Characteristics and outcomes of children admitted to paediatric intensive care units with life-threatening pertussis infection in Great Britain 2023-2024.

Abstract

Describe clinical characteristics, treatment and outcomes of children treated for life-threatening pertussis in paediatric intensive care units during the 2023-2024 outbreak in Great Britain. National multi-centre audit. All paediatric intensive care units (PICUs) in Great Britain. Between November 2023 and June 2024, 54 children with a proven diagnosis of <i>Bordetella pertussis</i> as the primary reason for intensive care admission requiring invasive ventilation. None. Mortality on PICU, length of stay and number of invasive ventilation days. Median admission age 43 days, with peak blood white cell count (WCC) from 6×10⁹/L to 149×10⁹/L. 23% of infants' mothers were vaccinated during pregnancy (national average 59%). Mortality was 11/54 (20%), with 10 in infants <3 months. The survivor with the highest WCC peaked at 82×10⁹/L prior to exchange transfusion (XT), and the highest peak WCC in a survivor without XT was 71×10⁹/L. Eighteen patients underwent 27 XTs for leucoreduction, initiated at median peak WCC of 54×10⁹/L (range 32-148). All who died had XT planned, with nine completing. None with a peak WCC of <51×10⁹/L died, although four patients underwent XTs. In patients with rising WCC, survivors' rise rate was lower than those who died (0.23×10⁹/L/hour vs 1.4×10⁹/L/hour). In children invasively ventilated due to <i>Bordetella pertussis,</i> higher peak WCC, rapid WCC rise and a primary admission reason other than apnoeas are associated with mortality. XTs can be avoided in WCC <50×10⁹/L. Maternal vaccination rate was lower in this cohort than the general population.