Impact of vaccinating pregnant women against pertussis on hospitalizations of children under one year of age in a tertiary hospital in Catalonia

INTRODUCTION

The recommendation for pertussis vaccination in pregnancy was established in Catalonia in February 2014. The objective of this study was to compare the hospitalization rate for pertussis in children under one year of age before and after the implementation of the vaccination program.

METHODS

Observational and retrospective study of patients under one year of age admitted to hospital with a diagnosis of pertussis. The hospitalization rate of patients under one year of age of the period prior to the vaccination program (2008-2013) was compared with the period with vaccination program (2014-2019) in the total of children under one year of age and in 2subgroups: children under 3 months and between 3-11 months.

RESULTS

Hospitalization rate was significantly lower in the period with vaccination program in children under one year of age and specifically in children under 3 months (2.43 vs. 4.72 per 1,000 person-years and 6.47 vs. 13.11 per 1,000 person-years, respectively). The rate ratios were: 0.51 (95% CI 0.36-0.73) for children under one year of age; 0.49 (95% CI 0.32-0.75) for those younger than 3 months and 0.56 (95% CI 0.30-1.03) for those with 3-11 months. No statistically significant differences were observed in the clinical severity between both periods.

CONCLUSION

The introduction of the pertussis vaccination program in pregnancy was associated with a global lower hospitalization rate for pertussis in children under one year of age and specifically in those under 3 months of age.

Clinical-epidemiological study of Bordetella pertussis infection in the Gran Canaria island in the period, 2008-2016

OBJECTIVE

Describe the epidemiological and clinical pattern of Bordetella pertussis infection (whooping cough) among hospitalised infants less than one year-old in a paediatric hospital in Gran Canaria.

PATIENTS AND METHODS

A retrospective review of the patient hospital records was performed, and recording only those with a microbiological diagnosis of pertussis infection detected using polymerase chain reaction, from January 2008 to December 2016.

RESULTS

A total of 110 patients were identified, of which 105 (95.4%) were less than 6 months old, and 59.1% were males. The annual incidence of hospital admissions was estimated between 13.7 and 425.0 cases per 100 000 infants <12 months old, with 2 peaks in 2011 and 2015. Household members were the main potential sources of infection. Main clinical features were pertussis cough associated with signs of catarrh, cyanosis, and lymphocytosis. Complications occurred in 15.4% of the patients (mainly pneumonia), but the outcome was favourable in all the cases. A lower age and non-vaccination were associated with an increased risk of developing complications (p < .05). Viral co-infection occurred in 31.6% of infants diagnosed with pertussis.

CONCLUSIONS

The incidence of pertussis has increased in the last years in Gran Canaria, with a lower development of complications and mortality rates compared with the previous period. Lower age and non-vaccination status are considered risk factors for developing complications. Vaccination in pregnant women will probably lead to a decline in the incidence in the future, especially in infants younger than 6 months.

Ellipsometric-based novel DNA biosensor for label-free, real-time detection of Bordetella parapertussis

Pertussis (or whooping cough) is a contagious disease mainly affecting infants and children and predominantly caused by Bordetella pertussis followed by Bordetella parapertussis. B. parapertussis causes a milder cough but usually symptomatically appears like B. pertussis infection. Thus the epidemiology of illness caused by B. parapertussis is not well understood. In this study, a sensitive and specific method for the rapid diagnosis of B. parapertussis is presented. The covalent immobilization of thiol-terminated DNA oligonucleotides (ss DNA SAM) on a silicon surface by disulfide bond formation is investigated with atomic force microscopy (AFM) and ellipsometry. The measurements indicated an average layer thickness of 5 ± 0.84 nm for 2 μg/μl concentration and 24 h incubation time. This thickness changed to 8.4 ± 0.92 nm for the same concentration (2 μg/μl) by altering the incubation time to 48 h. Ellipsometric data recorded before and after hybridization of B. parapertussis revealed an increase in mean grain area from 91 nm2 to 227 nm2 and a change in the refractive index from 1.489 to 1.648 for 2 μg/μl B. parapertussis, respectively. This change in the refractive index was used to evaluate the amount of adsorbed molecules and their density. The results showed that the density of adsorbed molecules increased from 0.2 to 0.97 g/cm3 after B. parapertussis attachment, respectively. To confirm the hybridization of B. parapertussis to ss DNA SAM, the ds DNA SAM was denatured and the ss DNA SAM surface was reproduced with an average height variation of 6.42 ± 0.75 nm. This showed the stability of the DNA film that can be tuned by varying the concentration and incubation time, thus providing a robust method for the label-free detection of B. parapertussis other than routinely used PCR detection.

