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Bordetella pertussis in School-Age Children, Adolescents and Adults: A Systematic Review of Epidemiology and Mortality in Europe. Infect Dis Ther 2021; 10:2071-2118. [PMID: 34435338 PMCID: PMC8387212 DOI: 10.1007/s40121-021-00520-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Pertussis (whooping cough) epidemics persist globally despite high vaccine coverage among infants and young children. The resurgence of pertussis in high-income countries is partly due to waning vaccine immunity, resulting in a pool of unprotected adolescents and adults. However, pertussis is generally less severe in adolescents and adults, and this difference in presentation means it can often be unrecognised by healthcare professionals, meaning that it is largely under-diagnosed in older populations. A systematic search of MEDLINE, EMBASE and BIOSIS was undertaken to identify studies published between 1 January 1990 and 17 June 2019, with information on pertussis epidemiology and mortality in school-aged children, adolescents and adults in Europe. A formal statistical comparison (e.g. using meta-analyses) was not possible because of the mix of methodologies reported. There were 69 epidemiological studies and 19 mortality studies identified for review. Over the past decade, the reported incidence of notified pertussis cases varied widely between European countries, which is likely associated with differences in surveillance systems, diagnostic techniques and reporting regulations. However, several studies show that pertussis is circulating among adolescents and adults in Europe, and although pertussis-related morbidity and mortality are highest in infants, there is evidence that adults aged > 50 years are at increased risk. For example, in a hospital-based surveillance study in Portugal, between 2000 and 2015, 94% of hospitalised pertussis cases were infants aged < 1 year, with a case fatality rate (CFR) of 0.8%; however, among hospitalised adult cases of pertussis, the CFRs were 11.5% (aged 18–64 years) and 17.4% (aged > 65 years). Very few European countries currently include pertussis boosters for adults in the national immunisation strategy. In addition to increasing pertussis vaccination coverage in adolescents and adults, mitigation strategies in European countries should include improved diagnosis and treatment in these populations.
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Age-related differences in antibody avidities to pertussis toxin and filamentous hemagglutinin in a healthy Japanese population. Vaccine 2019; 37:2463-2469. [PMID: 30930008 DOI: 10.1016/j.vaccine.2019.03.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 02/06/2023]
Abstract
To gain insights into the current Japanese pertussis immunization schedule, we examined the distributions of antibody titers and avidities to pertussis toxin (PT) and filamentous hemagglutinin (FHA) in 460 Japanese healthy subjects (aged 1-60 years) based on age category. Our avidity enzyme-linked immunosorbent assays revealed that young children aged 1-2 years, which corresponded to ages after receiving primary and/or booster pertussis vaccinations, had relatively high-avidity anti-PT IgG (mean avidity index [AI], 40.5%) compared with other age groups (AI, 26.5-31.9%); however, they had relatively low-avidity anti-FHA IgG (AI, 41.8%). In contrast, children aged 3-6 years had both low-avidity anti-PT IgG (AI, 26.5%) and low-avidity anti-FHA IgG (AI, 40.4%). A significant age-related difference in anti-PT IgG avidity was observed between children aged 1-2 years and 3-6 years (P < 0.05); however, the difference in anti-FHA IgG avidity was not significant. The anti-PT IgG avidity was positively correlated with the antibody titer, especially among children aged 1-15 years (rs = 0.508-0.685; P < 0.01), indicating that the avidity of vaccine-induced anti-PT IgG decreases with decreasing IgG antibody titer to PT. Our findings strongly suggest that vaccine-induced anti-PT IgG avidity rapidly wanes after vaccination, but this is not observed for anti-FHA IgG avidity. Because children aged 3-6 years have both low-quantity and low-quality antibodies against PT, an additional booster vaccination with acellular pertussis vaccines is required for such children in Japan.
