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Evans NJ, Arakkal AT, Cavanaugh JE, Newland JG, Polgreen PM, Miller AC. The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: A population-based cohort study. Infect Control Hosp Epidemiol 2023; 44:1629-1636. [PMID: 36919206 PMCID: PMC10587384 DOI: 10.1017/ice.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To estimate the incidence, duration and risk factors for diagnostic delays associated with pertussis. DESIGN We used longitudinal retrospective insurance claims from the Marketscan Commercial Claims and Encounters, Medicare Supplemental (2001-2020), and Multi-State Medicaid (2014-2018) databases. SETTING Inpatient, emergency department, and outpatient visits. PATIENTS The study included patients diagnosed with pertussis (International Classification of Diseases [ICD] codes) and receipt of macrolide antibiotic treatment. METHODS We estimated the number of visits with pertussis-related symptoms before diagnosis beyond that expected in the absence of diagnostic delays. Using a bootstrapping approach, we estimated the number of visits representing a delay, the number of missed diagnostic opportunities per patient, and the duration of delays. Results were stratified by age groups. We also used a logistic regression model to evaluate potential factors associated with delay. RESULTS We identified 20,828 patients meeting inclusion criteria. On average, patients had almost 2 missed opportunities prior to diagnosis, and delay duration was 12 days. Across age groups, the percentage of patients experiencing a delay ranged from 29.7% to 37.6%. The duration of delays increased considerably with age from an average of 5.6 days for patients aged <2 years to 13.8 days for patients aged ≥18 years. Factors associated with increased risk of delays included emergency department visits, telehealth visits, and recent prescriptions for antibiotics not effective against pertussis. CONCLUSIONS Diagnostic delays for pertussis are frequent. More work is needed to decrease diagnostic delays, especially among adults. Earlier case identification may play an important role in the response to outbreaks by facilitating treatment, isolation, and improved contact tracing.
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Affiliation(s)
- Nicholas J. Evans
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Alan T. Arakkal
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | | | - Jason G. Newland
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | | | - Aaron C. Miller
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
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Liu C, Yang L, Cheng Y, Xu H, Xu F. Risk factors associated with death in infants <120 days old with severe pertussis: a case-control study. BMC Infect Dis 2020; 20:852. [PMID: 33198647 PMCID: PMC7668018 DOI: 10.1186/s12879-020-05535-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Pertussis is a serious infectious disease in young infants, and severe cases frequently cause death. Our study explored risk factors for death from severe pertussis. Method A case-control study of infants with severe pertussis admitted to the paediatric intensive care unit (PICU) in the Children’s Hospital of Chongqing Medical University, China, from January 1, 2013, to June 30, 2019, was conducted. Pertussis was confirmed by clinical features and laboratory examinations. Severe pertussis was defined as patients with pertussis resulting in PICU admission or death. To understand the risk factors for death, we compared fatal and nonfatal cases of severe pertussis in infants aged < 120 days by collecting clinical and laboratory data. Results The participants included 63 infants < 120 days of age with severe pertussis. Fifteen fatal cases were confirmed and compared with 44 nonfatal severe pertussis cases, Four patients with termination of treatment were excluded. In the univariate analysis, the risk factors associated with death included apnoea (P = 0.001), leukocytosis (white blood cell (WBC) count≥30 × 109/L (P = 0.001) or ≥ 50 × 109/L (P = 0)), highest lymphocyte count (P = 0), pulmonary hypertension (P = 0.001), and length of PICU stay (P = 0.003). The multivariate analysis revealed that apnoea (OR 23.722, 95%CI 2.796–201.26, P = 0.004), leukocytosis (OR 63.708, 95%CI 3.574–1135.674, P = 0.005) and pulmonary hypertension (OR 26.109, 95%CI 1.800–378.809, P = 0.017) were significantly associated with death. Conclusion Leukocytosis and pulmonary hypertension exhibited the greatest associations with death in infants with severe pertussis admitted to the PICU. Vaccination is still the most effective protection method against pertussis.
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Affiliation(s)
- Cong Liu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Lin Yang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.,Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yuwei Cheng
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.,Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Hongmei Xu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Feng Xu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China. .,Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
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Top KA, Macartney K, Bettinger JA, Tan B, Blyth CC, Marshall HS, Vaudry W, Halperin SA, McIntyre P. Active surveillance of acute paediatric hospitalisations demonstrates the impact of vaccination programmes and informs vaccine policy in Canada and Australia. ACTA ACUST UNITED AC 2020; 25. [PMID: 32613939 PMCID: PMC7331140 DOI: 10.2807/1560-7917.es.2020.25.25.1900562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sentinel surveillance of acute hospitalisations in response to infectious disease emergencies such as the 2009 influenza A(H1N1)pdm09 pandemic is well described, but recognition of its potential to supplement routine public health surveillance and provide scalability for emergency responses has been limited. We summarise the achievements of two national paediatric hospital surveillance networks relevant to vaccine programmes and emerging infectious diseases in Canada (Canadian Immunization Monitoring Program Active; IMPACT from 1991) and Australia (Paediatric Active Enhanced Disease Surveillance; PAEDS from 2007) and discuss opportunities and challenges in applying their model to other contexts. Both networks were established to enhance capacity to measure vaccine preventable disease burden, vaccine programme impact, and safety, with their scope occasionally being increased with emerging infectious diseases’ surveillance. Their active surveillance has increased data accuracy and utility for syndromic conditions (e.g. encephalitis), pathogen-specific diseases (e.g. pertussis, rotavirus, influenza), and adverse events following immunisation (e.g. febrile seizure), enabled correlation of biological specimens with clinical context and supported responses to emerging infections (e.g. pandemic influenza, parechovirus, COVID-19). The demonstrated long-term value of continuous, rather than incident-related, operation of these networks in strengthening routine surveillance, bridging research gaps, and providing scalable public health response, supports their applicability to other countries.
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Affiliation(s)
- Karina A Top
- These authors contributed equally.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Kristine Macartney
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance and The Children's Hospital Westmead, Sydney, Australia.,These authors contributed equally
| | - Julie A Bettinger
- University of British Columbia and Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, Canada
| | - Ben Tan
- University of Saskatchewan, Royal University Hospital, Saskatoon, Canada
| | - Christopher C Blyth
- Telethon Kids Institute and School of Medicine, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide and VIRTU Women's and Children's Health Network, Adelaide, Australia
| | - Wendy Vaudry
- University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre, Halifax, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Peter McIntyre
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance and The Children's Hospital Westmead, Sydney, Australia
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- The IMPACT and PAEDS investigators are acknowledged at the end of this article
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4
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Abu-Raya B, Bettinger JA, Vanderkooi OG, Vaudry W, Halperin SA, Sadarangani M. Burden of Children Hospitalized With Pertussis in Canada in the Acellular Pertussis Vaccine Era, 1999-2015. J Pediatric Infect Dis Soc 2020; 9:118-127. [PMID: 30535079 PMCID: PMC7192396 DOI: 10.1093/jpids/piy128] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent increases in pertussis morbidity and mortality rates among young infants have led to a recommendation in some countries for vaccination against pertussis during pregnancy. Having data on the burden of pediatric pertussis in a large population over time is important for establishing the true burden of disease in the acellular pertussis (aP) vaccine era. Here, we describe age-specific epidemiology and morbidity and mortality rates in children hospitalized with pertussis over 17 years across Canada in the aP vaccine era. METHODS Patients aged ≤16 years who were admitted to 1 of 12 pediatric tertiary-care hospitals across Canada between 1999 and 2015 with confirmed (laboratory-confirmed or epidemiologically linked) or probable (clinically diagnosed) pertussis were included. RESULTS Overall, 1402 patients with pertussis were included. Infants aged <2 months had the highest mean annual incidences of pertussis hospitalization and intensive care unit (ICU) admission (116.40 [95% confidence interval (CI), 85.32-147.49] and 33.48 [95% CI, 26.35-40.62] per 100 000 population, respectively). The overall proportion of children who required ICU admission was 25.46%, and the proportion was highest in infants aged <2 months (37.90%). Over the span of this study, 21 deaths occurred. Age of <16 weeks, prematurity, encephalopathy, and a confirmed pertussis diagnosis were independent risk factors for ICU admission. Age of <4 weeks, prematurity, and female sex were independent risk factors for death. CONCLUSIONS In the aP vaccine era, endemic pertussis still contributes considerably to childhood morbidity and death, particularly in infants aged <2 months. Vaccination against pertussis during pregnancy has the potential to reduce this disease burden.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Otto G Vanderkooi
- Departments of Paediatrics, Microbiology, Immunology and Infectious Diseases, Pathology, and Laboratory Medicine, University of Calgary, Canada
- Alberta Children’s Hospital Research Institute, Alberta Health Services, Canada
| | - Wendy Vaudry
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
- Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
- Department of Microbiology and Immunology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
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The clinical characteristics and prognosis of pertussis among unvaccinated infants in the pediatric intensive care unit. Turk Arch Pediatr 2020; 55:54-59. [PMID: 32231450 PMCID: PMC7096560 DOI: 10.14744/turkpediatriars.2020.82435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
Abstract
Aim: To evaluate the clinical characteristics, risk factors, and prognosis of pertussis in the pediatric intensive care unit. Material and Methods: Patients who were hospitalized in pediatric intensive care unit between January 2017 and January 2019 and diagnosed as having pertussis were retrospectively evaluated. Samples were taken from tracheal aspirate material in intubated patients and nasopharyngeal swabs in the other patients. Samples for Bordetella pertussis were studied using multiplex real-time polymerase chain reaction. Results: Eighteen patients were admitted to our pediatric intensive care unit with a diagnosis of pertussis. Ten patients were female (55.5%), and all patients were unvaccinated. The median age was 40 (range, 38–47.5) days and the median intensive care unit stay was 9 (range, 5–14) days. All patients had respiratory distress, 14 patients had cough (77.7%), four patients had fever (22.2%), and three patients had convulsions (16.6%). Seven patients were intubated. Three patients died of multiple organ failure and cardiogenic shock despite extracorporeal treatment. Respiratory syncytial virus was found in two patients and rhinovirus was found in one patient. The median leukocyte count was significantly higher in non-survivors than in survivors. Blood exchange was performed in three patients due to hyperleukocytosis. Pulmonary hypertension was the most common cardiac pathology detected in echocardiographic examinations. Conclusion: We found that high leukocyte count, viral co-infection, and severe pulmonary hypertension were associated with mortality and morbidity in pertussis.
