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Liu Y, Yang Y, Zhou J, Zhang X, Gu L, Xu Y, Lu Z, Xie Q, Zhang X, Hua C. Economic burden of pertussis in children: A single-center analysis in Hangzhou, China. Hum Vaccin Immunother 2024; 20:2343199. [PMID: 38647026 PMCID: PMC11037283 DOI: 10.1080/21645515.2024.2343199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
The "reemergence of pertussis" has elicited international concerns, occurring paradoxically amidst the expansion of immunization programs. This study was aimed to evaluate quantitatively the economic burden and identify the determinants that influence the cost associated with treating pertussis in Chinese children. We evaluated the economic burden by Chinese children diagnosed with pertussis at the Children's Hospital, Zhejiang University School of Medicine in 2022. Direct medical expenses and the utilization of medical resources attributed to pertussis were calculated. A generalized linear regression model was applied to analyze the determinants that were associated with the direct medical expenses among patients. Among the 1110 pertussis patients included in the study, 1060 were outpatients and 50 were inpatients. The average direct medical cost was ¥1878.70(i.e. $279.33). Living in urban areas (OR:1.27, p = .04), complications (OR:1.40, p < .001), hospitalization (OR:10.04, p < .001), and ≥ 3 medical visits (OR:3.71, p < .001) were associated with increased direct medical expenses. Having received four doses of the pertussis vaccine was associated with reduced direct medical expenses (OR:0.81, p = .04). This study underscores a substantial economic burden of pertussis in Hangzhou, with pronounced implications for patients residing in urban areas, experiencing complications, requiring hospitalization, having multiple medical consultations, or lacking comprehensive pertussis vaccination.
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Affiliation(s)
- Yan Liu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yingying Yang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jinsi Zhou
- Department of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xuechao Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Lintao Gu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yuyang Xu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Zhaojun Lu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qixin Xie
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaoping Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Chunzhen Hua
- Department of Infectious Diseases, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Pearce R, Chen J, Chin KL, Guignard A, Latorre LA, MacIntyre CR, Schoeninger B, Shantakumar S. Population-Based Study of Pertussis Incidence and Risk Factors among Persons >50 Years of Age, Australia. Emerg Infect Dis 2024; 30:105-115. [PMID: 38146987 PMCID: PMC10756356 DOI: 10.3201/eid3001.230261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Despite vaccination programs, pertussis has been poorly controlled, especially among older adults in Australia. This longitudinal, retrospective, observational study aimed to estimate the incidence and risk factors of pertussis among persons ≥50 years of age in Australia in the primary care setting, including those with underlying chronic obstructive pulmonary disease (COPD) or asthma. We used the IQVIA general practitioner electronic medical record database to identify patients ≥50 years of age with a clinical diagnosis of pertussis during 2015-2019. Pertussis incidence rates ranged from 57.6 to 91.4 per 100,000 persons and were higher among women and highest in those 50-64 years of age. Patients with COPD or asthma had higher incidence rates and an increased risk for pertussis compared with the overall population ≥50 years of age. Our findings suggest that persons ≥50 years of age in Australia with COPD or asthma have a higher incidence of and risk for pertussis diagnosis.
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Guzman-Holst A, Gomez JA, Cintra O, Van Oorschot D, Jamet N, Nieto-Guevara J. Assessing the Underestimation of Adult Pertussis Disease in Five Latin American Countries. Infect Dis Ther 2023; 12:2791-2806. [PMID: 38095808 PMCID: PMC10746655 DOI: 10.1007/s40121-023-00895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Pertussis, a contagious respiratory disease, is underreported in adults. The study objective was to quantify underestimation of pertussis cases in adults aged ≥ 50 years in five Latin American countries (Argentina, Brazil, Chile, Mexico, Peru). METHODS A previously published probabilistic model was adapted to adjust the number of pertussis cases reported to national surveillance systems by successive multiplication steps (proportion of pertussis cases seeking healthcare; proportion with a specimen collected; proportion sent for confirmatory testing; proportion positive for pertussis; proportion reported to passive surveillance). The proportions at each step were added in a random effects model to produce a pooled overall proportion, and a final multiplier was calculated as the simple inverse of this proportion. This multiplier was applied to the number of cases reported to surveillance to estimate the number of pertussis cases. Monte Carlo simulation with 10,000 iterations estimated median as well as upper and lower 90% values. Input data were obtained from surveillance systems and published sources. RESULTS The estimated median underestimation factor for pertussis cases in adults ranged from 104 (90% limits 40, 451) in Chile to 114 (90% limits 39, 419) in Argentina. In all five countries, the largest estimated number of cases was in the group aged 50-59 years. The highest number per 100,000 population was in the group aged ≥ 90 years in most countries. The estimated median underestimation factor for pertussis hospitalizations was 2.3 (90% limits 1.8, 3.3) in Brazil and 2.4 (90% limits 1.8, 3.2) in Chile (data not available for other countries). CONCLUSION This analysis indicates that the number of pertussis cases in adults aged ≥ 50 years in five Latin American countries is approximately 100 times higher than the number captured in surveillance data. These results could support decision-making in the diagnosis, management, and prevention of pertussis disease in adults.