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Rahimian M, HosseiniB M. Serological study of Bordetella Pertussis, Mycoplasma Pneumonia and Chlamydia Pneumonia in Iranian hajj pilgrims with prolonged cough illnesses: A follow-up study. Respir Med 2017; 132:122-131. [PMID: 29229084 DOI: 10.1016/j.rmed.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hajj pilgrimage is the biggest and longest mass gathering in the Muslim world. Annually, about 50% of more than 2.5 million pilgrims participating in this ritual get involved in severe devastating coughs. Most coughs continue, so the pilgrims turn back home and transmit them to family members and other people. Despite the high prevalence of coughs for many years, what causes them remains unknown. Considering the pertussis-like clinical picture of the so-called "hajj coughs", the researchers conducted a study to measure antibodies against three known common atypical bacteria, namely Bordetella Pertussis, Chlamydia Pneumonia and Mycoplasma Pneumonia. PATIENTS AND METHODS The study was done on three out of eleven groups of pilgrims from Yazd province, central Iran. The sample was selected randomly and consisted of 202 pilgrims who completed an informed consent. Their blood samples were taken, and the plasma was separated and then stored at -70 °C. After turning back from the journey, the pilgrims had their second blood samples taken. As many as 52 pilgrims failed to come for the second sampling, and two samples were broken during transportation. The final analysis was performed on the remaining 148 pairs of samples. RESULTS Antibodies were already elevated in many pilgrims before the journey probably due to their old age (causing more exposure to pathogens) or unplanned pertussis vaccination. After their return, antibody elevation was only mild, again probably due to the old age of the participants (i.e. due to their weaker immune systems). Some antibodies even fell down without any known reason. In this study, previous hajj journey was assumed as a prophylactic factor, due to acquisition of immunity. Coughs with a prolonged pertussis-like picture were also presumed to be more related than other types of coughs to atypical pathogens. Statistical tests showed that the history of previous journeys had no prophylactic effect. Also, no correlation was found between the clinical pictures of coughs and infection with atypical bacteria. CONCLUSION Even though some rises and falls occurred in the antibodies titer, the variations could hardly be attributed to coughs in this study. Indeed, the variation of antibodies had no meaningful relationship with clinical factors. In this regard, further studies are needed to clarify the reason for the so-called "hajj coughs", but epidemiological studies will be difficult to do until easier and more reliable methods become available for accurate diagnosis.
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Affiliation(s)
- Masoud Rahimian
- Internal Medicine Department, Division of Pulmonology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Moriuchi T, Otsuka N, Hiramatsu Y, Shibayama K, Kamachi K. A high seroprevalence of antibodies to pertussis toxin among Japanese adults: Qualitative and quantitative analyses. PLoS One 2017; 12:e0181181. [PMID: 28700751 PMCID: PMC5507317 DOI: 10.1371/journal.pone.0181181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 06/27/2017] [Indexed: 11/19/2022] Open
Abstract
In 2013, national serosurveillance detected a high seroprevalence of antibodies to pertussis toxin (PT) from Bordetella pertussis among Japanese adults. Thus, we aimed to determine the cause(s) of this high seroprevalence, and analyzed the titers of antibodies to PT and filamentous hemagglutinin (FHA) among adults (35-44 years old), young children (4-7 years old), and older children (10-14 years old). Our quantitative analyses revealed that adults had higher seroprevalences of anti-PT IgG and PT-neutralizing antibodies, and similar titers of anti-FHA IgG, compared to the young and older children. Positive correlations were observed between the titers of PT-neutralizing antibodies and anti-PT IgG in all age groups (rs values of 0.326-0.522), although the correlation tended to decrease with age. The ratio of PT-neutralizing antibodies to anti-PT IgG was significantly different when we compared the serum and purified IgG fractions among adults (p = 0.016), although this result was not observed among young and older children. Thus, it appears that some adults had non-IgG immunoglobulins to PT. Our analyses also revealed that adults had high-avidity anti-PT IgG (avidity index: 63.5%, similar results were observed among the children); however, the adults had lower-avidity anti-FHA IgG (37.9%, p < 0.05). It is possible that low-avidity anti-FHA IgG is related to infection with other respiratory pathogens (e.g., Bordetella parapertussis, Haemophilus influenzae, or Mycoplasma pneumoniae), which produces antibodies to FHA-like proteins. Our observations suggest that these adults had been infected with B. pertussis and other pathogen(s) during their adulthood.
