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The performance of respiratory illness surveillance case definitions to detect Bordetella pertussis in children aged < 5 years seeking healthcare for respiratory illness in South Africa, 2017-2023
Background: Pertussis is vaccine‐preventable and requires surveillance to guide interventions. Assessing the performance of syndromic surveillance and the World Health Organization (WHO) pertussis case definitions can improve sensitivity and accuracy in detecting laboratory‐confirmed Bordetella pert...
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| Format: | Thesis |
| Language: | English English |
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Department of Public Health and Family Medicine
2025
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| _version_ | 1867613634725675009 |
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| access_status_str | Open Access |
| author | Jensen, Katherine |
| author2 | De Voux, Alex |
| author_browse | De Voux, Alex Jensen, Katherine |
| author_facet | De Voux, Alex Jensen, Katherine |
| author_sort | Jensen, Katherine |
| collection | Thesis |
| description | Background: Pertussis is vaccine‐preventable and requires surveillance to guide interventions. Assessing the performance of syndromic surveillance and the World Health Organization (WHO) pertussis case definitions can improve sensitivity and accuracy in detecting laboratory‐confirmed Bordetella pertussis, ensuring effective monitoring in South Africa. Methods: We conducted a secondary analysis of respiratory illness surveillance data among children aged <5 years across sentinel sites from January 2017 through December 2023. Participants were enrolled as either outpatients eligible for influenza‐like illness (ILI), or hospitalised patients eligible for severe respiratory infection (SRI) surveillance. Nasopharyngeal swabs were tested for B. pertussis using polymerase chain reaction (PCR). Sensitivity, specificity, and other performance indicators of case definitions were evaluated against PCR results. Results: Of 23,887 participants, 23,640 (99.0%) had PCR results. B. pertussis was detected in 0.7% (30/4,125) from ILI and 1.6% (314/19,517) from SRI surveillance. Compared to the WHO pertussis case definition, a modified WHO pertussis case definition which includes apnoea and omits cough duration, improved sensitivity (ILI: 30.0% vs. 43.3%; SRI: 55.7% vs. 60.2%), but reduced specificity (ILI: 90.5% vs. 75.8%; SRI: 88.3% vs. 80.9% %). Negative predictive values were high for both definitions (ILI: 99.5% vs. 99.4%; SRI: 99.2% vs. 99.2%). The WHO pertussis case definition missed 44.3% of hospital laboratory‐confirmed cases, while the modified case definition missed 39.8%. Conclusion: Both WHO and modified pertussis case definitions missed many laboratory‐confirmed pertussis cases, likely underestimating disease burden. Revising the WHO pertussis case definition and integrating pertussis into syndromic surveillance is recommended to improve detection while optimising resources. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/42371 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:39:16.408Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/42371 The performance of respiratory illness surveillance case definitions to detect Bordetella pertussis in children aged < 5 years seeking healthcare for respiratory illness in South Africa, 2017-2023 Jensen, Katherine De Voux, Alex Walaza, Sibongile surveillance whooping cough pertussis case definition sensitivity specificity predictive value children southern Africa Background: Pertussis is vaccine‐preventable and requires surveillance to guide interventions. Assessing the performance of syndromic surveillance and the World Health Organization (WHO) pertussis case definitions can improve sensitivity and accuracy in detecting laboratory‐confirmed Bordetella pertussis, ensuring effective monitoring in South Africa. Methods: We conducted a secondary analysis of respiratory illness surveillance data among children aged <5 years across sentinel sites from January 2017 through December 2023. Participants were enrolled as either outpatients eligible for influenza‐like illness (ILI), or hospitalised patients eligible for severe respiratory infection (SRI) surveillance. Nasopharyngeal swabs were tested for B. pertussis using polymerase chain reaction (PCR). Sensitivity, specificity, and other performance indicators of case definitions were evaluated against PCR results. Results: Of 23,887 participants, 23,640 (99.0%) had PCR results. B. pertussis was detected in 0.7% (30/4,125) from ILI and 1.6% (314/19,517) from SRI surveillance. Compared to the WHO pertussis case definition, a modified WHO pertussis case definition which includes apnoea and omits cough duration, improved sensitivity (ILI: 30.0% vs. 43.3%; SRI: 55.7% vs. 60.2%), but reduced specificity (ILI: 90.5% vs. 75.8%; SRI: 88.3% vs. 80.9% %). Negative predictive values were high for both definitions (ILI: 99.5% vs. 99.4%; SRI: 99.2% vs. 99.2%). The WHO pertussis case definition missed 44.3% of hospital laboratory‐confirmed cases, while the modified case definition missed 39.8%. Conclusion: Both WHO and modified pertussis case definitions missed many laboratory‐confirmed pertussis cases, likely underestimating disease burden. Revising the WHO pertussis case definition and integrating pertussis into syndromic surveillance is recommended to improve detection while optimising resources. 2025-12-01T09:43:31Z 2025-12-01T09:43:31Z 2025 2025-12-01T06:44:02Z Thesis / Dissertation Masters MPH http://hdl.handle.net/11427/42371 en eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | surveillance whooping cough pertussis case definition sensitivity specificity predictive value children southern Africa Jensen, Katherine The performance of respiratory illness surveillance case definitions to detect Bordetella pertussis in children aged < 5 years seeking healthcare for respiratory illness in South Africa, 2017-2023 |
| thesis_degree_str | Master's |
| title | The performance of respiratory illness surveillance case definitions to detect Bordetella pertussis in children aged < 5 years seeking healthcare for respiratory illness in South Africa, 2017-2023 |
| title_full | The performance of respiratory illness surveillance case definitions to detect Bordetella pertussis in children aged < 5 years seeking healthcare for respiratory illness in South Africa, 2017-2023 |
| title_fullStr | The performance of respiratory illness surveillance case definitions to detect Bordetella pertussis in children aged < 5 years seeking healthcare for respiratory illness in South Africa, 2017-2023 |
| title_full_unstemmed | The performance of respiratory illness surveillance case definitions to detect Bordetella pertussis in children aged < 5 years seeking healthcare for respiratory illness in South Africa, 2017-2023 |
| title_short | The performance of respiratory illness surveillance case definitions to detect Bordetella pertussis in children aged < 5 years seeking healthcare for respiratory illness in South Africa, 2017-2023 |
| title_sort | performance of respiratory illness surveillance case definitions to detect bordetella pertussis in children aged 5 years seeking healthcare for respiratory illness in south africa 2017 2023 |
| topic | surveillance whooping cough pertussis case definition sensitivity specificity predictive value children southern Africa |
| url | http://hdl.handle.net/11427/42371 |
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