Risk Factors Associated With Bordetella Pertussis Among Infants <= 4 Months Of Age In The Pre-Tdap Era United States, 2002-2005

Background: In the United States, infants have the highest reported pertussis incidence and death rates. Improved understanding of infant risk factors is needed to optimize prevention strategies.Methods: We prospectively enrolled infants <= 4 months of age with incident-confirmed pertussis from 4 sites during 2002-2005 (preceding pertussis antigen-containing vaccination recommendations for adolescents/ adults); each case-patient was age and site matched with 2 control subjects. Caregivers completed structured interviews. Infants and their contacts >= 11 years of age were offered serologic testing for IgG; being seropositive was defined as >= 94 anti-pertussis toxin IgG enzyme-linked immunosorbent assay units per milliliter.Results: Enrolled subjects (115 case-patients; 230 control subjects) had 4396 contacts during incubation periods; 83 (72%) case-patients had >= 1 contact with prolonged (>= 5 days) new cough in primary or secondary households. In multivariable analysis, the odds for pertussis were higher for infants with primary/secondary household contacts who had a prolonged new cough, compared with infants who did not. These contacts included mother [adjusted matched odds ratio (aMOR), 43.8; 95% confidence interval (CI), 6.45-298.0] and >= 1 nonmother contact (aMOR, 20.1; 95% CI, 6.48-62.7). Infants receiving breast milk with 0-1 formula feedings daily had decreased pertussis odds (aMOR, 0.27; 95% CI, 0.08-0.89), compared with those receiving more formula. Of 41 tested case-patients, 37 (90%) were seropositive.Conclusions: Pertussis in infants was associated with prolonged new cough (>= 5 days) in infants' household contacts. Findings suggest that breastfeeding protects against pertussis and warrants recommendation with pertussis prevention strategies, which currently include pertussis vaccination of pregnant mothers and infants' close contacts.