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Affiliation(s)
- Takumi Moriuchi
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
- Department of Pediatrics, St Marianna University School of Medicine, Kawasaki, Japan
| | - Nao Otsuka
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yukihiro Hiramatsu
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazunari Kamachi
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
- * E-mail:
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Rodríguez de la Pinta ML, Castro Lareo MI, Ramon Torrell JM, García de Lomas J, Devadiga R, Reyes J, McCoig C, Tafalla M, García-Corbeira P. Seroprevalence of pertussis amongst healthcare professionals in Spain. Vaccine 2015; 34:1109-14. [PMID: 26718690 DOI: 10.1016/j.vaccine.2015.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This multi-center, hospital-based observational study determined the seroprevalence of pertussis antibodies amongst healthcare professionals from three different hospitals in Spain to ascertain the health status of professionals attending to susceptible groups who are at risk of contracting and transmitting pertussis. METHODS Medical professionals from three hospitals in Spain were recruited for this study (NCT01706224). Serum samples from subjects were assessed for anti-pertussis antibodies by ELISA. The percentage of subjects positive for anti-pertussis antibodies were determined by age-strata, gender, vaccination status, professional level (physicians, nurses, ancillary nurses and midwives), hospital department, number of working years, numbers of hours spent with the patient as well as number of children in the household. RESULTS Overall, 31.2% of subjects were seropositive; 3.3% of these healthcare professionals had ELISA values indicative of current or recent infection. There were no significant differences in terms of pertussis prevalence with respect to age, gender, hospital department, profession, number of working years and number of hours spent with patients. These levels of seronegativity amongst healthcare workers further strengthen the rationale for vaccination amongst this specific population against pertussis.
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Affiliation(s)
| | | | - Josep Maria Ramon Torrell
- IDIBELL; Hospital Universitario de Bellvitge, Feixa Llarga s/n, Hospitalet Llobregat, 08907 Barcelona, Spain.
| | - Juan García de Lomas
- Department of Microbiology, Facultad de Medicina, Av Blasco Ibañez 17, 46010 Valencia, Spain; Instituto Valenciano de Microbiología, Bétera, 46117 Valencia, Spain.
| | - Raghavendra Devadiga
- GSK Pharmaceuticals Pvt. Ltd., CDOC-B, #5 Embassy Links, S.R.T. Road, 560052 Bangalore, India.
| | - Janet Reyes
- GSK Vaccines, C/Severo Ochoa 2, Tres Cantos, 28760 Madrid, Spain.
| | - Cynthia McCoig
- GSK Vaccines, C/Severo Ochoa 2, Tres Cantos, 28760 Madrid, Spain.
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Zhang Y, Huang H, Gao Z, Liu Y, Liu P, Ding Y, Wang L, Chen D, Wu S. A sera-epidemiological study on pertussis immunity levels among community populations and an analysis of the underlying factors in Tianjin China. Vaccine 2015; 33:7183-7187. [PMID: 26562317 DOI: 10.1016/j.vaccine.2015.10.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study is to characterize the sera-epidemiology of pertussis immunity levels among community populations and to identify the underlying factors. Moreover, our study will help resolve new issues encountered during the control and prevention of pertussis reemergence. METHODS The anti-pertussis antibody levels among community populations were examined using enzyme linked immunosorbent assays (ELISA) over three years. Comparative studies were carried out to assess the efficacy of different types of vaccines. Meanwhile, the duration of protection provided by DTaP within the under-7 age group was subjected to further analysis. RESULTS The average positive rate for anti-pertussis antibody was 49.15% across all community populations, among which the 4-12 age group showed a rate substantially lower than those of other groups (P<0.001). There was no statistically significant difference in anti-pertussis antibody levels (P=0.977) between people receiving three and four doses of the vaccine. The surveillance results showed that the positive antibody response rate elicited by component pertussis combo (DTcP) vaccines (84.44%) was strikingly higher than that elicited by acellular pertussis combo (DTaP) vaccines (37.22%, P<0.001). More specifically, when given 4 doses of DTcP vaccines, 66.67% of the people showed positive anti-pertussis toxin (PT) antibody levels, which was higher than the ratio of 9.87% (P<0.001) in the case of DTaP vaccines. The positive anti-pertussis antibody levels peaked at 73% within the first five months following vaccination and then gradually decreased to below 20% in four years. The positive rate was inversely correlated with the length of time after vaccination (r=-0.929, P=0.003). CONCLUSIONS The anti-pertussis antibody levels were not only relatively low among community populations, but also dropped excessively rapidly among vaccinated populations. Natural infection is an important contributor to the high pertussis immunity levels seen in adolescents and adults. The efficacy of DTaP remains to be improved.
