Risk markers for pertussis among infants <4 months of age: Understanding the hispanic disparity

Kathleen Winter, Kathleen Harriman

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objectives: Hispanic infants are at greater risk of pertussis compared with other racial/ethnic groups. Studies have shown that the source of Bordetella pertussis infection for most infants is household members. Using a case-control study, we examined risk markers for pertussis among Hispanic and non-Hispanic infants and evaluated whether maternal parity, a proxy for household size, contributes to the ethnic disparity. Methods: We evaluated infants born in California during 2013-2014; cases were infants reported to California Department of Public Health with pertussis occurring before 4 months of age, and controls were infants who survived to at least 4 months of age without pertussis. Bivariate comparisons and multivariate logistic regression models were used to identify risk markers for pertussis in Hispanic and non-Hispanic infants. Results: Increased maternal parity was associated with greater risk of pertussis, with a clear dose response observed with increasing risk for additional prior births. Teenage mothers were more likely to have infants with pertussis. These were both independent risk factors across all racial/ethnic groups, even when adjusting for important covariates. Preterm birth and Medicaid insurance were also identified as independent risk markers among Hispanic infants only. Conclusions: Infants of all races/ethnicities with older siblings or born to younger mothers are at increased risk of pertussis. Among Hispanic infants, prematurity and Medicaid insurance were independent risk markers for pertussis. These factors highlight the need to ensure prompt immunization of pregnant women with Tdap at the earliest opportunity starting at 27 weeks gestation.

Original languageEnglish
Pages (from-to)126-131
Number of pages6
JournalPediatric Infectious Disease Journal
Issue number2
StatePublished - Feb 1 2018

Bibliographical note

Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.


  • Hispanic
  • Tetanus toxoid
  • infant
  • pertussis
  • reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases


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