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Sompagdee N, Anuwutnavin S, Phongsamart W, Senawong S, Umrod P, Robkhonburi A. Seroprevalence of Bordetella pertussis antibodies and anti-pertussis antibody response after a single dose of reduced-antigen combined diphtheria, tetanus, and acellular pertussis vaccine (Tdap) in pregnant Thai women. Vaccine 2020; 38:2725-2733. [PMID: 32070680 DOI: 10.1016/j.vaccine.2020.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maternal immunization with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) has recently been implemented to prevent infant pertussis. Tdap is still not routinely recommended in Thailand, and there are limited data to support or challenge this strategy. OBJECTIVES The primary aim was to determine the seroprevalence of anti-pertussis toxin antibodies (anti-PT IgG) among pregnant Thai women. The secondary aims were to evaluate antibodies response after Tdap vaccination between seronegative and seropositive mothers and to compare the different antibody titers at delivery among seropositive mothers who received Tdap to those who received tetanus-diphtheria vaccine (Td). METHODS This randomized clinical trial was conducted during April 2018 to April 2019 at Siriraj Hospital, Bangkok, Thailand. A total of 129 pregnant women were included. Paired blood samples for anti-PT IgG levels were obtained during the first antenatal visit and at delivery. A baseline cut-off value of <5 IU/ml indicated seronegativity. There were 29 exclusions from the original 129 enrollment. All seronegative participants (n = 69) received Tdap, while the seropositive group were randomized 1:1 to receive either Tdap (n = 18) or Td (n = 13) during 27-36 weeks' gestation. The antibody levels from both sera were compared between groups. RESULTS The seroprevalence of maternal anti-PT IgG was 33.3% (43/129). There was no significant difference in the increment of antibody levels after Tdap vaccination between the seronegative and seropositive groups (30.2 vs. 42 IU/ml; p = 0.183). Among seropositive groups, all Tdap recipients had increased antibody titers at delivery, while all Td recipients showed waning of immunity throughout gestation. (42 IU/ml vs. -7.4 IU/ml; p < 0.001). CONCLUSION Most pregnant Thai women have seronegative against pertussis. Most seropositive mothers had initial low antibody titers and their immunity significantly decreased before delivery. Our findings highlight the need for universal pertussis immunization in pregnancy regardless of individual baseline immunity.
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Affiliation(s)
- Nalat Sompagdee
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sanitra Anuwutnavin
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Wanatpreeya Phongsamart
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sansnee Senawong
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pinklow Umrod
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amporn Robkhonburi
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Anyiwe K, Richardson M, Brophy J, Sander B. Assessing adolescent immunization options for pertussis in Canada: A cost-utility analysis. Vaccine 2019; 38:1825-1833. [PMID: 31889607 DOI: 10.1016/j.vaccine.2019.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adolescent tetanus, diphtheria and pertussis (Tdap) immunization helps prevent pertussis infection. Timing of Tdap receipt represents an important facet of successful adolescent pertussis immunization. Potential strategies for timing of vaccine administration are each associated with different benefits - including disease prevention - and costs. The objective of this study was to assess the cost-utility of adolescent pertussis immunization strategies in Canada. METHODS A cost-utility analysis was conducted using a pertussis disease history-simulating Markov model, with adolescents (beginning at age 10 years) as the cohort of interest. The model assessed three Tdap vaccination strategies: (1) immunization of 10 year olds, (2) removal of adolescent vaccination, and (3) immunization of 14 year olds (status quo). The analysis was conducted from a healthcare payer perspective and used a lifetime time horizon. Primary outcomes included life years, quality-adjusted life years (QALYs), health system costs, and an incremental cost-effectiveness ratio (ICER). Costs and outcomes were discounted at 1.5 percent annually. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty. RESULTS The current recommended adolescent immunization strategy (at age 14) resulted in an average of 40.4432 expected QALYs and $26.28 per individual. This strategy was dominated by immunization at 10 years and no immunization. Compared to no immunization, immunizing adolescents at age 10 had an ICER of $74,899 per QALY. Results were most sensitive to the incidence of pertussis and the utility of moderate or severe pertussis. At a cost-effectiveness threshold of $50,000/QALY, removal of adolescent vaccination represented the most cost-effective strategy in 78% of simulations. CONCLUSION Analysis assumes a policy context where immunization of pregnant women is recommended. Findings suggest that alternate adolescent Tdap vaccine strategies - either immunization of 10 year olds, or removal of the adolescent vaccine - are more cost-effective than the current practice of immunizing 14 year olds.
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Affiliation(s)
- Kika Anyiwe
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
| | - Marina Richardson
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Jason Brophy
- Department of Pediatrics, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Division of Infectious Diseases, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M6, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; ICES, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada
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Epidemiology and Outcome of Hospitalized Infants With Pertussis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Halperin SA, Langley JM, Ye L, MacKinnon-Cameron D, Elsherif M, Allen VM, Smith B, Halperin BA, McNeil SA, Vanderkooi OG, Dwinnell S, Wilson RD, Tapiero B, Boucher M, Le Saux N, Gruslin A, Vaudry W, Chandra S, Dobson S, Money D. A Randomized Controlled Trial of the Safety and Immunogenicity of Tetanus, Diphtheria, and Acellular Pertussis Vaccine Immunization During Pregnancy and Subsequent Infant Immune Response. Clin Infect Dis 2019; 67:1063-1071. [PMID: 30010773 DOI: 10.1093/cid/ciy244] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Immunization of pregnant women with tetanus-diphtheria-acellular pertussis vaccine (Tdap) provides protection against pertussis to the newborn infant. Methods In a randomized, controlled, observer-blind, multicenter clinical trial, we measured the safety and immunogenicity of Tdap during pregnancy and the effect on the infant's immune response to primary vaccination at 2, 4, and 6 months and booster vaccination at 12 months of age. A total of 273 women received either Tdap or tetanus-diphtheria (Td) vaccine in the third trimester and provided information for the safety analysis and samples for the immunogenicity analyses; 261 infants provided serum for the immunogenicity analyses. Results Rates of adverse events were similar in both groups. Infants of Tdap recipients had cord blood levels that were 21% higher than maternal levels for pertussis toxoid (PT), 13% higher for filamentous hemagglutinin (FHA), 4% higher for pertactin (PRN), and 7% higher for fimbriae (FIM). These infants had significantly higher PT antibody levels at birth and at 2 months and significantly higher FHA, PRN, and FIM antibodies at birth and 2 and 4 months, but significantly lower PT and FHA antibody levels at 6 and 7 months and significantly lower PRN and FIM antibody levels at 7 months than infants whose mothers received Td. Differences persisted prebooster at 12 months for all antigens and postbooster 1 month later for PT, FHA, and FIM. Conclusions This study demonstrated that Tdap during pregnancy results in higher levels of antibodies early in infancy but lower levels after the primary vaccine series. Clinical Trials Registration NCT00553228.