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Affiliation(s)
- Ying Zhang
- Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China.
| | - Haitao Huang
- Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Zhigang Gao
- Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Yong Liu
- Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Peng Liu
- Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Yaxing Ding
- Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Lijuan Wang
- Hangu Centers for Disease Control and Prevention, Tianjin, 300480, China
| | - Derong Chen
- Hongqiao Centers for Disease Control and Prevention, Tianjin, 300132, China
| | - Shuqing Wu
- Beichen Centers for Disease Control and Prevention, Tianjin, 300400, China
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Barkoff AM, Gröndahl-Yli-Hannuksela K, He Q. Seroprevalence studies of pertussis: what have we learned from different immunized populations. Pathog Dis 2015. [PMID: 26208655 DOI: 10.1093/femspd/ftv050] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bordetella pertussis is a pathogen-causing whooping cough (pertussis) in humans. Although vaccination against the disease is effective, the bacterium is still circulating among population and can even cause death. Especially young infants, who lack protection, are vulnerable. The laboratory diagnostic methods to detect B. pertussis are culture, PCR and ELISA serology. Reported cases of the disease vary among countries but usually the incidence rates are low, <1 to 10/100 000. However, pertussis often goes unrecognized among patients as it presents itself like the common cold, especially in adults and elders who are often the source of the infection. This makes pertussis difficult to monitor and control. Serological surveillance is an easy manner to estimate the real burden of the disease among population. Furthermore, to have reliable results, anti-PT IgG antibodies should be measured, as PT is the only specific antigen to B. pertussis. This review aims to evaluate available pertussis seroprevalence studies throughout the world, and to compare the findings from countries with different vaccination histories and strategies. Estimation of the real burden of pertussis is compared to reported numbers. In addition, future aspects in seroprevalence studies are considered.
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Affiliation(s)
- Alex-Mikael Barkoff
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
| | | | - Qiushui He
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
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Prevalence of antibody to Bordetella pertussis in neonates and prevalence of recent pertussis infection in pregnant women in Catalonia (Spain) in 2003 and 2013. Pediatr Infect Dis J 2014; 33:1114-8. [PMID: 24871642 DOI: 10.1097/inf.0000000000000413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infections because of Bordetella pertussis still occur in infants and adults in European countries, despite vaccination coverage against pertussis being high. METHODS IgG antibody titers to pertussis toxin (anti-PT) were assessed using an enzyme-linked immunosorbent assay test (Serion ELISA classic) in 353 cord blood samples from neonates of a representative sample of pregnant women obtained in Catalonia (Spain) in 2013. Neonates with anti-PT titers ≤ 40 international units (IU)/mL were considered to be unprotected against pertussis. IgG-PT titers >100 IU/mL in umbilical cord samples were considered to be indicative of a current or recent pertussis infection (12 months) in pregnant women. The age-standardized prevalence of recent pertussis infection obtained in this study was compared with the prevalence obtained in 2003. RESULTS The mean anti-PT titer in neonates was 10.8 IU/mL and 89.8% of neonates were unprotected against pertussis. The prevalence of unprotected neonates as defined by cord blood anti-PT ≤ 40 IU/mL was 90%. The prevalence of recent pertussis infection in pregnant women as defined by cord blood anti-PT >100 IU/mL was 2%. The diphtheria-tetanus-pertussis vaccination coverage during childhood in pregnant women was 75%. The age-standardized prevalence of recent pertussis infection in pregnant women observed in this study (2.2%) was slightly higher than the prevalence obtained in 2003 (1.5%), with an odds ratio = 1.45 (95% confidence intervals: 0.5-3.9), although differences were not statistically significant. CONCLUSIONS Most neonates are unprotected against pertussis and pertussis infections are frequent in pregnant women in Catalonia. Infants and pregnant women should be the priority population groups for pertussis prevention programs in Catalonia.