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Affiliation(s)
| | | | | | | | | | - Javier Nieto-Guevara
- GSK, Oceania Business Plaza, Punta Pacifica, Torre 1000 Piso 34, Panama City, Panama.
- SNI-Senacyt Panama, Panama City, Panama.
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Callender M, Harvill ET. Maternal vaccination: shaping the neonatal response to pertussis. Front Immunol 2023; 14:1210580. [PMID: 37520565 PMCID: PMC10374427 DOI: 10.3389/fimmu.2023.1210580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Antepartum maternal vaccination can protect highly sensitive newborns before they are old enough to receive their own vaccines. Two vaccines are currently recommended during pregnancy: the flu vaccine and the Tdap vaccine against tetanus, diphtheria, and pertussis. Although there is strong evidence that maternal vaccination works to protect the offspring, limitations in the understanding of vaccines and of maternal transfer of immunity compound to obscure our understanding of how they work. Here we focus on the example of pertussis to explore the possible mechanisms involved in the transfer of protection to offspring and how these may impact the newborn's response to future exposure to pertussis. For example, Tdap vaccines induce pathogen specific antibodies, and those antibodies are known to be transferred from mother to the fetus in utero and to the newborn via milk. But antibodies alone have modest impact on pertussis disease, and even less effect on colonization/transmission. Maternal immune cells can also be transferred to offspring and may play a direct role in protection from disease and/or influence the developing neonatal immune system. However, some of the transferred immunity may also blunt the offspring's response to subsequent vaccination. In this review we will summarize the protection conferred to offspring by maternal vaccination against pertussis and the likely mechanisms by which protection is transferred, identifying the many knowledge gaps that limit our most effective application of this approach.
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Affiliation(s)
- Maiya Callender
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
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Wu D, Jing R, Zheng H, He K, Li Y, Yu W, Yin Z, Fang H. Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:666-675. [PMID: 36328326 DOI: 10.1016/j.jval.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017. METHODS We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges. RESULTS Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust. CONCLUSIONS Over the lifetime of 40 birth cohorts, China's immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.
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Affiliation(s)
- Dan Wu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Rize Jing
- School of Public Administration and Policy, Renmin University of China, Beijing, China; Health Science, Hospital Reform and Medical Big Data Liberal Arts and Sciences Cross Platform, Renmin University of China, Beijing, China
| | - Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kun He
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yixing Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenzhou Yu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China; Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China; Institute of Global Health and Development, Peking University, Beijing, China.
