Brote de tos ferina con elevada tasa de ataque en niños y adolescentes bien vacunados

[Access to complementary tests for the diagnosis of infectious diseases in primary care paediatric clinics]

INTRODUCTION

The performing of complementary tests in infectious processes can increase the diagnostic precision, the adequacy of treatments, as well as determining the epidemiology and pattern of bacterial resistance of the community. The Infectious Pathology Group of the Spanish Association of Primary Care Paediatrics (GPI-AEPap) has designed this study in order to determine the availability of complementary tests (CT) for paediatricians working in Primary Care of the public health system as well as their results.

MATERIAL AND METHODS

Observational cross-sectional descriptive national study was carried out using a voluntary self-report questionnaire distributed online to all AEPap members and to the subscribers of the PEDIAP distribution list between the months of April and May 2017.

RESULTS

A total of 517 responses were obtained. An analysis was made of the data from the professional environment, as well as those related to the request for basic supplementary tests (blood count, biochemistry, and routine urine analysis), the use of Rapid Antigen Detection Test for group A Streptococcus, bacterial cultures, serology, diagnostic tests for pertussis and tuberculosis (Mantoux), as well as imaging tests.

CONCLUSIONS

There is variability between Autonomous Communities and healthcare areas. Areas for improvement were found in the accessibility to different CT, collection time and sending of samples, delay in receiving results, as well as waiting times for non-urgent imaging tests. These affect the intervention and resolution capacity of the primary care paediatrician.

Influence of health literacy on acceptance of influenza and pertussis vaccinations: a cross-sectional study among Spanish pregnant women

OBJECTIVES

Immunisations against influenza and Bordetella pertussis infection are recommended to pregnant women in Valencia (Spain), yet vaccination rates remain low. Health literacy (HL) appears as a crucial factor in vaccination decision-making. We explored the relation between HL of pregnant women and decisions to receive influenza and pertussis immunisations.

SETTING

University hospital in Valencia (Spain).

PARTICIPANTS

119 women who gave birth at a hospital in Valencia (Spain) between November 2015 and May 2016. Women in the immediate postpartum period (more than 27 weeks of gestation), between November 2015 and May 2016 were included in the study. Women with impairments, language barriers or illiteracy which prevented completion of the questionnaires, or those who were under 18 years were excluded from enrolment.

PRIMARY AND SECONDARY OUTCOME MEASURES

HL level; influenza and pertussis immunisation rate; reasons for rejection of vaccination.

RESULTS

119 participants were included (mean age 32.3±5.5 years, 52% primiparous, 95% full-term deliveries). A higher education level was associated with Short Assessment of Health Literacy for Spanish Adults _50 (adjusted R²=0.22, p=0.014) and Newest Vital Sign (adjusted R²=0.258, p=0.001) scores. Depending on the scale, 56%-85% of participants had adequate HL. 52% (62/119) and 94% (112/119) of women received influenza and pertussis immunisation, respectively. Women rejecting influenza vaccine had a higher HL level (measured by SALHSA_50 tool) than those accepting it (Kruskal-Wallis test p=0.022). 24% of women who declined influenza vaccination felt the vaccine was unnecessary, and 23% claimed to have insufficient information.

CONCLUSIONS

Influenza vaccination rate was suboptimal in our study. Women with high HL were more likely to decline immunisation. Information from professionals needs to match patients' HL levels to reduce negative perceptions of vaccination.

Importance of Enhanced Surveillance for Prevention of Pertussis in Children

BACKGROUND

Bordetella pertussis infection causes considerable morbidity, even in countries with high vaccination coverage. Surveillance of pertussis is usually passive and based on mandatory reporting. We assessed the epidemiologic and clinical characteristics of pertussis cases detected by passive or enhanced surveillance.