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Affiliation(s)
- Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Microbiology and Immunology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Community Health and Epidemiology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Lingyun Ye
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - May Elsherif
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Victoria M Allen
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Community Health and Epidemiology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Obstetrics and Gynaecology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Bruce Smith
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Mathematics and Statistics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Beth A Halperin
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,School of Nursing, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Medicine, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Otto G Vanderkooi
- Departments of Paediatrics, Microbiology, Immunology and Infectious Diseases, Pathology, and Laboratory Medicine.,Alberta Children's Hospital Research Institute, Alberta Health Services
| | | | - R Douglas Wilson
- Alberta Children's Hospital Research Institute, Alberta Health Services.,Department of Obstetrics and Gynaecology, University of Calgary.,Department of Medical Genetics, Cumming School of Medicine, University of Calgary
| | - Bruce Tapiero
- Centre Hospitalier Universitaire Sainte-Justine and University of Montreal
| | - Marc Boucher
- Centre Hospitalier Universitaire Sainte-Justine and University of Montreal
| | | | - Andrée Gruslin
- Department of Obstetrics and Gynaecology, University of Ottawa
| | - Wendy Vaudry
- Department of Pediatrics, University of Alberta and the Women and Children's Health Research Institute, Edmonton
| | - Sue Chandra
- Department of Obstetrics and Gynecology, University of Alberta and the Women and Children's Health Research Institute, Edmonton
| | - Simon Dobson
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Deborah Money
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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10
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van der Maas NAT, Sanders EAM, Versteegh FGA, Baauw A, Westerhof A, de Melker HE. Pertussis hospitalizations among term and preterm infants: clinical course and vaccine effectiveness. BMC Infect Dis 2019; 19:919. [PMID: 31664950 PMCID: PMC6820906 DOI: 10.1186/s12879-019-4563-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pertussis causes severe disease in young unvaccinated infants, with preterms potentially at highest risk. We studied pertussis in hospitalized infants as related to gestational age (GA) and vaccination history. METHODS Medical record data of 0-2y old patients hospitalized for pertussis during 2005-2014 were linked to vaccination data. Multivariable logistic regression was used to study the association between GA and vaccination history on the clinical disease course. We compared vaccine effectiveness (VE) against hospitalization for pertussis between term and preterm infants (i.e., <37w GA) using the screening method as developed by Farrington. RESULTS Of 1187 records, medical data from 676 were retrieved. Of these, 12% concerned preterms, whereas they are 8% of Dutch birth cohorts. Median age at admission was 3 m for preterms and 2 m for terms (p < 0.001). Preterms more often had received pertussis vaccination (62% vs 44%; p = 0.01) and more often had coinfections (37% vs 21%; p = 0.01). Preterms tended more often to have complications, to require artificial respiration or to need admittance to the intensive care unit (ICU). Preterms had longer ICU stays (15d vs 9d; p = 0.004). Vaccinated preterms and terms had a lower median length of hospital stay and lower crude risks of apneas and the need for artificial respiration, additional oxygen, and ICU admittance than those not vaccinated. After adjustment for presence of coinfections and age at admittance, these differences were not significant, except the lower need of oxygen treatment in vaccinated terms. Effectiveness of the first vaccination against pertussis hospitalizations was 95% (95% CI 93-96%) and 73% (95% CI 20-91%) in terms and preterms, respectively. Effectiveness of the second dose of the primary vaccination series was comparable in both groups (86 and 99%, respectively). CONCLUSIONS Infants hospitalized for pertussis suffer from severe disease. Preterms were overrepresented, with higher need for intensive treatment and less VE of first vaccination. These findings stress the need for alternative prevention, in particular prenatal vaccination of mothers, to reduce pertussis in both groups.
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Affiliation(s)
- Nicoline A T van der Maas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PObox 1, 3720BA, Bilthoven, The Netherlands.
| | - Elisabeth A M Sanders
- Department of Paediatric Immunology and Infectious Diseases, University Medical Hospital Utrecht, Utrecht, the Netherlands
| | - Florens G A Versteegh
- University of Groningen, University Medical Centre Groningen/Beatrix Children's Hospital, Groningen, the Netherlands
| | - Albertine Baauw
- Department of Paediatrics, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anneke Westerhof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PObox 1, 3720BA, Bilthoven, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PObox 1, 3720BA, Bilthoven, The Netherlands
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11
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McGirr A, Fisman DN, Tuite AR. The health and economic burden of pertussis in Canada: A microsimulation study. Vaccine 2019; 37:7240-7247. [PMID: 31585727 DOI: 10.1016/j.vaccine.2019.09.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite excellent vaccine coverage, pertussis persists in Canada, with high incidence during recent outbreaks and non-negligible incidence in non-outbreak years. While Canadian pertussis incidence is well-characterized, the full health and economic impact of pertussis have not been examined in Canada. We estimated age-specific life years (LYs) and quality-adjusted life years (QALYs) lost, and costs due to pertussis in Ontario, Canada, using a model-based approach. METHODS We developed a microsimulation model to simulate pertussis natural history. Daily probabilities of pertussis complications, hospitalizations, and disease sequelae as well as utilities and costs for health states were literature-derived. A healthcare payer perspective was used with a lifetime time horizon. Model outcomes were compared to those from a model with no pertussis health states. Probabilistic sensitivity analyses were used to generate distributions for estimates. Economic burden was estimated by multiplying case cost estimates by annual age-specific incidence. RESULTS Overall, LYs lost per pertussis case was low, with negligible LYs lost in those aged >4 years. Infants (<6 months) had the greatest mean QALY loss per case (0.58), while adults lost only 0.05 QALYs per case. Infants experienced the greatest mean cost per case of $22,768 (95% CI: 21,144-23,406). Case costs generally declined with age, but increased in seniors (aged 65+) with mean cost of $1920 (95% CI: 1800-2033). Based on historic age-specific incidence, pertussis costs the Ontario healthcare system approximately $7.6-$21.5 M annually. In total economic cost estimates with QALYs valued at 1xGDP (3xGDP) per capita, the net impact of pertussis in Ontario was estimated at $21.7-$66.5 M annually ($50.0-$156.3 M). For all of Canada, total economic costs were estimated at $79.6-$241.3 M ($187.5-$580.5 M) annually. CONCLUSION The health and economic consequences of pertussis persistence are substantial and highlight the need for improved control strategies.
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Affiliation(s)
- Ashleigh McGirr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David N Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Rubin K, Glazer S. The Potential Role of Subclinical Bordetella pertussis Infection in Epilepsy. Front Cell Infect Microbiol 2019; 9:302. [PMID: 31555605 PMCID: PMC6723097 DOI: 10.3389/fcimb.2019.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/07/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keith Rubin
- ILiAD Biotechnologies, Weston, FL, United States
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13
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Gopal Krishnan S, Fun WH, Ramadras MD, Yunus R, Lye YF, Sararaks S. Pertussis clinical case definition: Time for change in developing countries? PLoS One 2019; 14:e0219534. [PMID: 31291359 PMCID: PMC6619773 DOI: 10.1371/journal.pone.0219534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/27/2019] [Indexed: 01/29/2023] Open
Abstract
Background Developing countries still struggle with late detection and mortality from pertussis. A review of clinical case definitions is necessary for early disease detection. This paper aimed to study possible clinical characteristics for earlier pertussis detection in a sporadic setting. Methods We conducted a retrospective review of medical and laboratory records in a general paediatric ward of a district hospital in a developing country. Inclusion criteria were all children hospitalised with nasopharyngeal swab taken for Bordetella pertussis. We compared sensitivity and specificity of World Health Organization diagnostic criteria with other clinical characteristics. Polymerase chain reaction Bordetella pertussis was the gold standard used. Results Out of 207 eligible admissions, the study retrieved 128 complete records. Approximately half of the children were less than 3 months old. The World Health Organization diagnostic criteria had a low sensitivity (15%), but high specificity (92%). In comparison, combinations that included paroxysmal cough, ill contact and facial congestion had higher sensitivity. Increasing cough duration improved specificity while compromising sensitivity. Conclusion Several clinical characteristics such as paroxysmal cough, facial congestion and a history of ill contact have potential for early clinical detection. Conventional emphasis on cough duration may hamper early detection.
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Affiliation(s)
| | - Weng Hong Fun
- Centre For Health Outcomes Research, Institute For Health Systems Research, Selangor, Malaysia
- * E-mail:
| | | | - Rahmah Yunus
- Paediatrics Department, Hospital Kulim, Kedah, Malaysia
| | - Yik Fan Lye
- Paediatrics Department, Hospital Kulim, Kedah, Malaysia
| | - Sondi Sararaks
- Centre For Health Outcomes Research, Institute For Health Systems Research, Selangor, Malaysia
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14
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Phadke VK, McCracken JP, Kriss JL, Lopez MR, Lindblade KA, Bryan JP, Garcia ME, Funes CE, Omer SB. Clinical Characteristics of Hospitalized Infants With Laboratory-Confirmed Pertussis in Guatemala. J Pediatric Infect Dis Soc 2018; 7:310-316. [PMID: 29045690 PMCID: PMC5899054 DOI: 10.1093/jpids/pix081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pertussis is an important cause of hospitalization and death in infants too young to be vaccinated (aged <2 months). Limited data on infant pertussis have been reported from Central America. The aim of this study was to characterize acute respiratory illnesses (ARIs) attributable to Bordetella pertussis among infants enrolled in an ongoing surveillance study in Guatemala. METHODS As part of a population-based surveillance study in Guatemala, infants aged <2 months who presented with ARI and required hospitalization were enrolled, and nasopharyngeal and oropharyngeal swab specimens were obtained. For this study, these specimens were tested for B pertussis using real-time polymerase chain reaction (PCR). RESULTS Among 301 infants hospitalized with ARI, we found 11 with pertussis confirmed by PCR (pertussis-positive infants). Compared to pertussis-negative infants, pertussis-positive infants had a higher mean admission white blood cell count (20900 vs 12579 cells/μl, respectively; P = .024), absolute lymphocyte count (11517 vs 5591 cells/μl, respectively; P < .001), rate of admission to the intensive care unit (64% vs 35%, respectively; P = .054), and case fatality rate (18% vs 3%, respectively; P = .014). Ten of the 11 pertussis-positive infants had cough at presentation; the majority (80%) of them had a cough duration of <7 days, and only 1 had a cough duration of >14 days. Fever (temperature ≥ 38°C) was documented in nearly half (45%) of the pertussis-positive infants (range, 38.0-38.4°C). CONCLUSIONS In this study of infants <2 months of age hospitalized with ARI in Guatemala, pertussis-positive infants had a high rate of intensive care unit admission and a higher case fatality rate than pertussis-negative infants.
