Epidemiology of pertussis-related paediatric intensive care unit (ICU) admissions in Australia, 1997–2013: an observational study

OBJECTIVE: To review the epidemiology of pertussis-related intensive care unit (ICU) admissions across Australia, over a 17-year period. DESIGN: Retrospective descriptive study. SETTING: Australian ICUs contributing data to the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry. The number of contributing ICUs increased over the study period, from 8 specialist paediatric ICUs in 1997 to 8 specialist paediatric and 13 general ICUs in 2013. PARTICIPANTS: All paediatric (<16 years) ICU admissions, coded as pertussis-related, between 1 January 1997 and 31 December 2013. RESULTS: A total of 373 pertussis-coded ICU admissions were identified in the ANZPIC Registry over the study period. Of these cases, 52.8% occurred during the 4 years of the recent Australian epidemic (2009–2012). ICU admissions were most likely to occur in infants aged younger than 6 weeks (41.8%, n=156) and aged 6 weeks to 4 months (42.9%, n=160). The median length of stay for pertussis-related ICU admissions was 3.6 days, with 77.5% of cases staying in ICU for <7 days. Approximately half of all admissions (54.8%) required some form of respiratory support, with 32.7% requiring invasive respiratory support. Over the study period, 23 deaths were recorded (6.2% of pertussis-related ICU admissions), of which 20 (87.0%) were infants <4 months old. CONCLUSIONS: Pertussis-related ICU admissions occur primarily in infants too young to be fully protected from active immunisation. More needs to be done to protect these high-risk infants, such as maternal immunisation.