METHODS

A prospective population-based study was carried out from January 2012 to December 2013 in Catalonia and Navarre, 2 Spanish regions with a total population of 8.2 million. For each confirmed case, variables of age, sex, clinical symptoms, laboratory results and vaccination status were investigated. Associations between the variables studied and the type of surveillance were assessed by odds ratio (OR) and its 95% confidence interval (CI). Logistic regression was used to estimate adjusted OR (aOR).

RESULTS

In children <18 years of age, passive surveillance was the most important source of detection (95.7% in <1 year). In children 5-10 years of age, passive surveillance detected 67.5% of cases. In those ≥18 years, enhanced surveillance was the most frequent source of case detection (82.5%). Inspiratory whoop (aOR: 1.94; 95% CI: 1.40-2.70), apnea (aOR: 1.92; 95% CI: 1.28-2.87) and posttussive vomiting (aOR: 1.43; 95% CI: 1.04-1.96) were symptoms included in the clinical case definition that were associated with passive surveillance.

CONCLUSIONS

Underreporting of symptomatic cases is important not only in adults, but also in children >1 year of age and suggests that providing clinics with free, fast laboratory diagnostic tests, together with enhanced surveillance of family contacts of any age is necessary to better determine existing cases. Enhanced surveillance may be helpful to better understand transmission patterns in the family and in the community.

[Acellular vaccines (DTPa/dTpa) against whooping cough, protection duration]

INTRODUCTION

An increase in whooping cough in most of the developed countries has been detected in the last decade.

OBJECTIVE

To determine whether the administration of dTpa vaccine instead of DTPa fifth dose is contributing to the appearance of these cases.

METHODS

A descriptive study based on cases of whooping cough reported during an epidemic period in the city of Alicante in the first 5 months of 2014. Only pertussis cases confirmed by PCR were included in the study, and only those vaccinated with 5 doses were included in the analysis of the period of protection.

RESULTS

A total of 104 cases of pertussis confirmed by PCR were reported, with 85 cases (82%) having had 5 doses of vaccine. The mean time and standard deviation (SD) of protection was 2.1±1.1 years with dTpa, and 5.1±1.5 years with DTPa (p<.001). In the protection, adjusted for age, it was observed that, after 3 years, only 47.6% of people vaccinated with dTpa were still protected, while people vaccinated with DTPa were 100% protected (P<.001).

CONCLUSIONS

This study found that people who were properly vaccinated against pertussis and received their last re-vaccination dose with dTpa had a shorter period of protection than those who were vaccinated with DTPa.

Whole-Genome Sequence of a Bordetella pertussis Brazilian Vaccine Strain

Despite the reduction in incidence after vaccination, pertussis disease is still considered a public health problem worldwide, mainly due to recent and potential new outbreaks. We report here the complete genome of the Bordetella pertussis Butantan strain used in the Brazilian National Immunization Program as a whole-cell pertussis antigen to compose vaccines such as DTwP (diphtheria, tetanus, and whole-cell pertussis).

Clustered cases of Bordetella pertussis infection cause high levels of IgG antibodies against pertussis toxin in adolescents in Gaobeidian city, China

SUMMARY In a large serosurvey performed in Gaobeidian city, China, 1032 children and adolescents aged 3-18 years were divided into three age groups: 3-6, 7-11, and 12-18 years. The geometric mean of IgG antibodies against pertussis toxin (anti-PT IgG) varied from 3.47 IU/ml (3-6 years) to 8.71 IU/ml (12-18 years) and the seroprevalence (≥ 40 IU/ml) varied from 4.48% (7-11 years) to 11.76% (12-18 years). Infections were clustered in three secondary schools (schools 1-3). However, excluding secondary schools 1-3, the IgG PT levels, seroprevalence and rates of recent infections (>100 IU/ml) in secondary schools 4-7 (where infections were not clustered) were very close to those in the 3-6 and 7-11 years age groups. This suggests that the high seroprevalence and anti-PT IgG levels in adolescents in Gaobeidian city, China were caused by the clustered cases in certain secondary schools. Our results also suggested that pertussis was still circulating in China, and the reported incidence might be underestimated.