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Réplica a «Situación de la tos ferina en la Comunidad Valenciana: ¿asistimos a una reactivación epidémica?». Enferm Infecc Microbiol Clin 2014; 32:271-2. [DOI: 10.1016/j.eimc.2013.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 11/20/2022]
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González-Escalada A, García-García L, Viguera-Ester P, Marín-García P, García J, Gil-de-Miguel A, Gil-Prieto R. Seroprevalence of antibodies against measles, rubella, mumps, varicella-zoster, and B. Pertussis in young adults of Madrid, Spain. Hum Vaccin Immunother 2013; 9:1918-25. [PMID: 23793571 DOI: 10.4161/hv.25127] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In recent years, there has been an increase in the number of cases of certain immunopreventable diseases in our country. A high proportion of these have been recorded among the young adult population. The aim of this study was to determine the seroprevalence of antibodies against immunopreventable diseases with the greatest health impacts on the young adult population (19-39 y of age) in Madrid. We collected a total of 1,153 serum samples from healthy volunteers undergoing routine medical visits and used ELISA to determine the presence of IgG antibodies against measles, rubella, mumps, and varicella zoster, as well as Bordetella pertussis. The Pearson's χ(2) test was used to compare prevalences, the Mann-Whitney U test was used to compare means, and the Kruskal-Wallis test was applied for variables with more than 2 categories. Statistical significance was achieved with p values of<0.05. The global prevalence of antibodies was 92.1% for measles, 94.4% for rubella, 88.3% for mumps, 92.8% for varicella zoster, and 70.2% for B. pertussis. No statistically significant differences were found between genders. The prevalence of antibodies against measles was more than 95% in the group of individuals born after 1986, and the percentage of individuals susceptible to rubella was less than 5% in women born after 1986. In spite of adequate vaccination coverage, in our region, a population of young adults exists who have not achieved the objectives of the WHO for the elimination of measles and congenital rubella syndrome.
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Affiliation(s)
- Alba González-Escalada
- Departments of Preventive Medicine and Public Health and Medical Immunology and Microbiology; University Rey Juan Carlos; Madrid, Spain
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Cevik M, Beyazova U, Aral A, Duyan Camurdan A, Ozkan S, Sahin F, Aybay C. Seroprevalence of IgG antibodies against Bordetella pertussis in healthy individuals aged 4–24 years in Turkey. Clin Microbiol Infect 2008; 14:388-90. [DOI: 10.1111/j.1469-0691.2007.01926.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Recent findings on pertussis epidemiology in Turkey. Eur J Clin Microbiol Infect Dis 2008; 27:335-41. [DOI: 10.1007/s10096-007-0442-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
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Ozkan S, Aksakal FN, Tuzun H, Aycan S, Maral I, Cirak MY, Bumin MA, Ozkan S. Bordetella pertussis Seroprevalence Among Vaccinated School Children in Ankara, Turkey. Infection 2007; 35:387-9. [PMID: 17882361 DOI: 10.1007/s15010-007-6204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 04/17/2007] [Indexed: 10/22/2022]
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Moraga F, Roca J, Méndez C, Rodrigo C, Pineda V, Martinez A, Baraibar R, Boronat M. Epidemiology and surveillance of pertussis among infants in Catalonia, Spain, during 1997-2001. Pediatr Infect Dis J 2005; 24:510-3. [PMID: 15933560 DOI: 10.1097/01.inf.0000164701.50766.62] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite high levels of vaccination coverage in Spain and Catalonia (98% in 2002), pertussis is a significant cause of morbidity among infants. The study aim was to estimate the incidence of hospitalizations for pertussis among infants from 1997 through 2001 in Catalonia. METHODS A retrospective review of records for patients <12 months of age with a diagnosis of pertussis (International Classification of Diseases, 9th revision, code 033) at discharge from 11 Catalonian hospitals was performed. RESULTS Three hundred forty-six patients were identified, 62 (1997), 28 (1998), 59 (1999), 150 (2000) and 47 (2001), of whom 284 (82%) were <4 months of age. The incidence of hospitalizations because of whooping cough from 1997 through 2001 in Catalonia was estimated at 118 cases per 100,000 inhabitants <12 months of age. Symptoms included paroxysmal cough (95%), cyanosis (67.9%), vomiting (36.7%) and apneic episodes (27.7%). Three infants (0.8%) died, all <2 months of age. Two hundred thirty-four patients (67.6%) were unvaccinated (222 patients were <3 months of age). Six patients (1.7%) were fully vaccinated (3 doses). Considering that only 220 patients <12 months of age were reported through the Catalonian Notification System in 1997-2001, at least 126 hospitalizations (36.4%) for pertussis were not reported to this system (mean difference per year, 32.6%; range, 8.4-56%). CONCLUSIONS In this study, hospitalizations exceeded the number of notifications by at least 32.6%; therefore, the real incidence is likely to be greatly underestimated. Pertussis incidence remains high among infants, most of whom are <4 months of age and have had no or 1 dose of vaccine.