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Affiliation(s)
- Varun K Phadke
- Division of Infectious Diseases, School of Medicine,Correspondence: V. K. Phadke, MD, 49 Jesse Hill Jr. Dr, Atlanta, GA 30303 ()
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City
| | - Jennifer L Kriss
- Department of Epidemiology, Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City, Guatemala
| | - Maria R Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City
| | - Kim A Lindblade
- Division of Global Health Protection, Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City, Guatemala
| | - Joe P Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City, Guatemala,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Miguel E Garcia
- Department of Pediatrics, Hospital Nacional de Cuilapa, Santa Rosa, Guatemala
| | - Carlos E Funes
- Department of Pediatrics, Hospital Regional de Occidente, Quetzaltenango, Guatemala
| | - Saad B Omer
- Department of Epidemiology, Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City, Guatemala,Hubert Department of Global Health, Rollins School of Public Health,Emory Vaccine Center, Emory University, Atlanta, Georgia
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Abstract
Background The introduction of the acellular pertussis vaccine may have changed the epidemiological and clinical features of pertussis in Canadian children. Objective To describe the demographics, clinical presentation and outcomes of children and adolescents with pertussis presenting to a tertiary care hospital. Methods Retrospective cohort of consecutive patients evaluated at the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ) and tested with a bacterial multiplex real-time polymerase chain reaction (PCR) for Bordetella pertussis or B. parapertussis between June 2015 and March 2017. Demographics, clinical presentations and outcomes were described for positive test results. The Modified Preziosi Scale was used to assess disease severity; severe disease was defined as a score ≥7. Results The age distribution of the 144 positive patients with a clinical encounter at CHUSJ was as follows: less than three months (n=25/144, 17.4%), four months to nine years (n=63/144, 43.8%) and 10 to 18 years (n=56/144, 38.9%). The most common symptoms at presentation were paroxysmal cough (70.1%), post-tussive emesis (47.2%) and coryza (33.3%). Over 84.0% of cases in infants less than three months of age had severe pertussis (92.0% required hospitalization and 28.0% intensive care admission). In children four months to nine years of age, 22.2% had severe pertussis and 11.1% required hospitalization. Only two (3.6%) children greater than 10 years had severe disease. Conclusion Pertussis still affects children of all ages in Quebec. In older children, it tends to be a milder disease. When it affects infants, who do not yet have full protection from pertussis vaccination, it often causes severe disease, especially in those less than three months of age. This evidence further supports the implementation of a pertussis vaccination program in pregnant women.
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Shimizu H, Seki K, Shiga K, Nakayama T, Mori M. Safety and efficacy of DTaP-IPV vaccine use in healthcare workers for prevention of pertussis. Vaccine 2018; 36:5935-5939. [DOI: 10.1016/j.vaccine.2018.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 05/21/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
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MacDougall DM, Halperin BA, Langley JM, McNeil SA, MacKinnon-Cameron D, Li L, Halperin SA. Knowledge, attitudes, beliefs, and behaviors of pregnant women approached to participate in a Tdap maternal immunization randomized, controlled trial. Hum Vaccin Immunother 2017; 12:879-85. [PMID: 27176822 PMCID: PMC4962967 DOI: 10.1080/21645515.2015.1130193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Immunization with pertussis vaccine during pregnancy is recommended in a number of countries to prevent newborn deaths from whooping cough. In some jurisdictions, vaccine uptake during pregnancy is low. We undertook a survey of the knowledge, attitudes, beliefs, and behaviors of pregnant women who had been approached to participate in a randomized, controlled trial of tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy. A total of 346 women completed the survey. Knowledge about pertussis and pertussis vaccine was generally low; the mean number of correct answers was 10.65 out of 19 questions. Attitudes toward maternal immunization were generally favorable; 51.7%–94.7% of women had positive responses to 10 attitudinal statements. Substantial uncertainty was shown in responses to a number of the attitudinal statements related to vaccination during pregnancy; 22.3%–45.7% neither agreed nor disagreed with the statements. Importantly, 89% of women reported that they would get immunized with pertussis vaccine during pregnancy if their physician recommended it. We conclude that a national recommendation to be immunized with pertussis vaccine during pregnancy supported by their physicians' recommendation would be well received by Canadian women.
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Affiliation(s)
- Donna M MacDougall
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority , Halifax , Nova Scotia , Canada.,b School of Nursing, St. Francis Xavier University , Antigonish , Nova Scotia , Canada
| | - Beth A Halperin
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority , Halifax , Nova Scotia , Canada.,c School of Nursing, Dalhousie University , Halifax , Nova Scotia , Canada.,d Department of Pediatrics , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Joanne M Langley
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority , Halifax , Nova Scotia , Canada.,d Department of Pediatrics , Dalhousie University , Halifax , Nova Scotia , Canada.,e Department of Community Health and Epidemiology , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Shelly A McNeil
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority , Halifax , Nova Scotia , Canada.,f Department of Medicine , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Donna MacKinnon-Cameron
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority , Halifax , Nova Scotia , Canada
| | - Li Li
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority , Halifax , Nova Scotia , Canada
| | - Scott A Halperin
- a Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Nova Scotia Health Authority , Halifax , Nova Scotia , Canada.,d Department of Pediatrics , Dalhousie University , Halifax , Nova Scotia , Canada.,g Department of Microbiology & Immunology , Dalhousie University , Halifax , Nova Scotia , Canada
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18
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Chong CY, Yung CF, Tan NWH, Acharyya S, Thoon KC. Risk factors of ICU or high dependency requirements amongst hospitalized pediatric pertussis cases: A 10 year retrospective series, Singapore. Vaccine 2017; 35:6422-6428. [PMID: 29032896 DOI: 10.1016/j.vaccine.2017.09.085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pertussis causes the highest complication rates and deaths in the infant group. Our study explored risk factors for ICU/high dependency (HD) admissions and intubation/non-invasive ventilation (NIV). METHODS A retrospective review of pertussis admissions over 10 years from 2007 to 2016 was done at KK Women's and Children's Hospital, Singapore. To understand risk factors for severe pertussis infection, we compared cases requiring ICU/HD care with controls admitted to the general ward. Risk factors for intubation/NIV were also studied. Vaccine efficacy for protection against ICU/HD admission or intubation/NIV was also calculated. RESULTS There were 200 pertussis patients with a median age of 2.75 months. Sixty-one % were ≤3 months and 14.5% were <6 weeks old. Majority of patients (77%) had no prior pertussis vaccination. After removing 3 patients with missing vaccination records, 20 cases were compared with 177 controls. On univariate analysis, risk factors for ICU/HD admission comprised: Age ≤3 months, contact history, underlying co-morbidity, prematurity, absent DTaP vaccination, lymphocytosis, hyperleukocytosis (wbc ≥50×109/L), thrombocytosis (platelet ≥500×109/L), and pneumonia. Multivariate analysis revealed that age ≤3 months (OR 40, 95% CI 4.57-1111.11, p=.007), co-morbidity (OR 8.46 (95% CI 1.47-56.89, p=.019), pneumonia (OR 18.08, 95% CI 3.22-132.15, p=.002), white cell count (OR 1.07, 95% CI 1.01-1.14, p=.023) and cyanosis (OR 5.09, 95% CI 1.31-24.71, p=.026) were risk factors for ICU/HD admission. Prior DTaP vaccination had a vaccine effectiveness of 86.5% in preventing ICU/HD admission and 82.1% in preventing intubation/NIV. CONCLUSIONS As the majority of pertussis patients were infants ≤3 months old who are at high risk for ICU/HD admission and intubation/NIV, prevention is key to reducing pertussis morbidity. Even though not statistically significant, DTaP vaccination had a role in preventing ICU/HD admission and intubation/NIV.
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Affiliation(s)
- Chia-Yin Chong
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Chee-Fu Yung
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Natalie Woon-Hui Tan
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Sanchalika Acharyya
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Koh-Cheng Thoon
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
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Risk Factors Associated With Bordetella pertussis Among Infants ≤4 Months of Age in the Pre-Tdap Era: United States, 2002-2005. Pediatr Infect Dis J 2017; 36:726-735. [PMID: 28033240 PMCID: PMC8508157 DOI: 10.1097/inf.0000000000001528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States, infants have the highest reported pertussis incidence and death rates. Improved understanding of infant risk factors is needed to optimize prevention strategies. METHODS We prospectively enrolled infants ≤4 months of age with incident-confirmed pertussis from 4 sites during 2002-2005 (preceding pertussis antigen-containing vaccination recommendations for adolescents/adults); each case-patient was age and site matched with 2 control subjects. Caregivers completed structured interviews. Infants and their contacts ≥11 years of age were offered serologic testing for IgG; being seropositive was defined as ≥94 antipertussis toxin IgG enzyme-linked immunosorbent assay units per milliliter. RESULTS Enrolled subjects (115 case-patients; 230 control subjects) had 4396 contacts during incubation periods; 83 (72%) case-patients had ≥1 contact with prolonged (≥5 days) new cough in primary or secondary households. In multivariable analysis, the odds for pertussis were higher for infants with primary/secondary household contacts who had a prolonged new cough, compared with infants who did not. These contacts included mother [adjusted matched odds ratio (aMOR), 43.8; 95% confidence interval (CI), 6.45-298.0] and ≥1 nonmother contact (aMOR, 20.1; 95% CI, 6.48-62.7). Infants receiving breast milk with 0-1 formula feedings daily had decreased pertussis odds (aMOR, 0.27; 95% CI, 0.08-0.89), compared with those receiving more formula. Of 41 tested case-patients, 37 (90%) were seropositive. CONCLUSIONS Pertussis in infants was associated with prolonged new cough (≥5 days) in infants' household contacts. Findings suggest that breastfeeding protects against pertussis and warrants recommendation with pertussis prevention strategies, which currently include pertussis vaccination of pregnant mothers and infants' close contacts.