Pertussis diagnostic practices of general practitioners in the Netherlands: A survey study

Background: Pertussis testing is most important when transmission to vulnerable groups is likely. Patients with signs and symptoms suggestive of pertussis are prevalent in primary care, yet general practitioners' (GPs) reasons (not) to test for pertussis are largely unknown.Objectives: To evaluate GP-reported diagnostic practices for pertussis, reasons for (not) testing and intentions towards testing among GPs.Methods: A total of 594 Dutch GPs were invited by email to participate in a survey study including a questionnaire reflecting on their pertussis diagnostic practices, reasons for (not) testing and the intention to test for pertussis in the year of 2013. Intention to test was measured as the likelihood to test for eight clinical vignettes.Results: In total, 122 GPs (21%) completed the online questionnaire. Most GPs reported having diagnosed at least one pertussis case (84%) in the previous year. Of all GPs, 14% did not perform any pertussis tests in the last year. The most reported reason for testing was to confirm the clinical pertussis diagnosis (70%); the most reported reason for not testing was that the diagnostic test result does not influence treatment (70%). Overall, judging from the clinical vignettes, GPs reported being more likely to perform diagnostic testing based on symptoms than based on vulnerable groups at risk.Conclusion: In contrast to national guidelines, our results suggest that GPs report to test for pertussis mainly based on clinical symptoms rather than based on protecting vulnerable groups at risk.

Prenatal vaccination of mothers and hepatitis B vaccination of their infants

Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and influenza vaccination are recommended during pregnancy primarily to prevent influenza and pertussis in mothers and their infants. This study examines associations between prenatal Tdap vaccination and influenza vaccination of mothers and hepatitis B vaccination of their infants. A retrospective cohort study was conducted using data from electronic medical records from 15,468 deliveries to 14,925 mothers occurring April 2, 2014-December 3, 2016 at a university hospital in Texas. Hepatitis B vaccine receipt in the first 3 days of life was dichotomized. Margins post-estimation commands in Stata SE 15.1 were used to obtain predicted probabilities and risk differences after estimating odds ratios in logistic regression with robust variance estimates. Adjusted models included maternal age, race/ethnicity, Medicaid use, year of delivery, parity, and gravidity. Infants of mothers who received prenatal influenza vaccination in the 2014-2015 and 2015-2016 influenza seasons were more likely than those of mothers who did not to receive a hepatitis B vaccine in their first 3 days of life (adjusted risk difference (RD) 2.8%, 95% confidence interval (CI) 1.5-4.1% and RD 2.2%, 95% CI 0.9-3.5%, respectively). Hepatitis B vaccination was also higher among infants of Tdap-eligible mothers who received prenatal Tdap vaccination during pregnancy compared to those of mothers who did not (adjusted RD 9.1%, 95% CI 7.6-10.5%). Overall, prenatal vaccination was significantly associated with uptake of infant hepatitis B vaccine.

Exploring the reasons for low pertussis vaccine effectiveness in Ontario, Canada, 2006-2008: a Canadian Immunization Research Network study

OBJECTIVES

Although pertussis vaccines have been widely used for many decades, a burden of illness persists. Resurgences in Ontario, Canada, have not been substantial in the past decade, but an outbreak of pertussis occurred in Toronto between 1 October 2005 and 31 March 2006. Previous Ontario studies found high vaccine effectiveness (VE) in the initial years post-immunization. In order to explore the impact of outbreaks and external factors on VE, we investigated pertussis VE during the period 2006-2008.