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6
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Wang M, Pan J, Li X, Li M, Liu Z, Zhao Q, Luo L, Chen H, Chen S, Jiang F, Zhang L, Wang W, Wang Y. ARIMA and ARIMA-ERNN models for prediction of pertussis incidence in mainland China from 2004 to 2021. BMC Public Health 2022; 22:1447. [PMID: 35906580 PMCID: PMC9338508 DOI: 10.1186/s12889-022-13872-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To compare an autoregressive integrated moving average (ARIMA) model with a model that combines ARIMA with the Elman recurrent neural network (ARIMA-ERNN) in predicting the incidence of pertussis in mainland China. Background The incidence of pertussis has increased rapidly in mainland China since 2016, making the disease an increasing public health threat. There is a pressing need for models capable of accurately predicting the incidence of pertussis in order to guide prevention and control measures. We developed and compared two models for predicting pertussis incidence in mainland China. Methods Data on the incidence of pertussis in mainland China from 2004 to 2019 were obtained from the official website of the Chinese Center for Disease Control and Prevention. An ARIMA model was established using SAS (ver. 9.4) software and an ARIMA-ERNN model was established using MATLAB (ver. R2019a) software. The performances of these models were compared. Results From 2004 to 2019, there were 104,837 reported cases of pertussis in mainland China, with an increasing incidence over time. The incidence of pertussis showed obvious seasonal characteristics, with the peak lasting from March to September every year. Compared with the mean squared error (MSE), mean absolute error (MAE), and mean absolute percentage error (MAPE) of the ARIMA model, those of the ARIMA-ERNN model were 81.43%, 95.97% and 80.86% lower, respectively, in fitting performance. In terms of prediction performance, the MAE, MSE and MAPE were 37.75%, 56.88% and 43.75% lower, respectively. Conclusion The fitting and prediction performances of the ARIMA-ERNN model were better than those of the ARIMA model. This provides theoretical support for the prediction of infectious diseases and should be beneficial to public health decision making.
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Affiliation(s)
- Meng Wang
- School of Public Health, Fudan University, Shanghai, 200032, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Jinhua Pan
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China.,Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Zhejiang University, Hangzhou, 310003, China
| | - Xinghui Li
- School of Public Health, Fudan University, Shanghai, 200032, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Mengying Li
- School of Public Health, Fudan University, Shanghai, 200032, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Zhixi Liu
- School of Public Health, Fudan University, Shanghai, 200032, China.,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Qi Zhao
- School of Public Health, Fudan University, Shanghai, 200032, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Linyun Luo
- China National Biotec Group Company Limited, Beijing, 100024, China
| | - Haiping Chen
- China National Biotec Group Company Limited, Beijing, 100024, China
| | - Sirui Chen
- Hunan Normal University, Hunan, 410081, China
| | - Feng Jiang
- Institute of Expanded Programme On Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guizhou Province, Guiyang, 550004, People's Republic of China
| | - Liping Zhang
- Minhang Center for Disease Control and Prevention, Shanghai, 201100, China
| | - Weibing Wang
- School of Public Health, Fudan University, Shanghai, 200032, China. .,Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, 200032, China.
| | - Ying Wang
- School of Public Health, Fudan University, Shanghai, 200032, China. .,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
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Gabutti G, Cetin I, Conversano M, Costantino C, Durando P, Giuffrida S. Experts' Opinion for Improving Pertussis Vaccination Rates in Adolescents and Adults: A Call to Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074412. [PMID: 35410091 PMCID: PMC8998413 DOI: 10.3390/ijerph19074412] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 12/25/2022]
Abstract
This article highlights the importance of diphtheria-tetanus-acellular pertussis (with reduced antigen content, dTap) vaccination in preventing pertussis, a respiratory infection that is still widespread and easily transmitted. In particular, it highlights the need to receive a booster vaccination throughout life to maintain high antibody levels, which decrease through time. This document collects the opinions that emerged from the comparison between major Italian experts in the field of vaccination. This working group was created to promote a "call to action", aimed at raising awareness among all institutions, public health authorities, and health workers involved in the vaccination process, about the importance of dTap vaccine administration and with the mindset of implementing the strategic vaccination plan provided by the National Vaccine Plan (NVP). In fact, despite this vaccine being included in the NVP, there are some issues attributable to the practice of vaccination (local health authorities, vaccination centers, occupational health services, gynecology centers, societies of work). Therefore, it is necessary that the Ministry defines the vaccination coverage objectives, identifies the groups of subjects who should receive the booster vaccine (subjects exposed to greater risk of infection, subjects over 60, pregnant women), and applies all the necessary measures to encourage the implementation of this practice.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, Section of Public Health Medicine, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-34-7888-9342