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Abstract
Pertussis is a highly infectious vaccine-preventable cough illness that continues to be a significant source of morbidity and mortality around the world. The majority of human illness is caused by Bordetella pertussis, and some is caused by Bordetella parapertussis. Bordetella is a Gram-negative, pleomorphic, aerobic coccobacillus. In the past several years, even countries with high immunization rates in early childhood have experienced rises in pertussis cases. Reasons for the resurgence of reported pertussis may include molecular changes in the organism and increased awareness and diagnostic capabilities, as well as lessened vaccine efficacy and waning immunity. The most morbidity and mortality with pertussis infection is seen in infants too young to benefit from immunization. Severe infection requiring hospitalization, including in an intensive care setting, is mostly seen in those under 3 months of age. As a result, research and public health actions have been aimed at better understanding and reducing the spread of Bordetella pertussis. Studies comparing the cost benefit of cocooning strategies versus immunization of pregnant women have been favorable towards immunizing pregnant women. This strategy is expected to prevent a larger number of pertussis cases, hospitalizations, and deaths in infants <1 year old while also being cost-effective. Studies have demonstrated that the source of infection in infants usually is a family member. Efforts to immunize children and adults, in particular pregnant women, need to remain strong.
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Ward A, Caro J, Bassinet L, Housset B, O'Brien JA, Guiso N. Health and Economic Consequences of an Outbreak of Pertussis Among Healthcare Workers in a Hospital in France. Infect Control Hosp Epidemiol 2016; 26:288-92. [PMID: 15796282 DOI: 10.1086/502541] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBackground:Bordetella pertussisis highly contagious, and because immunity wanes after vaccination, it continues to be a cause of cough among adults.Objective:To describe the healthcare services used and productivity losses accrued by healthcare workers (HCWs) missing work due to pertussis.Methods:After 3 pertussis cases were confirmed among HCWs, all hospital employees and patients with a cough were screened between November 2000 and March 2001. Each potential case underwent diagnostic tests and received antibiotics (spiramycin or azithromycin) when appropriate. Symptomatic employees were not allowed to return to work until they received an antibiotic for at least 5 days. Services used (physician visits and calls, antibiotics, diagnostic tests, hospitalization, and treatment provided to their contacts) were combined with cost estimates (in 2002 euros) for these services in France.Results:Ninety-one potential cases were identified (77 HCWs, 12 patients, and 2 family members). Of them, 89% received antibiotics and 22% had at least one contact who was also treated. Approximately half (55%) of the HCWs who were cases missed 5 days of work. Four patients were admitted to the hospital as a result of the infection. The average medical cost was 297 euros per potential case: diagnostic tests accounted for 32% and hospitalization for 31%. Total cost (medical and productivity) was 46,661 euros for 91 cases, 42% from productivity losses. An investigation to identify these potential cases also accrued additional costs.Conclusion:Serious adverse health and economic consequences arose from transmission of pertussis among HCWs, their families, and patients.
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Liptzin DR, Landau LI, Taussig LM. Sex and the lung: Observations, hypotheses, and future directions. Pediatr Pulmonol 2015; 50:1159-69. [PMID: 25906765 DOI: 10.1002/ppul.23178] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 02/21/2015] [Accepted: 02/24/2015] [Indexed: 11/05/2022]
Abstract
Sex-related differences in a variety of lung diseases in infants and young children are reviewed, including respiratory distress syndrome, and chronic lung disease of prematurity, lower respiratory tract illnesses and wheezing, asthma, diffuse, and interstitial lung diseases, and cystic fibrosis. Differences in anatomy and physiology, such as airway size, airway muscle bulk, airway reactivity, airway tone, and cough reflexes may explain much of these sex differences. Better understanding of sex-related lung differences could help personalize respiratory treatment.
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Affiliation(s)
- Deborah R Liptzin
- Section of Pulmonology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Louis I Landau
- School of Pediatrics and Child Health, The University of Western Australia, Crawley, Australia
| | - Lynn M Taussig
- Section of Pulmonology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Office of the Provost, University of Denver, Denver, Colorado
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Castillo ME, Bada C, Del Aguila O, Petrozzi-Helasvuo V, Casabona-Ore V, Reyes I, Del Valle-Mendoza J. Detection of Bordetella pertussis using a PCR test in infants younger than one year old hospitalized with whooping cough in five Peruvian hospitals. Int J Infect Dis 2015; 41:36-41. [PMID: 26523641 DOI: 10.1016/j.ijid.2015.10.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/29/2015] [Accepted: 10/24/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To report the incidence, epidemiology, and clinical features of Bordetella pertussis in Peruvian infants under 1 year old. PATIENTS AND METHODS A prospective cross-sectional study was conducted in five hospitals in Peru from January 2010 to July 2012. A total of 392 infants under 1 year old were admitted with a clinical diagnosis of whooping cough and tested for B. pertussis by PCR. RESULTS The pertussis toxin and IS481 genes were detected in 39.54% (155/392) of the cases. Infants aged less than 3 months were the most affected, with a prevalence of 73.55% (114/155). The most common household contact was the mother, identified in 20% (31/155) of cases. Paroxysm of coughing (89.03%, 138/155), cyanosis (68.39%, 106/155), respiratory distress (67.09%, 104/155), and breastfeeding difficulties (39.35%, 61/155) were the most frequent symptoms reported. CONCLUSION An increase in pertussis cases has been reported in recent years in Peru, despite national immunization efforts. Surveillance with PCR for B. pertussis is essential, especially in infants less than 1 year old, in whom a higher rate of disease-related complications and higher mortality have been reported.
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Affiliation(s)
| | - Carlos Bada
- Hospital de Emergencias Pediátricas, La Victoria, Lima, Peru
| | | | - Verónica Petrozzi-Helasvuo
- Centro de Investigación de la Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos cuadra 2, Chorrillos, Lima, Peru
| | - Verónica Casabona-Ore
- Centro de Investigación de la Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos cuadra 2, Chorrillos, Lima, Peru
| | - Isabel Reyes
- Hospital de Emergencias Pediátricas, La Victoria, Lima, Peru
| | - Juana Del Valle-Mendoza
- Centro de Investigación de la Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Av. San Marcos cuadra 2, Chorrillos, Lima, Peru.
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Guimarães LM, Carneiro ELNDC, Carvalho-Costa FA. Increasing incidence of pertussis in Brazil: a retrospective study using surveillance data. BMC Infect Dis 2015; 15:442. [PMID: 26498058 PMCID: PMC4619034 DOI: 10.1186/s12879-015-1222-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries have reported an increase in the incidence of pertussis, which has become a global public health concern. METHODS In this study, the epidemiology of pertussis in Brazil was assessed retrospectively using surveillance data gathered from case notification forms from 2007 to 2014. RESULTS From 2007 to 2014, 80,068 suspected cases of pertussis were reported in Brazil. Of these, 24,612 (32 %) were confirmed by various criteria. The annual distribution of confirmed cases demonstrated a significant increase in incidence rate since 2012. A seasonal pattern in which cases occur most frequently between the end of spring and midsummer has been identified. Among the confirmed cases, 34.5 % occurred in infants aged 0-2 months, 22.4 % occurred in infants aged 3-6 months, 21 % occurred in children aged 7 months to 4 years, and 8 % were reported in adults >21 years. Of the confirmed cases, 47.2 % met only clinical criteria, 15.5 % met clinical and epidemiological criteria, and 36.6 % were confirmed in a laboratory. The overall case fatality rate was 2.1 %, reaching 4.7 % among infants aged 0-2 months. The complications most commonly reported in the notification forms were pneumonia, encephalitis, dehydration, otitis, and malnutrition. Of the confirmed cases, 23.1 % occurred in subjects who received at least 3 doses of the pertussis vaccine. Within this group, there were 1098 infants aged 7 to 15 months and 2079 children aged 16 months to 4 years. In 2012, 18 states did not achieve 95 % immunization coverage, a number that dropped to 10 and 6 in 2013 and 2014, respectively. CONCLUSIONS Brazil's main challenges in facing pertussis resurgence will be to offer the best quality medical attention to reduce mortality, to improve the infrastructure for laboratory diagnosis and to increase vaccination coverage. Additional studies to assess the effectiveness of the current vaccination schedule and basic research on the genetics and evolution of circulating B. pertussis strains are also needed.
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Affiliation(s)
- Lucas Melo Guimarães
- Regional Office Oswaldo Cruz Foundation (Fiocruz), Teresina, Piauí, Brazil. .,Laboratory of Epidemiology and Molecular Systematics, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
| | | | - Filipe Anibal Carvalho-Costa
- Regional Office Oswaldo Cruz Foundation (Fiocruz), Teresina, Piauí, Brazil. .,Laboratory of Epidemiology and Molecular Systematics, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
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Resurgence of pertussis at the age of vaccination: clinical, epidemiological, and molecular aspects. J Pediatr (Rio J) 2015; 91:333-8. [PMID: 25623040 DOI: 10.1016/j.jped.2014.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/02/2014] [Accepted: 09/08/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Report the incidence, epidemiology, clinical features, death, and vaccination status of patients with whooping cough and perform genotypic characterization of isolates of B. pertussis identified in the state of Paraná, during January 2007 to December 2013. METHODS Cross-sectional study including 1,209 patients with pertussis. Data were obtained through the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação - SINAN) and molecular epidemiology was performed by repetitive sequence-based polymerase chain reaction (rep-PCR; DiversiLab®, bioMerieux, France). RESULTS The incidence of pertussis in the state of Paraná increased sharply from 0.15-0.76 per 100,000 habitants between 2007-2010 to 1.7-4.28 per 100,000 between 2011-2013. Patients with less than 1 year of age were more stricken (67.5%). Fifty-nine children (5%) developed pertussis even after receiving three doses and two diphtheria-tetanus-pertussis (DTP) boosters vaccine. The most common complications were pneumonia (14.5%), otitis (0.9%), and encephalopathy (0.7%). Isolates of B. pertussis were grouped into two groups (G1 and G2) and eight distinct patterns (G1: P1-P5 and G2: P6-P8). CONCLUSION The resurgence of pertussis should stimulate new research to develop vaccines with greater capacity of protection against current clones and also encourage implementation of new strategies for vaccination in order to reduce the risk of disease in infants.
