD had nearly a 2-fold increased pertussis risk vs the general population (RR, 1.83; 95% CI, 1.57-2.12). Those aged 45 to 64 years had a similar increased risk with those aged 65 years and older.
The COPD group had 84 cases of pertussis with complications, with an IR of 3.40 (95% CI, 2.67-4.13) per 100,000 person-years. The risk for pertussis with complications was greater in the COPD group compared with the general population (RR, 2.82; 95% CI, 2.14-3.27). The increased risk for pertussis with complications tended to be higher in participants aged 45 to 64 years vs those aged 65 years and older.
In the 262 patients who had pertussis in the COPD cohort, exacerbations occurred most commonly during the 30-day window before (26%) and after (22%) the pertussis diagnosis and continued at higher levels for at least 180 days postdiagnosis. A new macrolide prescription was issued for fewer than 10% of patients up to 30 days before a pertussis diagnosis. This rate increased afterward, with a peak of 27.9% in the 30-day window postdiagnosis and then decreasing to 2.3% at 31 to 60 days.
Among several study limitations, these findings are based on an employee-insured population in which data were collected for reimbursement purposes. Also, reporting of pertussis is often delayed, with some cases reported as late as 40 days after disease onset, which may limit the usefulness of the data.
“In adults, particularly those with asthma or COPD, vaccination against pertussis could help avoid the health burden from pertussis, pertussis-related complications, and the degradation of chronic respiratory conditions,” the researchers stated.
Disclosure: The study was funded by Sanofi. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Naeger S, Pool V, Macina D. Increased burden of pertussis among adolescents and adults with asthma or COPD in the United States, 2007 to 2019. Chest. Open Access. Published online December 19, 2023. doi:10.1016/j.chest.2023.12.020