| | - Irene Cetin
- Obstetrics and Gynecology, Department “Woman, Mother and Child”—ASST Fatebenefratelli Sacco, Buzzi Children’ Hospital, University of Milan, 20157 Milan, Italy;
| | | | - Claudio Costantino
- Department of Health Promotion, Maternal and Child Care, Internal Medicine and Excellence Specialties, University of Palermo, 90133 Palermo, Italy;
| | - Paolo Durando
- Occupational Medicine, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Sandro Giuffrida
- Department of Prevention, Azienda Sanitaria Provinciale of Reggio Calabria, 89124 Reggio Calabria, Italy;
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8
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Hon KLE, Li YMJ, Leung AKC, Wong AHC, Leung KKY, Ng DKK. Childhood pertussis is still here: An Asian city's perspectives. Pediatr Pulmonol 2022; 57:796-799. [PMID: 35049154 DOI: 10.1002/ppul.25839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pertussis, or whooping cough, is a highly contagious respiratory infection that is caused by the bacterium Bordetella pertussis. It is one of the most common causes of death in childhood. It is also a frequent cause of chronic cough in children, adolescents, and adults. METHODS Global and Hong Kong perspectives of childhood pertussis were described. RESULTS Hong Kong has prided herself in the city's childhood immunization program. There appear to be no major outbreaks of pertussis since the 1960s. Nevertheless, pediatricians may see isolated cases of pertussis or pertussis-like cases from time to time. Occasionally, infants are severely affected with apneas and managed with ventilator supports in the PICU. Outbreaks of the notifiable disease continue to occur despite a reasonable surveillance system and vaccination program in Hong Kong. Vaccination of mothers, adolescents, and adults are efficacious methods to further reduce the risks of pertussis. Macrolides remain efficacious antibiotics especially used early during the infectious phase. Infants with pertussis may require intensive care support and morbidity is high. CONCLUSIONS Physicians should be reminded from time to time that outbreaks of pertussis still exist in Hong Kong and in many cities globally.
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Affiliation(s)
- Kam Lun E Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Yee Ming Jennifer Li
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Canada
| | - Karen Ka Yan Leung
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Daniel K K Ng
- Department of Paediatrics, Hong Kong Sanatorium & Hospital, Hong Kong
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Muloiwa R, Dube FS, Nicol MP, Hussey GD, Zar HJ. Co-detection of Bordetella pertussis and other respiratory organisms in children hospitalised with lower respiratory tract infection. Sci Rep 2020; 10:16412. [PMID: 33009451 PMCID: PMC7532201 DOI: 10.1038/s41598-020-73462-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022] Open
Abstract
Multiple potential pathogens are frequently co-detected among children with lower respiratory tract infection (LRTI). Evidence indicates that Bordetella pertussis has an important role in the aetiology of LRTI. We aimed to study the association between B. pertussis and other respiratory pathogens in children hospitalised with severe LRTI, and to assess clinical relevance of co-detection. Nasopharyngeal (NP) swabs and induced sputa (IS) were tested with a B. pertussis specific PCR; additionally, IS was tested for other pathogens using a multiplex PCR. We included 454 children, median age 8 months (IQR 4-18), 31 (7%) of whom tested positive for B. pertussis. Children with B. pertussis had more bacterial pathogens detected (3 versus 2; P < 0.001). While B. pertussis showed no association with most pathogens, it was independently associated with Chlamydia pneumoniae, Mycoplasma pneumoniae and parainfluenza viruses with adjusted risk ratios of 4.01 (1.03-15.64), 4.17 (1.42-12.27) and 2.13 (1.03-4.55), respectively. There was a consistent increased risk of severe disease with B. pertussis. Patterns indicated even higher risks when B. pertussis was co-detected with any of the three organisms although not statistically significant. Improving vaccine coverage against B. pertussis would impact not only the incidence of pertussis but also that of severe LRTI generally.
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Affiliation(s)
- Rudzani Muloiwa
- Department of Paediatrics and Child Health, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
| | - Felix S Dube
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Crawley, Australia
| | - Mark P Nicol
- Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Crawley, Australia
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gregory D Hussey
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Vaccines for Africa Initiative, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- SA-MRC Unit On Child and Adolescent Lung Health, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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10
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Guillot S, Mizrahi A, Armatys N, Chat L, Le Monnier A, Brisse S, Toubiana J. Low Detection Rate of Bordetella pertussis Using the BioFire FilmArray Respiratory Panel 2 plus. Open Forum Infect Dis 2020; 7:ofaa267. [PMID: 32793765 PMCID: PMC7415305 DOI: 10.1093/ofid/ofaa267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Syndromic respiratory panels are increasingly used worldwide. Their performance for detection of Bordetella pertussis needs to be evaluated. We found that the FilmArray Respiratory Panel 2plus (RP2+) assay, which uses the pertussis toxin promoter target for B. pertussis, can only detect highly charged samples. Negative RP2+ results should not be interpreted as an absence of B. pertussis in clinical samples.