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Torres RS, Santos TZ, Torres RA, Pereira VV, Fávero LA, Filho OR, Penkal ML, Araujo LS. Resurgence of pertussis at the age of vaccination: clinical, epidemiological, and molecular aspects. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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MacDougall D, Halperin BA, MacKinnon-Cameron D, Li L, McNeil SA, Langley JM, Halperin SA. Universal tetanus, diphtheria, acellular pertussis (Tdap) vaccination of adults: What Canadian health care providers know and need to know. Hum Vaccin Immunother 2015; 11:2167-79. [PMID: 26090861 DOI: 10.1080/21645515.2015.1046662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is recommended for all adults in both Canada and the United States. There are few data on the proportion of Canadian adults vaccinated with Tdap; however, anecdotal reports indicate that uptake is low. This study aimed to explore the knowledge, attitudes, beliefs, and behaviors of Canadian health care providers (HCPs) in an attempt to identify potential barriers and facilitators to Tdap uptake. HCPs were surveyed and a geographic and practice representative sample was obtained (N =1,167). In addition, 8 focus groups and 4 interviews were conducted nationwide. Results from the survey indicate that less than half (47.5%) of all respondents reported being immunized with Tdap themselves, while 58.5% routinely offer Tdap to their adult patients. Knowledge scores were relatively low (63.2% correct answers). The best predictor of following the adult Tdap immunization guidelines was awareness of and agreement with those recommendations. Respondents who were aware of the recommendations were more likely to think that Tdap is safe and effective, that their patients are at significant risk of getting pertussis, and to feel that they have sufficient information (p < 0.0001 for each statement). Focus group data supported the survey results and indicated that there are substantial gaps in knowledge of pertussis and Tdap among Canadian HCPs. Lack of public knowledge about adult immunization, lack of immunization registries, a costing differential between Td and Tdap, workload required to deliver the vaccine, and vaccine hesitancy were identified as barriers to compliance with the national recommendations for universal adult immunization, and suggestions were provided to better translate recommendations to front-line practitioners.
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Affiliation(s)
- D MacDougall
- a Canadian Center for Vaccinology; Dalhousie University, IWK Health Centre ; and the Nova Scotia Health Authority ; Halifax , NS Canada
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Goldstein ND, Newbern EC, Evans AA, Drezner K, Welles SL. Choice of measures of vaccination and estimates of risk of pediatric pertussis. Vaccine 2015; 33:3970-5. [PMID: 26093200 DOI: 10.1016/j.vaccine.2015.06.033] [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: 02/18/2015] [Revised: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection. METHODS City-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis. RESULTS Being UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group. CONCLUSION Examining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.
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Affiliation(s)
- Neal D Goldstein
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19104, United States.
| | - E Claire Newbern
- Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA 19146, United States
| | - Alison A Evans
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19104, United States
| | - Kate Drezner
- Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA 19146, United States
| | - Seth L Welles
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19104, United States
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Abstract
BACKGROUND Australia recently experienced its worst pertussis epidemic since introduction of pertussis vaccine into the National Immunisation Program. This study aimed to determine factors associated with severe pertussis in hospitalized children during an epidemic using a novel pertussis severity scoring (PSS) system. METHODS This prospective, observational, multicenter study enrolled children hospitalized with laboratory confirmed pertussis from 8 tertiary pediatric hospitals during a 12 month period (May 2009-April 2010). Variables assessed included demographics, clinical symptoms and relevant medical and immunization history. Cases were scored using objective clinical findings with cases classified as either severe (PSS > 5) or not severe (PSS ≤ 5). Logistic regression models were used to predict variables associated with severe disease. RESULTS One hundred twenty hospitalized children 0-17 years of age were enrolled with a median PSS of 5 (interquartile range 3-7). Most (61.7%) were classified as not severe with 38.3% (46/120) severe. Most severe cases (54.3%) were <2 months of age. Presence of coinfection [odds ratio (OR): 4.82, CI: 1.66-14.00], <2 months old (OR: 4.76, CI: 1.48-15.32), fever >37.5°C (OR: 5.97, CI: 1.19-29.96) and history of prematurity (OR: 5.00, CI: 1.27-19.71) were independently associated with severe disease. A total of 70 cases in children ≥2 months of age, almost a third (n = 23) had not received pertussis vaccine. CONCLUSIONS Most severe pertussis occurred in young, unimmunized infants, although severe disease was also observed in children >12 months of age and previously vaccinated children. Children admitted with pertussis with evidence of coinfection, history of prematurity or fever on presentation need close monitoring.
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Thampi N, Gurol-Urganci I, Crowcroft NS, Sander B. Pertussis post-exposure prophylaxis among household contacts: a cost-utility analysis. PLoS One 2015; 10:e0119271. [PMID: 25747269 PMCID: PMC4352053 DOI: 10.1371/journal.pone.0119271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/29/2015] [Indexed: 12/04/2022] Open
Abstract
Background Recent pertussis outbreaks have prompted re-examination of post-exposure prophylaxis (PEP) strategies, when immunization is not immediately protective. Chemoprophylaxis is recommended to household contacts; however there are concerns of clinical failure and significant adverse events, especially with erythromycin among infants who have the highest disease burden. Newer macrolides offer fewer side effects at higher drug costs. We sought to determine the cost-effectiveness of PEP strategies from the health care payer perspective. Methods A Markov model was constructed to examine 4 mutually exclusive strategies: erythromycin, azithromycin, clarithromycin, or no intervention, stratified by age group of contacts (“infant”, “child”, and “adult”). Transition probabilities, costs and quality-adjusted life years (QALYs) were derived from the literature. Chronic neurologic sequelae were modeled over a lifetime, with costs and QALYs discounted at 5%. Associated health outcomes and costs were compared, and incremental cost-effectiveness ratios (ICER) were calculated in 2012 Canadian dollars. Deterministic and probabilistic sensitivity analyses were performed to evaluate the degree of uncertainty in the results. Findings Azithromycin offered the highest QALYs in all scenarios. While this was the dominant strategy among infants, it produced an ICER of $16,963 per QALY among children and $2,415 per QALY among adults. Total QALYs with azithromycin were 19.7 for a 5-kg infant, 19.4 for a 10-year-old child, and 18.8 for a 30-year-old adult. The costs of azithromycin PEP among infants, children and adults were $1,976, $132 and $90, respectively. While results were sensitive to changes in PEP effectiveness (11% to 87%), disease transmission (variable among age groups) and hospitalization costs ($379 to $59,644), the choice of strategy remained unchanged. Interpretation Pertussis PEP is a cost-effective strategy compared with no intervention and plays an important role in contact management, potentially in outbreak situations. From a healthcare payer perspective, azithromycin is the optimal strategy among all contact groups.
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Affiliation(s)
- Nisha Thampi
- Division of Infectious Diseases, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- * E-mail:
| | - Ipek Gurol-Urganci
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Natasha S. Crowcroft
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, ON, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
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Lobzin YV, Babachenko IV, Shamsheva OV, Tetenkova AA, Bakhareva NV, Boitsov VP, Zvereva NN. Retrospective Study of the Clinical Epidemiological Characteristics of Pertussis in Infants Prior to Their First Vaccination in the Russian Federation. Infect Dis Ther 2015; 4:113-123. [PMID: 25663041 PMCID: PMC4363213 DOI: 10.1007/s40121-015-0059-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The coverage of pediatric pertussis vaccination in the Russian Federation is high, generally using a diphtheria, tetanus, and whole-cell pertussis vaccine in a 3-, 4.5-, and 6-month primary series and with a booster at 18 months of age. However, with no registered pertussis vaccines for adults, unvaccinated adolescents and adults can be a major source of infection of infants under 3 months of age. METHODS A multicenter, retrospective, clinical epidemiological analysis to characterize pertussis in infants aged up to 3 months who contracted pertussis and were hospitalized in four different cities in the Russian Federation was performed. Archived medical records and a questionnaire were used to collect the relevant epidemiological and clinical aspects for each case of pertussis over a 2-year period. RESULTS Infants in four different regions of the Russian Federation in the first 3 months of life, prior to their first pertussis vaccination, are at risk of pertussis infection. The severity is generally worse in neonates, and can lead to complications that can require intensive care. CONCLUSION Prior to vaccination, young infants in the Russian Federation remain vulnerable to severe pertussis, which may be worsened by their proximity to unvaccinated adults.
