Background: There are scant data on the prevalence and clinical course of pertussis disease among infants with\npneumonia in low- and middle-income countries. While pertussis vaccination coverage is high (greater than equal to 90%) among\ninfants in Botswana, human immunodeficiency virus (HIV) infection affects nearly one-third of pregnancies.\nWe aimed to evaluate the prevalence and clinical course of pertussis disease in a cohort of HIV-unexposed\nuninfected (HUU), HIV-exposed uninfected (HEU), and HIV-infected infants with pneumonia in Botswana.\nMethods: We recruited children 1â??23 months of age with clinical pneumonia at a tertiary care hospital in\nGaborone, Botswana between April 2012 and June 2016. We obtained nasopharyngeal swab specimens at\nenrollment and tested these samples using a previously validated in-house real-time PCR assay that detects a\nunique sequence of the porin gene of Bordetella pertussis.\nResults: B. pertussis was identified in 1/248 (0.4%) HUU, 3/110 (2.7%) HEU, and 0/33 (0.0%) HIV-infected children. All\npertussis-associated pneumonia cases occurred in infants 1â??5 months of age (prevalence, 1.0% [1/103] in HUU and\n4.8% [3/62] in HEU infants). No HEU infants with pertussis-associated pneumonia were taking cotrimoxazole\nprophylaxis at the time of hospital presentation. One HUU infant with pertussis-associated pneumonia required\nintensive care unit admission for mechanical ventilation, but there were no deaths.\nConclusions: The prevalence of pertussis was low among infants and young children with pneumonia in\nBotswana. Although vaccination against pertussis in pregnancy is designed to prevent classical pertussis disease,\nreduction of pertussis-associated pneumonia might be an important additional benefit.
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