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Affiliation(s)
- Sophie Guillot
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Assaf Mizrahi
- Clinical Microbiology Laboratory, Saint Joseph Hospital, Paris, France.,Institut Micalis, UMR1319, Université Paris-Saclay, INRAe, AgroParisTech, Bactéries Pathogènes et Santé, Chatenay-Malabry, France
| | - Nathalie Armatys
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Laureen Chat
- Clinical Microbiology Laboratory, Saint Joseph Hospital, Paris, France
| | - Alban Le Monnier
- Clinical Microbiology Laboratory, Saint Joseph Hospital, Paris, France.,Institut Micalis, UMR1319, Université Paris-Saclay, INRAe, AgroParisTech, Bactéries Pathogènes et Santé, Chatenay-Malabry, France
| | - Sylvain Brisse
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Julie Toubiana
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France.,General Paediatrics and Paediatric Infectious Diseases Department, Hôpital Necker-Enfants Malades, APHP, Université de Paris, Paris, France
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11
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Cost-effectiveness analysis of universal adult immunization with tetanus-diphtheria-acellular pertussis vaccine (Tdap) versus current practice in Brazil. Vaccine 2019; 38:46-53. [PMID: 31648911 DOI: 10.1016/j.vaccine.2019.09.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pertussis outbreak occurred in Brazil from 2011 to 2014, despite high coverage of whole-cell pertussis containing vaccines in early childhood. Infants were the most affected. This study aimed to evaluate the cost-effectiveness of introducing universal adult vaccination with Tdap into the National Immunization Program in Brazil. METHODS Economic evaluation using a dynamic model to compare two strategies: (1) universal vaccination with single dose of Tdap at 20 years of age and (2) current practice (only pregnant women pertussis vaccination). The health system perspective was adopted. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Vaccine effectiveness (VE) was obtained from a population-based observational study. Epidemiological, resource utilization and cost estimates were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS), based on life expectancy at birth in Brazil in 2015. Univariate and multivariate sensitivity analysis were performed. RESULTS Adult vaccination with VE of 82.6% and coverage of 40%, at price of US$7.01 per dose, and assuming herd protection would avoid 167 infant deaths by pertussis, saving 12,325 years of life and costing a total of US$105495891.61, from the health system perspective. The universal immunization would result in ICER of US$8459.13. The results were highly sensitive to disease incidence. CONCLUSIONS The results suggest that universal adult vaccination with Tdap would not be a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
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Zhu DD, Wang XL, Zhang XP, Ma JJ, Kong DL, Zhang MM, Guo XD, Wang C. A Dissolvable Microneedle Formulation of Bordetella pertussis Subunit Vaccine: Translational Development and Immunological Evaluation in Mice. ACS APPLIED BIO MATERIALS 2019; 2:5053-5061. [DOI: 10.1021/acsabm.9b00730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dan Dan Zhu
- Beijing Laboratory of Biomedical Materials, College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Xiao Li Wang
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, People's Republic of China
| | - Xiao Peng Zhang
- Beijing Laboratory of Biomedical Materials, College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Jing Jing Ma
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, People's Republic of China
| | - De Ling Kong
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, People's Republic of China
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, People's Republic of China
| | - Ming Ming Zhang
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, People's Republic of China
| | - Xin Dong Guo
- Beijing Laboratory of Biomedical Materials, College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Chun Wang
- Department of Biomedical Engineering, University of Minnesota, 7-105 Hasselmo Hall, 312 Church Street S.E., Minneapolis, Minnesota 55455, United States
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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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14