METHODS

We assessed pertussis VE using a frequency-matched case-control study for the period 1 March 2006 to 31 December 2008. We used logistic regression to estimate VE by age, time since last vaccination, and vaccination status according to the Ontario recommended schedule. We compared analyses including and excluding cases from Toronto, and to two recent Ontario pertussis VE studies.

RESULTS

We included 1797 confirmed cases and 7188 matched controls. Most cases were under 4 years of age during the study period. Pertussis VE was 3.8% (95% CI: - 21.0, 24.0) in the period 15-364 days following the last pertussis vaccine dose, and increased with increasing time since vaccination. Pertussis VE in the first 15-364 days excluding Toronto increased to 57.1% (95% CI: 26.0, 75.1), but the trend of increasing VE with time since vaccination persisted. Although VE was higher in older (6-11 years) than younger (0-5 years) children, it was lower at 12-13 years than after 14 years.

CONCLUSION

VE was lower in comparison with other studies conducted in Ontario, particularly in younger children. Various factors occurring during the study period may have influenced the results, including clinical testing of asymptomatic contacts, laboratory testing and methods and reporting practice, and a sensitive case definition. Further studies are needed to optimize methods for measuring VE to inform pertussis vaccine policy.

Pertussis vaccination in adults: a behavioral study of physicians from the US, France, and Germany

BACKGROUND

Pertussis is a highly contagious respiratory tract infection that affects all ages, though it is most severe in young infants. Adults, especially those with respiratory conditions or other chronic illnesses can also suffer serious consequences of pertussis. Pertussis vaccination is the best method of disease prevention in a lifetime. This behavioral study aimed to assess physicians' attitudes towards pertussis vaccination in adults and the importance of pertussis vaccination for disease prevention, especially in those with chronic illnesses, and to determine the impact of the COVID-19 pandemic on adult vaccination behaviors.

METHODS

Between November 2022 and January 2023, physicians from the US, France, and Germany registered in an independent online database were contacted to participate in this study. After eligibility screening, participating physicians completed an online questionnaire addressing topics related to physician recommendations and vaccination behavior around pertussis in adults.

RESULTS

Eight hundred physicians participated in the study (US: 400; France: 200; Germany: 200). Physicians' attitudes towards pertussis vaccination in adults were broadly similar between the countries. Overall, 65% of physicians believed in the importance of vaccination against pertussis, a lower proportion than for COVID-19 (82%), influenza (81%), pneumococcal disease (76%), and tetanus (73%). Physicians considered immunocompromised adults or those with chronic obstructive pulmonary disease (COPD), asthma, or other respiratory conditions to be at greatest risk from pertussis. Physicians estimated that two-thirds of the adult patients to whom they recommended pertussis vaccination agreed to receive it. The top reason why they felt patients did not receive pertussis vaccination as recommended was low perception of personal risk for pertussis. Physicians' pertussis vaccination behavior was found to be similar before and after the COVID-19 pandemic.

CONCLUSIONS

While physicians in the surveyed countries recognized the value of pertussis vaccination in adults, they ranked its importance lower than that of other adult vaccines. Physicians recognized the need to immunize vulnerable adults who are at risk of severe pertussis, such as those with asthma and/or COPD, but this awareness frequently did not result in vaccination of these priority groups, especially without official recommendations to support such vaccination in these groups.

High circulation of pertussis in infants and close contacts in Antananarivo, the capital of Madagascar in Africa, and Cambodia in Asia

BACKGROUND

Reliable data on whooping cough, a highly contagious disease sometimes fatal for infants, are largely lacking in low- and middle-income countries.

METHODS

We conducted a hospital-based prospective study (PS) on infants, and a household contact-case investigation (CCI) for positive cases throughout Cambodia and in the city of Antananarivo, Madagascar, between 2017 and 2019. The PS, in which Bordetella diagnostics (qPCR) were performed, included infants aged ≤6 months presenting with ≥5 days of cough associated with one pertussis-like symptom. CCI was performed using qPCR and serology regardless of clinical signs.