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Franco E, Giambi C, Ialacci R, Maurici M. Pertussis vaccination for adolescents and adults. Expert Opin Biol Ther 2005; 4:1669-76. [PMID: 15461578 DOI: 10.1517/14712598.4.10.1669] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Following the introduction of vaccines, the incidence of pertussis declined; however, since 1990, a progressive increase was noted, even in highly immunised populations. Periodic pertussis outbreaks are due to suboptimal efficacy of the vaccine and waning immunity with increasing age. A significant proportion of adolescents and adults with a prolonged cough present Bordetella pertussis, and infection is often transmitted to infants too young to be vaccinated. A high vaccination coverage in the whole population would be necessary to interrupt the circulation of B. pertussis, but immunisation programmes for adolescents and adults have been introduced recently and are accepted with difficulty. The lack of cost-benefit analysis and consistent epidemiological data makes it difficult to assess the role of pertussis elimination among public health priorities. At present, programmes targeted at risk groups for close contacts with infants are the most convenient for adult population, as more epidemiological and economic evidence is needed before a universal strategy can be discussed.
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Affiliation(s)
- Elisabetta Franco
- University Tor Vergata, Department of Public Health, Via Montpellier, 1 00133 Rome, Italy.
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Diez-Domingo J, Ballester A, Baldó JM, Planelles MV, Villarroya JV, Alvarez T, Carmen Peidró M, Calero P, Garcés MD, Sorribes I, Graullera M, Jubert A, San-Martín M, González A. Incidence of pertussis in persons < or =15 years of age in Valencia, Spain: seroprevalence of antibodies to pertussis toxin (PT) in children, adolescents and adults. J Infect 2004; 49:242-7. [PMID: 15337342 DOI: 10.1016/j.jinf.2004.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the incidence of pertussis in persons < or =15 years in age in Valencia, Spain. To assess the prevalence of IgG antibodies to pertussis toxin (PT) in children, adolescents and adults. METHODS Prospective study conducted at paediatric primary care centres. All persons < or =15 years in age presented with persistent cough were enrolled. Parents completed a brief questionnaire and immunization history was obtained from paediatrician records. A blood sample was obtained, for determination of IgG antibodies to Bordetella pertussis toxin (PT) by an ELISA method. A study confirmed-case was the presence of two conditions: (1) cough illness of > or =14 days duration; and (2) ELISA absorbance value of IgG to PT > or =2. Two subjects per clinical-case (same centre and range of age) and parents were asked to participate in the prevalence study. RESULTS Sixty-one children < or =15 years in age presented with symptoms leading to a clinical diagnosis of pertussis were detected. Serological evidence of recent pertussis was found in five of these patients (incidence of 46.0/100,000 persons < or =15 years in age). Prevalence of antibodies to B. pertussis (> or =0.3) in children < or =15 years in age and adults was 39 and 33%, respectively. Only a minority of children, adolescents and adults had absorbance values indicative of immunity (> or =1). CONCLUSIONS These incidence and seroprevalence results show that despite high immunization rates in infancy, B. pertussis is circulating in Spain.