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Affiliation(s)
- Yury V. Lobzin
- Scientific Research Institute of Children’s Infections, Saint Petersburg, Russia
- Mechnikov North-West State Medical University, Saint Petersburg, Russia
| | - Irina V. Babachenko
- Scientific Research Institute of Children’s Infections, Saint Petersburg, Russia
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Olga V. Shamsheva
- State Budget-funded Educational Establishment of Higher Professional Education Russian National Medical Research University of the Ministry of Health and Social Development of the Russian Federation, Moscow, Russia
| | | | - Natalia V. Bakhareva
- Chief Health Care Administration of the City of Krasnoyarsk, Krasnoyarsk, Russia
| | - Viktor P. Boitsov
- State Budget-funded Educational Establishment of Higher Professional Education Russian National Medical Research University of the Ministry of Health and Social Development of the Russian Federation, Moscow, Russia
| | - Natalia N. Zvereva
- State Budget-funded Educational Establishment of Higher Professional Education Russian National Medical Research University of the Ministry of Health and Social Development of the Russian Federation, Moscow, Russia
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Shojaei J, Saffar M, Hashemi A, Ghorbani G, Rezai M, Shahmohammadi S. Clinical and laboratory features of pertussis in hospitalized infants with confirmed versus probable pertussis cases. Ann Med Health Sci Res 2014; 4:910-4. [PMID: 25506485 PMCID: PMC4250990 DOI: 10.4103/2141-9248.144911] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The clinical presentations of pertussis infection have considerable variation. Many infections and illnesses can cause prolonged repetitive paroxysmal cough that could be confused with Bordetella pertussis infection. AIM This retrospective study was designed to compare the clinico-laboratory findings between two groups of hospitalized infants with confirmed, and those who have clinical pertussis disease; to identify the possible additional diagnostic clues "for the diagnosis of confirmed pertussis disease". SUBJECTS AND METHODS The study population consisted of infants ≤12 months of age with clinical diagnosis of pertussis that fulfilled the World Health Organization definition for pertussis or those diagnosed by physicians. Clinico-laboratory findings were compared between two groups of patients (confirmed vs. clinical cases). RESULTS From a total of 118 infants admitted with a clinical diagnosis of pertussis, 16% (19/118) were confirmed by laboratory to have confirmed pertussis. Twelve of 19 (63%) and 71.99% of confirmed and clinical cases were younger than 6 months of age, respectively. For most patients, the duration of symptoms before hospitalization was <14 days. There were no significant differences between two groups of patients for paroxysmal cough and facial discoloration. However, whoop and apnea were more common among confirmed pertussis cases: P = 0.01, and P = 0.02, respectively. Leukocytosis (≥16,000/ml) (P = 0.01) and lymphocytosis (≥11,000) (P = 0.02) were reported significantly more frequently in confirmed pertussis cases. CONCLUSION Given the unavailability of a highly sensitive diagnostic test, in every afebrile patient with paroxysmal cough lasting for ≥7 days associated with whoop and/or apnea, particularly if accompanied by leukocytosis/lymphocytosis, pertussis disease should be considered. In this situation, prompt administration of empiric treatment for cases, and providing control measures to prevent infection transmission to contacts are recommended.
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Affiliation(s)
- J Shojaei
- Department of Health, Provincial Center for Diseases Control and Prevention, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mj Saffar
- Department of Pediatric Infectious Diseases and Antimicrobial Resistant Nosocomial Infections Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - A Hashemi
- Department of Medical Records, Journal of Pediatrics Review Office, Bouali Sina Hospital, Sari, Iran
| | - Gr Ghorbani
- Department of Health, Provincial Center for Diseases Control and Prevention, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ms Rezai
- Department of Pediatric Infectious Diseases and Antimicrobial Resistant Nosocomial Infections Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - S Shahmohammadi
- Antimicrobial Resistant Nosocomial Infections Research Center, Journal of Pediatrics Review Office, Bouali Sina Hospital, Sari, Iran
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Lim GH, Deeks SL, Crowcroft NS. A cocoon immunisation strategy against pertussis for infants: does it make sense for Ontario? ACTA ACUST UNITED AC 2014; 19. [PMID: 24524236 DOI: 10.2807/1560-7917.es2014.19.5.20688] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pertussis deaths occur primarily among infants who have not been fully immunised. In Ontario, Canada, an adult booster dose was recently added to the publicly funded immunisation programme. We applied number-needed-to-treat analyses to estimate the number of adults that would need to be vaccinated (NNV) to prevent pertussis disease, hospitalisation and death among infants if a cocoon strategy were implemented. NNV=1/(P(M) X R) + 1/(P(F) X R), where P(M),P(F) (proportion of infants infected by mothers, fathers) were sourced from several studies. Rates of disease, hospitalisation or death (R) were derived from Ontario's reportable disease data and Discharge Abstract Database. After adjusting for under-reporting, the NNV to prevent one case, hospitalisation or death from pertussis was between 500-6,400, 12,000-63,000 and 1.1-12.8 million, respectively. Without adjustment, NNV increased to 5,000-60,000, 55,000-297,000 and 2.5-30.2 million, respectively. Rarer outcomes were associated with higher NNV. These analyses demonstrate the relative inefficiency of a cocoon strategy in Ontario, which has a well-established universal immunisation programme with relatively high coverage and low disease incidence. Other jurisdictions considering a cocoon programme should consider their local epidemiology.
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Affiliation(s)
- G H Lim
- Public Health Ontario, Toronto, Canada
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Ulloa-Gutierrez R, Avila-Aguero ML. Pertussis in Latin America: current situation and future vaccination challenges. Expert Rev Vaccines 2014; 7:1569-80. [DOI: 10.1586/14760584.7.10.1569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Evaluation of several approaches to immunize parents of neonates against B. pertussis. Vaccine 2013; 31:6087-91. [DOI: 10.1016/j.vaccine.2013.09.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/16/2013] [Accepted: 09/23/2013] [Indexed: 11/24/2022]
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Auger KA, Patrick SW, Davis MM. Infant hospitalizations for pertussis before and after Tdap recommendations for adolescents. Pediatrics 2013; 132:e1149-55. [PMID: 24144713 DOI: 10.1542/peds.2013-1747] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Recent universal vaccination efforts among children in the United States have markedly changed hospitalization patterns for many vaccine-preventable diseases. Infants with pertussis often require hospitalization to monitor for potentially life-threatening respiratory failure. In 2006, tetanus-diphtheria-acellular pertussis (Tdap) vaccination was recommended for universal administration to adolescents, a known source of pertussis in infants. By 2011, 78% of adolescents in the United States had received Tdap. We sought to understand if patterns of pertussis hospitalization for infants changed with adoption of Tdap vaccination among adolescents. METHODS Infants (aged <1 year) diagnosed with pertussis were identified in the Nationwide Inpatient Sample by using diagnostic codes. We used variance-weighted least-squares regression over preimplementation years (2000-2005) to estimate pertussis hospitalization patterns if Tdap had not been available. We compared expected hospitalization rates with observed rates for 2008-2011. Two years (2006 and 2007) were excluded from analysis during early Tdap implementation. RESULTS The incidence of hospitalization for pertussis in 2000 was 5.82 (95% confidence interval: 4.51-7.13) discharges per 10,000 infants in the US population. The rate increased during pre-Tdap years by a mean of 0.64 pertussis discharges per 10,000 infants per year (P for trend = .004). Observed hospitalization rates for pertussis among infants were significantly lower than expected in 2008, 2009, and 2011, but in 2010 the observed and expected rates of hospitalization were not significantly different. CONCLUSIONS Adolescent Tdap vaccination appears to be partially effective in preventing pertussis hospitalizations among infants. However, broader Tdap immunization coverage may be necessary to achieve sustainable reductions in infant pertussis burden.
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Affiliation(s)
- Katherine A Auger
- MSc, Cincinnati Children's Hospital, 3333 Burnet Ave, MLC 9016, Cincinnati, OH 45229.
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Abstract
Pertussis, or whopping cough, is an upper respiratory tract infection caused by Bordetella pertussis. It has long been a concern in pediatric populations, leading to aggressive vaccination strategies to help decrease pediatric disease. In recent years, recognition of pertussis infection in adult populations has increased, leading to more frequent diagnosis and recommendations for booster immunizations in the adult population. Early recognition and treatment as well as vaccination will help reduce the current increase in this disease.
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Affiliation(s)
- Tara B Spector
- Division of General Internal Medicine, University of Washington Medical Center, Health Science Building, B-503, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
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Campins M, Moreno-Pérez D, Gil-de Miguel A, González-Romo F, Moraga-Llop FA, Arístegui-Fernández J, Goncé-Mellgren A, Bayas JM, Salleras-Sanmartí L. Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina. Enferm Infecc Microbiol Clin 2013; 31:240-53. [DOI: 10.1016/j.eimc.2012.12.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Shuel M, Jamieson FB, Tang P, Brown S, Farrell D, Martin I, Stoltz J, Tsang RSW. Genetic analysis of Bordetella pertussis in Ontario, Canada reveals one predominant clone. Int J Infect Dis 2013; 17:e413-7. [PMID: 23352492 DOI: 10.1016/j.ijid.2012.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/11/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To characterize Bordetella pertussis isolates in Ontario, Canada in order to understand the clonal diversity of strains present in this province. METHODS A total of 521 isolates from the period 1998-2006 were analyzed by serotyping, pulsed-field gel electrophoresis (PFGE), and DNA sequencing of their virulence factors of pertactin, fimbriae 3, pertussis toxin subunit 1, and pertussis toxin gene promoter. Characteristics of the Ontario isolates were compared to those described for isolates from Europe and Australia. RESULTS A single predominant clone was identified in Ontario, Canada, represented by 83.5% of the 521 isolates analyzed. This clone was characterized by the genotype fim3B, prn2, ptxS1A, and ptxP3 (sequence type (ST)-1), and 72.9% of this clone displayed three closely related PFGE profiles of BpSR11, BpSR5, and BpSR12. Pertussis isolates in Europe with these PFGE profiles and virulence factor genotype are reported as common. The Australian epidemic clone was previously reported to have the genotype prn2 and ptxP3. CONCLUSION The finding of one predominant B. pertussis clone in Ontario, Canada, with characteristics identical to strains involved in epidemics in Europe and Australia, suggests a potential link of this strain to the resurgence of pertussis in this province.