RESULTS

In this study, 207 and 173 participants from Cambodia and Antananarivo were respectively enrolled. Respectively 26.1% (54/207) and 22.0% (38/173) of the infants were infected in the cohorts from Cambodia and Antananarivo. Cough longer than 10 days appeared as a risk factor in both countries, as well as coughing spells, apnea and normal pulmonary auscultation, having a coughing contact in Cambodia. In Antananarivo, being clinically well between coughing spells appeared as a risk factor. Five infants, all positive, died during the study. In Cambodia and Antananarivo respectively, 50.9% (118/232) and 67.8% (82/121) of the contact cases were positive. Respectively 94.4% (51/54) and 90.3% (28/31) of the households had at least one positive contact case.

CONCLUSION

The data show that pertussis circulates at high levels among infants and in their households both in Cambodia and in Antananarivo. Given the vulnerability of youngest infants, who are too young to receive fully primary vaccination, they need to be protected through boosters breaking transmission chains. Molecular diagnosis, as well as trained medical human resources to detect the disease early, are absolutely key to protect populations.

Addressing the consequences of missing vaccines: A case report of pertussis in a child with acute lymphoblastic leukemia

Pertussis, caused primarily by Bordetella pertussis and occasionally by Bordetella parapertussis, remains a major public health issue despite widespread vaccination efforts. Immunocompromised children, such as those with acute lymphoblastic leukemia, are particularly susceptible to vaccine-preventable diseases, underscoring the importance of ensuring adequate vaccination coverage. We report a case of a 3-year-old boy with ALL who developed a Bordetella parapertussis infection during chemotherapy. The child's lack of documented pertussis vaccination underscores critical gaps in primary healthcare and immunization practices. His case highlights the increased risk of severe infections in unvaccinated, immunocompromised patients and underscores the necessity of maintaining comprehensive vaccination records and robust primary healthcare systems to prevent such infections. The rapid diagnosis and initiation of appropriate antimicrobial therapy, highlights the critical role of early detection and tailored interventions in preventing severe outcomes.

[Epidemiological profile of pertussis in infants in Casablanca from 2012 to 2019]

Pertussis is a real public health problem due to high neonatal morbidity rates and resurgence despite high vaccination coverage. The purpose of this study is to analyze the epidemiological profile of pertussis in infants hospitalized from 2012 to 2019. We conducted a retrospective, descriptive study over a 7-year and 8-month period from January 2012 to July 2019. It involved 500 infants admitted with clinical suspicion of pertussis. The average age of infants was 72 days, ranging from 28 days to 18 months; 75% of infants were less than 3 months old. The peak incidence was registered in 2012 and 2016, with a summer predominance (32%); 460 infants (92%) were not or incompletely vaccinated, 42.2% of whom were too young to be vaccinated. A probable contaminant in the entourage was found in 43,6% of cases. Whooping cough and cyanosis were the main reason for hospitalization (77.6%). Chest radiography objectified bronchial disease (25,4%) and alveolar foci (22.7%). Blood count performed in 410 infants showed hyperlymphocytosis in 67.5% of cases. Polymerase chain reaction (PCR) on nasopharyngeal sample collected from 206 infants was positive for Bordetella pertussis in 64% of cases; 118 PCR performed in mothers were positive in 47.7% of cases. All infants received Clarithromycin. Pertussis is a major cause of morbidity in infants in Casablanca. The prevention strategy is based on vaccination of family members of infants. However, vaccination of pregnant women appears to be more effective.

Pertussis Vaccines and Vaccination Strategies. An Ever-Challenging Health Problem

Vaccines and vaccination against pertussis (whooping cough) have had one of the longest and most complex history, with alternating splendour and public disbelief, enthusiasm and concerns, overall resulting in changes in composition and replacement of vaccines, and associated vaccination strategies, including use of different vaccines in different countries, with no apparent equals for other bacterial vaccines. Of this both frustrating and exciting venue no end has been reached. In this note, I am shortly recapitulating the history of pertussis vaccines, from the inactivated, whole-cell vaccine to the acellular ones, with their merits and limitations, particularly concerning the debated issue of waning immunity, and a glimpse on a new vaccine proposal. Some reflections on the complexity and apparent peculiarity of this field are also made to the final scope of discussing aspects of the evolving strategies of disease control in a high-income country.

