Critical Pertussis in the PICU: Multinational Study in the Gulf Cooperation Council Region, 2022-2024.

OBJECTIVES

Critical pertussis is a life-threatening illness that predominantly affects young infants, with substantial morbidity and mortality. In this study, we aimed to describe the epidemiology, clinical features, and variability in management of pediatric critical pertussis in the Gulf Cooperation Council (GCC) region.

DESIGN

Multinational retrospective cohort study conducted between July 2022 and December 2024.

SETTING

Thirty-five PICUs in the six GCC countries.

PATIENTS: Children 16 years old or younger with laboratory-confirmed pertussis (by polymerase chain reaction or culture) admitted to a PICU.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

A total of 204 cases of critical pertussis were identified. Median (interquartile range [IQR]) age was 53 days (IQR, 36.5-89 d). Most patients (91.2%) were healthy before PICU admission. Comorbidities included acyanotic congenital heart disease (3.9%) or respiratory disease (2.9%). Only 17.3% had received infant pertussis vaccination and 4.1% had mothers vaccinated during pregnancy. The median duration of hospital stay was 9 days (IQR, 6-16 d), and PICU stay was 5 days (IQR, 3-10 d). Hyperleukocytosis (> 30 × 10 9 /L) occurred in 49.5%. Respiratory distress (47.6%) and apnea (28.4%) were the main reasons for PICU admission. Management varied widely: leukoreduction was performed in 27.4%, with significant variation in practice across countries. Use of high-flow nasal cannula and mechanical also varied across the region. Extracorporeal membrane oxygenation was rarely used (1.5%). Echocardiography was obtained in nearly half of the cohort, and revealed pulmonary hypertension in 24 patients. Overall mortality was 15.2%, most commonly attributed to septic shock and respiratory failure.

CONCLUSIONS

Critical pertussis predominantly affects young infants, with substantial morbidity, mortality, and wide variation in management practices. Our cohort from 2022 to 2024 highlights our GCC regional need for standardized care protocols and strengthened prevention.