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Affiliation(s)
- Michelle Shuel
- Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, 1015 Arlington Street, Winnipeg, Manitoba, Canada R3E 3R2
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Prevention of pertussis, tetanus, and diphtheria among pregnant, postpartum women, and infants. Clin Obstet Gynecol 2012; 55:498-509. [PMID: 22510633 DOI: 10.1097/grf.0b013e31824f3b38] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pertussis disease in the United States has been increasing since 1976 and many states are reporting epidemics. Pertussis is more severe in infants less than 3 months of age and is characterized by high hospital admission rates, apnea of the infant. The CDC recommends that Tdap be administered to all pregnant women after the 20th week of gestation to provide pertussis antibodies to the fetus which will offer protection against pertussis disease. Tdap is highly immunogenetic in the pregnant women and has an excellent safety profile. Tdap given to the postpartum patient and her cocoon family is an alternative strategy.
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Skowronski DM, Janjua NZ, Sonfack Tsafack EP, Ouakki M, Hoang L, De Serres G. The Number Needed to Vaccinate to Prevent Infant Pertussis Hospitalization and Death Through Parent Cocoon Immunization. Clin Infect Dis 2011; 54:318-27. [DOI: 10.1093/cid/cir836] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Halperin BA, Halperin SA. The reemergence of pertussis and infant deaths: is it time to immunize pregnant women? Future Microbiol 2011; 6:367-9. [PMID: 21526936 DOI: 10.2217/fmb.11.15] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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The Collaborative Pediatric Critical Care Research Network Critical Pertussis Study: collaborative research in pediatric critical care medicine. Pediatr Crit Care Med 2011; 12:387-92. [PMID: 21057366 PMCID: PMC3439849 DOI: 10.1097/pcc.0b013e3181fe4058] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an updated overview of critical pertussis to the pediatric critical care community and describe a study of critical pertussis recently undertaken. SETTING The six sites, seven hospitals of the Collaborative Pediatric Critical Care Research Network, and 17 outside sites at academic medical centers with pediatric intensive care units. RESULTS Despite high coverage for childhood vaccination, pertussis causes substantial morbidity and mortality in US children, especially among infants. In pediatric intensive care units, Bordetella pertussis is a community-acquired pathogen associated with critical illness and death. The incidence of medical and developmental sequelae in critical pertussis survivors remains unknown, and the appropriate strategies for treatment and support remain unclear. The Collaborative Pediatric Critical Care Research Network Critical Pertussis Study has begun to evaluate critical pertussis in a prospective cohort. CONCLUSION Research is urgently needed to provide an evidence base that might optimize management for critical pertussis, a serious, disabling, and too often fatal illness for U.S. children and those in the developing world.
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Choi KM, Kim KH, Kim YJ, Kim JH, Park SE, Lee HJ, Eun BW, Jo DS, Choi EH, Hong YJ. Recommendation for the use of newly introduced Tdap vaccine in Korea. KOREAN JOURNAL OF PEDIATRICS 2011; 54:141-5. [PMID: 21738546 PMCID: PMC3127146 DOI: 10.3345/kjp.2011.54.4.141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/15/2011] [Indexed: 12/04/2022]
Abstract
Pertussis is an acute respiratory infection characterized by paroxysmal cough and inspiratory whoop for over 2 weeks. The incidence of pertussis has decreased markedly after the introduction of DTwP/DTaP vaccine, but the incidence of pertussis has increased steadily among young infant and among adolescents and adults in many countries. Td vaccine was used in this age group but the increase in pertussis has lead to the development of a Tdap vaccine. The Tdap vaccine is a Td vaccine with a pertussis vaccine added and is thought to decrease the incidence and transmission of pertussis in the respective age group. In Korea, two products are approved by the KOREA FOOD & DRUG ADMINISTRATION, which are ADACEL™ (Sanofi-Pasteur, Totonto, Ontario, Canada) and BOOSTRIX® (GlaxoSmithKline Biologicals, Rixensart, Belgium) for those aged between 11-64. This report summarizes the recommendations approved by the Committee on Infectious Diseases, the Korean Pediatric Society.
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Affiliation(s)
- Kyong Min Choi
- The Committee on Infectious Diseases, the Korean Pediatric Society, Korea
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Westra TA, de Vries R, Tamminga JJ, Sauboin CJ, Postma MJ. Cost-effectiveness analysis of various pertussis vaccination strategies primarily aimed at protecting infants in the Netherlands. Clin Ther 2010; 32:1479-95. [PMID: 20728761 DOI: 10.1016/j.clinthera.2010.07.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pertussis is a highly contagious respiratory disease. Despite a high rate of vaccine coverage through the Dutch national immunization program, the incidence of pertussis remains high in the Netherlands and the risk of infection continues. Because pertussis is most severe in unimmunized infants and infants who have only received some of the recommended doses, new pertussis immunization strategies should be considered to protect this vulnerable population. OBJECTIVE This study was designed to estimate the cost-effectiveness of 3 new immunization strategies for possible addition to the current Dutch national immunization program: immunization of the infant at birth, immunization of the parents immediately after birth of the child (cocooning), and maternal immunization during the third trimester of pregnancy. METHODS A literature search was performed in the PubMed database for articles published in English, German, and Dutch using the following terms: pertussis, whooping cough, vaccination strategies, maternal immunization, cocooning, at birth, vaccine efficacy, mortality, underreporting, prevalence, incidence, and cost-effectiveness. A decision-tree model was developed for this analysis, and data on pertussis morbidity and costs were collected consistently for different age groups (infants <1 year of age and adults 25 to 34 years of age). The size of the infant cohort was set at 200,000 to approximate previous Dutch birth cohorts. The size of the adult cohort was set at 401,380 parents for the cocooning strategy and 201,380 mothers for the maternal immunization strategy. Health benefits (quality-adjusted life-years [QALYs]) and costs were estimated in both cohorts for each of the 3 immunization strate- gies. Incremental cost-effectiveness ratios were calculated from both a payer's and a societal perspective. The robustness of the results was determined through sensitivity analysis. RESULTS In the base-case analysis, cocooning and maternal immunization were found to be effective in reducing the incidence of pertussis among infants (123 and 174 infant cases were expected to be prevented, respectively). Furthermore, cocooning and maternal immunization were estimated to be cost-effective from a payer's perspective (euro4600 [US $6400]/QALY and euro3500 [$4900]/QALY, respectively) and even cost-saving from a societal perspective (savings of up to euro7200 [$10,100] and euro5000 [$7000], respectively). Sensitivity analyses revealed that favorable cost-effectiveness was generally robust. In the sensitivity analysis, the cost-effectiveness of cocooning and maternal immunization was mostly sensitive for changes in assumptions on underreporting (200-fold increase in reported number of symptomatic cases) of pertussis disease and infection. With no underreporting, the ICER was estimated at euro211,900 ($296,700)/QALY for cocooning and euro81,600 ($114,200)/QALY for maternal immunization from a payer's perspective. However, even at much lower levels of underreporting (20- to 30-fold increase in incidence), cost-effectiveness remained favorable. The cost-effectiveness of the third strategy, at-birth immunization, was highly unfavorable (euro329,900 [$461,900]/QALY from a payer's perspective and euro330,100 [$462,100]/ QALY from a societal perspective). CONCLUSIONS This study estimated that the addition of cocooning or maternal immunization to the current Dutch national immunization program likely would be cost-effective or even cost-saving. These estimates were mainly due to reduction in the number of cases among parents, which are likely to be mild and therefore would largely remain unreported. Immunization at birth was not a cost-effective strategy. Cocooning was the most expensive intervention to implement; however, it resulted in the highest number of QALYs gained (mainly in adults). Maternal immunization would offer better protection of infants, due to maternally acquired antibodies.
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Affiliation(s)
- Tjalke A Westra
- Department of Pharmacy, University of Groningen, the Netherlands.
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Hospitalizaciones por Bordetella pertussis: experiencia del Hospital del Niño de Panamá, periodo 2001 – 2008. An Pediatr (Barc) 2010; 72:172-8. [DOI: 10.1016/j.anpedi.2009.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 11/01/2009] [Accepted: 11/02/2009] [Indexed: 11/20/2022] Open
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Top KA, Halperin BA, Baxendale D, MacKinnon-Cameron D, Halperin SA. Pertussis immunization in paediatric healthcare workers: knowledge, attitudes, beliefs, and behaviour. Vaccine 2010; 28:2169-2173. [PMID: 20056190 DOI: 10.1016/j.vaccine.2009.12.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/09/2009] [Accepted: 12/23/2009] [Indexed: 01/05/2023]
Abstract
Healthcare workers' (HCWs) knowledge, attitudes, and beliefs regarding pertussis immunization were assessed and compared to the rate of vaccine uptake. A questionnaire was distributed to employees at a paediatric and maternity tertiary care centre. Respondents were then offered a dose of the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) at a free vaccine clinic. In total, 529 out of 3051 (17%) employees completed the survey and 61 received the Tdap vaccine. Although 76% of participants were willing to be immunized, only 15% presented to the clinic. There is a widespread acceptance of pertussis immunization among paediatric HCWs. Stated intentions may be poorly predictive of behaviour. Education and institutional or public funding may improve vaccine uptake.
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Affiliation(s)
- Karina A Top
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Beth A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Darlene Baxendale
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Scott A Halperin
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Iskedjian M, De Serres G, Einarson TR, Walker JH. Economic impact of the introduction of an acellular pertussis vaccine in Canada: A 6-year analysis. Vaccine 2010; 28:714-23. [DOI: 10.1016/j.vaccine.2009.10.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 10/13/2009] [Indexed: 11/29/2022]
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