Risk factors and prediction model of severe pertussis in infants < 12 months of age in Tianjin, China

Background

To identify risk factors associated with the prognosis of pertussis in infants (< 12 months).

Methods

A retrospective study on infants hospitalized with pertussis January 2017 to June 2019. The infants were divided into two groups according to the severity of disease: severe pertussis and non-severe pertussis groups. We collected all case data from medical records including socio-demographics, clinical manifestations, and auxiliary examinations. Univariate analysis and Logistic regression were used.

Results

Finally, a total of 84 infants with severe pertussis and 586 infants with non-severe pertussis were admitted. The data of 75% of the cases (severe pertussis group, n = 63; non-severe pertussis group, n = 189) were randomly selected for univariate and multivariate logistic regression analysis. The results showed rural area [P = 0.002, OR = 6.831, 95% CI (2.013–23.175)], hospital stay (days) [P = 0.002, OR = 1.304, 95% CI (1.107–1.536)], fever [P = 0.040, OR = 2.965, 95% CI (1.050–8.375)], cyanosis [P = 0.008, OR = 3.799, 95% CI (1.419–10.174)], pulmonary rales [P = 0.021, OR = 4.022, 95% CI (1.228–13.168)], breathing heavily [P = 0.001, OR = 58.811, 95% CI (5.503–628.507)] and abnormal liver function [P < 0.001, OR = 9.164, 95% CI (2.840–29.565)] were independent risk factors, and higher birth weight [P = 0.006, OR = 0.380, 95% CI (0.191–0.755)] was protective factor for severe pertussis in infants. The sensitivity and specificity of logistic regression model for remaining 25% data of severe group and common group were 76.2% and 81.0%, respectively, and the consistency rate was 79.8%.

Conclusions

The findings indicated risk factor prediction models may be useful for the early identification of severe pertussis in infants.

Impact of vaccinating pregnant women against pertussis on hospitalizations of children under one year of age in a tertiary hospital in Catalonia

INTRODUCTION

The recommendation for pertussis vaccination in pregnancy was established in Catalonia in February 2014. The objective of this study was to compare the hospitalisation rate for pertussis in children under one year of age before and after the implementation of the vaccination programme.

METHODS

Observational and retrospective study of patients under one year of age admitted to hospital with a diagnosis of pertussis. The hospitalisation rate of patients under one year of age of the period prior to the vaccination programme (2008-2013) was compared with the period with vaccination programme (2014-2019) in the total of children under one year of age and in 2 subgroups: children under 3 months and between 3-11 months.

RESULTS

Hospitalization rate was significantly lower in the period with vaccination programme in children under one year of age and specifically in children under 3 months (2.43 vs. 4.72 per 1000 person-years and 6.47 vs. 13.11 per 1000 person-years, respectively). The rate ratios were: 0.51 (95% CI 0.36-0.73) for children under one year of age; 0.49 (95% CI 0.32-0.75) for those younger than 3 months and 0.56 (95% CI 0.30-1.03) for those with 3-11 months. No statistically significant differences were observed in the clinical severity between both periods.

CONCLUSION

The introduction of the pertussis vaccination programme in pregnancy was associated with a global lower hospitalisation rate for pertussis in children under one year of age and specifically in those under 3 months of age.

The history of pertussis: from an ancient scourge to a contemporary health burden

The present article offers a historical overview on pertussis (whooping cough) by analysing the ancient epidemic manifestations of the disease and the path towards the discovery of an effective vaccine against it. The original mentions of pertussis are examined with reference to Mediaeval Afghanistan and the famous AD 1578 Paris epidemic described by the French physician Guillaume de Baillou. The historical data are then matched with information derived from analyses of phylogenetic trees of B. pertussis. Finally, this article also highlights some recent challenges posed to public health by this infectious disease.