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Affiliation(s)
- Javier Diez-Domingo
- Pediatrics, Primary Care, Generalitat Valenciana, and Vaccine Institute of Valencia (VIVA), Valencia, Spain.
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17
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Brote epidémico de tos ferina en una población con una elevada cobertura de vacunación. Diagnóstico en Atención Primaria. Semergen 2004. [DOI: 10.1016/s1138-3593(04)74312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Wilder-Smith A, Earnest A, Ravindran S, Paton NI. High Incidence of Pertussis among Hajj Pilgrims. Clin Infect Dis 2003; 37:1270-2. [PMID: 14557975 DOI: 10.1086/378748] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2002] [Accepted: 07/05/2003] [Indexed: 11/03/2022] Open
Abstract
Prolonged cough occurs in a large proportion of the 2 million pilgrims who participate in the annual Hajj in Saudi Arabia. In a prospective seroepidemiological study to determine the incidence of pertussis among 358 adult pilgrims, 5 (1.4%) were found to have acquired pertussis (defined as prolonged cough and a >4-fold increase in the level of immunoglobulin G to whole-cell pertussis antigen). Of the 40 pilgrims who had no pre-Hajj immunity to pertussis, 3 (7.5%) acquired pertussis. Administration of acellular pertussis vaccine to pilgrims before the Hajj should be considered to address this problem.
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Affiliation(s)
- Annelies Wilder-Smith
- Travellers' Health and Vaccination Centre, Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.
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19
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Ferrer Marcellés A, Moraga Llop FA, Olsina Tebar M, Campins Martí M, Planells Romeu I. [Culture-confirmed whooping cough in a tertiary center over a twelve-year period]. An Pediatr (Barc) 2003; 58:309-15. [PMID: 12681178 DOI: 10.1016/s1695-4033(03)78063-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To study the characteristics of patients diagnosed with whooping cough at a tertiary center in Barcelona, Spain. MATERIAL AND METHODS We performed a retrospective study of patients aged less than 18 years treated for pertussis-like cough or clinically-suspected whooping cough over a 12-year period (1989-2000). Only patients with isolated Bordetella spp. were included. The variables of age, sex, vaccination status, hospitalization, clinical manifestations, severity, and lethality were analyzed. RESULTS One hundred sixty-one patients with positive Bordetella spp. culture were identified. Of these, complete information was available in 149 (79 boys and 70 girls) with a median age of 3 months (range: 13 days-17 years); 77.2 % were aged 6 months or less. All the isolated strains corresponded to B. pertussis except three that corresponded to B. parapertussis. Three epidemic cycles (in 1989, 1992 and 2000) were observed during the study period. A total of 72.5 % of cases occurred between May and September. Bordetella spp. was associated with other bacteria in 28.2 % of the patients, viruses in 13.4 % and a bacterium and a virus in 4.7 %. One hundred twenty-one patients required hospitalization, of which 14.9 % were admitted to the intensive care unit. Age was the only factor associated with risk for hospitalization, which was more frequent in younger infants (p < 0.0001). Paroxysmal cough with cyanosis was present in 53.4 % of the patients, leucocytosis with lymphocytosis occurred in 67.5 % and apneas were present in 21.5 %. Chest X-ray revealed atelectasis in 34.1 %. The mean length of hospital stay was 11 days (range: 1-70 days). Three boys aged less than 3 months with malignant pertussis syndrome died (lethality: 2 %). More than half the patients (59.7 %) were not vaccinated (55.4 % for being under the age of 3 months) and only 16 % had received three or more vaccination doses. CONCLUSIONS Whooping cough continues to be a severe disease in infants, with a high admission rate during the first 6 months of life. New preventive strategies are required to protect infants who have not yet developed full immunity to this infection.
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Affiliation(s)
- A Ferrer Marcellés
- Servicios de Microbiología y Parasitología. Hospital Universitario Vall d'Hebron. Universidad Autónoma de Barcelona. España
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Campins Martí M, Moraga Llop F. Tos ferina. Situación epidemiológica y nuevas estrategias de vacunación. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1576-9887(02)70292-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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