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Bakhshaei P, Kazemi MH, Golara M, Abdolmaleki S, Khosravi-Eghbal R, Khoshnoodi J, Judaki MA, Salimi V, Douraghi M, Jeddi-Tehrani M, Shokri F. Investigation of the Cellular Immune Response to Recombinant Fragments of Filamentous Hemagglutinin and Pertactin of Bordetella pertussis in BALB/c Mice. J Interferon Cytokine Res 2019; 38:161-170. [PMID: 29638208 DOI: 10.1089/jir.2017.0060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Vaccination with whole-cell or acellular (Ac) vaccines has been very effective for the control of pertussis. The immune response to Ac vaccines has been generally associated with a shift toward the Th2 profile. In the present study, overlapping recombinant fragments of filamentous hemagglutinin (FHA) and pertactin (PRN) were produced in Escherichia coli. BALB/c mice were immunized with recombinant FHA and PRN together with the native pertussis toxin and alum or CpG as adjuvant. Immunized mice were subsequently aerosol challenged with Bordetella pertussis. Bacterial growth was assessed in bronchoalveolar lavage samples and the levels of cytokines were quantitated in supernatants of stimulated splenocytes by enzyme-linked immunosorbent assay. Our results demonstrated that both PRN and FHA antigens were able to induce IFN-γ, IL-4, and to some extent IL-17 cytokines in challenged mice. The level of IFN-γ was higher in response to CpG formulated antigens. These findings indicate immunoprotective efficacy of our recombinant FHA and PRN antigens in mice.
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Affiliation(s)
- Peyman Bakhshaei
- 1 Department of Immunology, Tehran University of Medical Sciences , Tehran, Iran
| | | | - Maryam Golara
- 1 Department of Immunology, Tehran University of Medical Sciences , Tehran, Iran
| | - Sara Abdolmaleki
- 1 Department of Immunology, Tehran University of Medical Sciences , Tehran, Iran
| | - Roya Khosravi-Eghbal
- 1 Department of Immunology, Tehran University of Medical Sciences , Tehran, Iran
| | - Jalal Khoshnoodi
- 1 Department of Immunology, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohammad Ali Judaki
- 1 Department of Immunology, Tehran University of Medical Sciences , Tehran, Iran
| | - Vahid Salimi
- 2 Department of Virology, Tehran University of Medical Sciences , Tehran, Iran
| | - Masoumeh Douraghi
- 3 Department of Microbiology, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran
| | - Mahmood Jeddi-Tehrani
- 4 Hybridoma Department, Monoclonal Antibody Research Center, Avicenna Research Institute , ACECR, Tehran, Iran
| | - Fazel Shokri
- 1 Department of Immunology, Tehran University of Medical Sciences , Tehran, Iran .,4 Hybridoma Department, Monoclonal Antibody Research Center, Avicenna Research Institute , ACECR, Tehran, Iran
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Markey K, Asokanathan C, Feavers I. Assays for Determining Pertussis Toxin Activity in Acellular Pertussis Vaccines. Toxins (Basel) 2019; 11:toxins11070417. [PMID: 31319496 PMCID: PMC6669641 DOI: 10.3390/toxins11070417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 12/29/2022] Open
Abstract
Whooping cough is caused by the bacterium Bordetella pertussis. There are currently two types of vaccines that can prevent the disease; whole cell vaccines (WCV) and acellular vaccines (ACV). The main virulence factor produced by the organism is pertussis toxin (PTx). This toxin is responsible for many physiological effects on the host, but it is also immunogenic and in its detoxified form is the main component of all ACVs. In producing toxoid for vaccines, it is vital to achieve a balance between sufficiently detoxifying PTx to render it safe while maintaining enough molecular structure that it retains its protective immunogenicity. To ensure that the first part of this balancing act has been successfully achieved, assays are required to accurately measure residual PTx activity in ACV products accurately. Quality control assays are also required to ensure that the detoxification procedures are robust and stable. This manuscript reviews the methods that have been used to achieve this aim, or may have the potential to replace them, and highlights their continuing requirement as vaccines that induce a longer lasting immunity are developed to prevent the re-occurrence of outbreaks that have been observed recently.