A new epidemic wave of Bordetella pertussis in paediatric population: impact and role of co-infections in pertussis disease

BACKGROUND

In recent months, Bordetella pertussis has reappeared after maintaining a low rate for many years. Although pertussis is usually characterized by a favorable course, several factors can contribute to the severity of the disease, such as mixed respiratory infections. In this study, we evaluate B.pertussis cases observed in the pediatric population followed at the Bambino Gesù Children's Hospital and analyzed the potential impact of co-infections in relation to disease severity.

METHODS

From January to May 2024, a total of 1,151 children and adolescents (both inpatients and outpatients) were screened for the presence of respiratory pathogens, including B.pertussis, with clinically relevant respiratory symptoms.

RESULTS

Among the 1,151 patients screened, 66 tested positive for B.pertussis. Fourteen patients had respiratory failure, and six of them required intensive care unit (ICU) admission, while 52 had mild infection. 23.3% of patients had B.pertussis alone, while 76.7% had co-infections (including 5 patients admitted to the ICU). A higher co-infection rate was observed in patients with respiratory failure than in those without failure (92.9% vs. 69.0%, p-value:0.041). Rhinovirus, Metapneumovirus and Parainfluenza-virus were the most prevalent in our pediatric population. Co-infections of human bocavirus with B.pertussis were observed exclusively in patients with respiratory failure.

CONCLUSIONS

Our results highlighted an increase in B.pertussis cases from January to May 2024, reaching a peak of cases in the month of May. This study shows a high rate of B.pertussis co-infection, and a trend toward association between B.pertussis and specific viruses, that might play a role in increasing disease severity.

Microfluidic point-of-care testing for the detection of Bordetella pertussis: A mini-review

Bordetella pertussis is a bacterial pathogen responsible for pertussis, which is a highly contagious respiratory disease. Despite the relatively high vaccination coverage, pertussis is considered a reemerging disease that necessitates enhanced strategies for identification, prevention, and control. The diagnosis of pertussis typically involves a combination of clinical evaluation, laboratory tests, and a thorough medical history. The current technologies for pertussis diagnosis have their own limitations, prompting the exploration of alternative diagnostic approaches that offer enhanced sensitivity, specificity, and speed. Microfluidic technology is considered a very promising tool for the diagnosis of infectious diseases, as it offers more rapid and accurate outputs. It allows point-of-care testing (POCT) at or near the patient site, which can be critical, especially for an outbreak or pandemic. In this paper, current pertussis diagnostic tools with their limitations were discussed, and microfluidic approaches for the diagnosis of pertussis were highlighted.

A scoping review of the reasons for and approaches to non-uptake of pertussis and influenza vaccinations in pregnant women in the United Kingdom and Ireland

BACKGROUND

Pertussis and influenza cause significant morbidity and mortality in pregnancy and the neonatal period. Maternal vaccination in pregnancy would reduce harm, but low vaccine uptake is a concern. This scoping review aimed to understand the reasons for, and approaches, to non-uptake of pertussis and influenza vaccinations in pregnant women in the UK and Ireland.

METHODS

The inclusion criteria of this scoping review consist of pregnant women who avail of pertussis and influenza vaccines in the UK and Ireland. MEDLINE, EMBASE, Web of Science and CINAHL databases were searched in June 2021 and updated in October 2022. Searches were limited to English language reports published after 2011. We followed the Joanna Briggs Institute guidance on scoping reviews. Data were extracted and charted.

RESULTS

Five themes emerged from the literature. Acceptability, as well as organisational and awareness issues, were overarching themes regarding reasons for and approaches to non-uptake of the vaccines respectively. Other themes included healthcare professional factors, information interpretation and pregnancy-related factors.

CONCLUSIONS

Women need clear, comprehensible information, ideally provided by their healthcare professionals, in a way that is meaningful and addresses their circumstances and risk perceptions. This research will serve as a base for future work that aims behaviour science interventions at the wider pregnant population as well as the target groups that have been identified in this review.

Genetic Profile Variation in Vaccine Strains and Clinical Isolates of Bordetella pertussis Recovered from Iranian Patients

BACKGROUND

Re-emergence of pertussis has been reported in Iran despite a high rate of vaccination coverage. Low efficacy of the vaccine might be due to the genetic divergence between clinical versus vaccine strains. In the current study, the genetic profiles of clinical isolates and vaccine strains of Bordetella pertussis (B. pertussis) were assessed by using Pulsed Field Gel Electrophoresis (PFGE).

METHODS

Following phenotypic and molecular identification of isolates, XbaI-digested genomic DNA of 5 clinical isolates, 2 vaccine strains and a Tohama I strain were analyzed by PFGE along with B. parapertussis as a control.

RESULTS

Seven distinct PFGE profiles were found among all examined isolates/strains. In 5 clinical isolates, 4 profiles were identified whereas the vaccine strains displayed 2 distinct profiles. The reference strain, Tohama I had a distinct profile. Vaccine and clinical profiles had low similarity, with relatedness of approximately 40%.

CONCLUSION

The genetic profiles of B. pertussis were different between circulating isolates and vaccine strains used in the national vaccination programs. Since new genetic profiles of B. pertussis can be disseminated periodically, the profiles of isolates circulating in the population should be monitored over the course of the re-emergence.

[Pertussis in Mexico, an epidemiological overview. A study of 19 years at the Instituto Mexicano del Seguro Social]

BACKGROUND

Bordetella pertussis infection remains a public health problem in several developed and developing we describe the epidemiological syndrome cases subsystem special surveillance of whooping cough from 1992 to 2011 at a population with social security.

METHODS

We obtained special cases subsystem Pertussis surveillance of 1992-2011. Univariate analysis was made of rates, ratios and proportions. Wilson was determined test for proportions to an alpha of 0.05, t-test for mean difference.

RESULTS

We appreciate epidemic cycles every three to five years, the average baseline incidence, excluding epidemic years, 0.1 is considered confirmed cases per 100 000 beneficiaries assigned to family medicine, the highest incidence was recorded in 1997 and 2009. The most affected were children under 1 year of age and in outbreaks, the disease occurred at older ages.

CONCLUSIONS

During the period observed intermediate epidemic cycles 5 and 3 years of age presentation is consistent in other countries.

Bordetella pertussis, a reemerging pathogen in pediatric respiratory infections. A study in Quito, Ecuador

Bordetella pertussis is the causative agent of pertussis, which mainly affects unvaccinated children, while Bordetella parapertussis causes a disease presenting clinical characteristics that are indistinguishable from whooping cough. Despite high vaccination coverage, pertussis remains a public health concern worldwide, with approximately 140000 cases reported annually. Here we determined the prevalence of B. pertussis and B. parapertussis infection among infants under one year of age by polymerase chain reaction (PCR); our aim being to identify whether the data obtained relates to the relevant sociodemographic and clinical data. The study included 86 samples of nasopharyngeal swabs from infants aged between 0-12 months, who were reported as probable cases of whooping cough by the health centers around the Ecuadorian highlands, from August 2016 to July 2017. The nasopharyngeal swabs were cultured and microbiological and molecular analyses were performed. B. pertussis was identified by PCR in 41% of the samples (30/86), more than half of which corresponded to infants aged between 0-3 months. Moreover, a statistically significant correlation (p<0.05) between the identification of bacteria in culture and the catarrhal stage of the disease was observed. The results obtained from the study highlighted the need for an active national surveillance of pertussis, in particular for laboratory testing, to provide a highly sensitive and more specific diagnosis of Bordetella infection.

Current practices of adjunctive therapy for pertussis at six Canadian tertiary care pediatric hospitals

OBJECTIVE

To document initial investigations and treatment used in the management of children hospitalized with pertussis.

DESIGN

Retrospective chart review encompassing admissions from January 1, 1991 to June 1, 1995.

SETTING

Six Canadian pediatric hospitals representing about 39% of the pediatric tertiary care beds in Canada.

PATIENTS

Four hundred and forty children who met the inclusion criterion of a primary admitting diagnosis of pertussis and who did not meet the exclusion criterion of nosocomially acquired pertussis or a prior admission for pertussis during the study period.

MAIN RESULTS

Most patients had cultures positive for Bordetella pertussis, although the proportion of positive tests varied widely among hospitals. Erythromycin was the most commonly used medication; however, only 47% of children received the recommended dosage. Salbutamol and corticosteroids were used most often in patients with reactive airways disease. Younger children and those with reactive airways disease had longer lengths of stay in hospital.

CONCLUSIONS

Pertussis treatment varied widely among the six hospitals studied, and was often not consistent with current Canadian recommendations. The results will allow practitioners to place their practices in a national perspective and provide a baseline for further studies.

Recent increase in infant pertussis cases in Europe and the critical importance of antenatal immunizations: We must do better…now

Recent months have seen an increase in pertussis cases in several countries across the Northern and Southern hemispheres. The lack of immune stimulation during the COVID-19 pandemic due to the reduced circulation of Bordetella pertussis, the pathogen responsible for pertussis, is likely to have led to increased population susceptibility which has been magnified the typical three to five yearly cyclical peaks in activity. Maternal immunization for pertussis proves highly effective in protecting infants under three months of age. It's also critical for immunizers and parents to maintain high and timely immunization uptake to ensure infants receive maximum early protection when they are most at risk of severe disease.

Serologic evidence of pertussis infection in vaccinated Iranian children

BACKGROUND

It seems that the incidence of pertussis-like illnesses is considerably increasing despite the wide coverage of immunization with the whole cell pertussis vaccine. We aimed to investigate the occurrence of pertussis in vaccinated children by measuring anti-pertussis antibodies.

METHODS

In this cross-sectional study, blood samples were taken from vaccinated children aged 2, 4, 6, 12, 18, and 72 months. Anti-pertussis IgG and IgA were measured by ELISA. P<0.05 was considered significant.

RESULTS

725 children were enrolled in the study. Geometric mean titers for IgG that showed a slight decease after 2 months of age and increased distinctly in children aged 72 months. The frequency of the individuals whose IgG was above the determined cut-off (derived from mean+2SD) was observed in 1% of the 2, 4, and 6-month-old infants, 6% of the 12 and 18-month-olds and 12% of the 6-year -old children. Positive IgA titers were detected in 5, 9, 6, 23, 11, and 8% of children aged 2, 4, 6, 12, 18, and 72 months, respectively.

CONCLUSION

Since a considerable percentage of children had high levels of anti-pertussis IgG antibodies (≥2 SD), positive anti-pertussis IgA, and most importantly an increased level of anti-pertussis IgG geometric mean titer at 6 years of age, further investigations regarding the protection provided by the presently used pertussis vaccine seems necessary.

Neurologic alterations in an HIV adult patient with pertussis: a case report

Background

Pertussis is a highly contagious disease of public health interest caused by the bacterium Bordetella pertussis. Although its incidence has decreased substantially after the introduction of a vaccination, the burden of the disease remains high. Although the paroxysmal phase is highly disabling, complications are uncommon and more prevalent in children than in adults. The most frequent neurological complication is encephalopathy, but seizures, paresis, paraplegia, ataxias, aphasias, and decerebration postures have also been described. The complication of decerebration postures has not been previously reported in adults.

Case presentation

We present a video case of an adult HIV patient with severe coughing paroxysms, post-tussive emesis and syncope, whose workup confirmed the diagnosis of a B. pertussis respiratory infection. During hospitalization, he had fluctuant encephalopathy and post-tussive decerebration postures following paroxysms. He was treated with antibiotic therapy and finally sent home without residual neurological deficits.

Conclusion

This case illustrates the biological plausibility of neurologic complications of pertussis in adults, which, albeit rare, can cause important morbidities. Future research should explore whether there are differences in the clinical presentation, risk factors and pathophysiology of the disease among adults or interventions aimed at preventing or treating pertussis encephalopathy.