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Affiliation(s)
- Kevin Markey
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK.
| | - Catpagavalli Asokanathan
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK
| | - Ian Feavers
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, UK
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16
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Moosa F, du Plessis M, Wolter N, Carrim M, Cohen C, von Mollendorf C, Walaza S, Tempia S, Dawood H, Variava E, von Gottberg A. Challenges and clinical relevance of molecular detection of Bordetella pertussis in South Africa. BMC Infect Dis 2019; 19:276. [PMID: 30898099 PMCID: PMC6429695 DOI: 10.1186/s12879-019-3869-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/04/2019] [Indexed: 11/30/2022] Open
Abstract
Background We assessed the utility of a multi-target, real-time PCR assay for Bordetella pertussis detection and diagnosis in patients with severe respiratory illness (SRI), influenza-like illness (ILI), and asymptomatic controls. Methods Real-time PCR detection of IS481, pIS1001, hIS1001 and ptxS1 was performed on nasopharyngeal specimens (SRI, ILI and controls) and induced sputum (SRI) collected from June 2012 to May 2016 through respiratory illness surveillance. Using PCR cycle threshold (Ct) value cut-offs, IS481 positive cases were classified as confirmed (Ct < 35) or possible (Ct 35–39) pertussis disease. Results Among 12,922 samples, 146 (1.1%) were IS481 positive of which 62% (90/146) were classified as confirmed. The attributable fraction (AF) was 92.2% (95% CI, 65.6 to 98.2%) and 90.5% (95% CI, 57.5 to 97.9%) amongst SRI and ILI PCR-confirmed pertussis cases, respectively. Amongst possible pertussis cases, AF was 36.9% (95% CI, − 142.3 to 83.6%) and 67.5% (95% CI, − 30.6 to 91.9%) in the SRI and ILI groups, respectively. Conclusion All IS481 positive specimens could be considered as B. pertussis infection, and potentially pertussis disease with supportive clinical information. Electronic supplementary material The online version of this article (10.1186/s12879-019-3869-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fahima Moosa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Maimuna Carrim
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Claire von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Halima Dawood
- Pietermaritzburg Metropolitan Hospitals, KwaZulu-Natal, and Caprisa, University of KwaZulu-Natal, Durban, South Africa
| | - Ebrahim Variava
- University of the Witwatersrand, Johannesburg, South Africa.,Klerksdorp-Tshepong Hospital, North West Province, Klerksdorp, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
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Fernandes EG, Rodrigues CCM, Sartori AMC, De Soárez PC, Novaes HMD. Economic evaluation of adolescents and adults' pertussis vaccination: A systematic review of current strategies. Hum Vaccin Immunother 2018; 15:14-27. [PMID: 30118618 PMCID: PMC6363086 DOI: 10.1080/21645515.2018.1509646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The reemergence of pertussis in the last two decades led to the introduction of adolescents and adults immunization strategies of tetanus–diphtheria–acellular pertussis vaccines (Tdap) in several countries. The health authorities must consider economic aspects when deciding to recommend and fund new programs. Here we present a systematic review of worldwide full economic evaluations of pertussis vaccination targeting adolescents or adults published from 2000. Studies were identified by searching MEDLINE, Excerpta Medica, CRD, and Lilacs databases. Twenty-seven economic evaluations of different strategies with Tdap were identified. Booster vaccination for adolescents and adults were the most frequent, followed by cocooning and pregnant women vaccination. Strategies performance varied considerably among different studies. Assumptions regarding underreporting correction, herd protection and vaccine coverage were crucial to cost-effectiveness results. Understanding the model and the parameters used is essential to understand the results, and identify the major issues important to public health decisions.
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Affiliation(s)
- Eder Gatti Fernandes
- a Departamento de Medicina Preventiva , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil.,b Divisão de Imunização, Centro de Vigilância Epidemiológica "Prof. Alexandre Vranjac" , Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde de São Paulo , São Paulo , SP , Brazil
| | - Camila Cristina Martini Rodrigues
- c Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
| | - Ana Marli Christovam Sartori
- c Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
| | - Patrícia Coelho De Soárez
- a Departamento de Medicina Preventiva , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brazil
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18
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Crowcroft NS, Johnson C, Chen C, Li Y, Marchand-Austin A, Bolotin S, Schwartz K, Deeks SL, Jamieson F, Drews S, Russell ML, Svenson LW, Simmonds K, Mahmud SM, Kwong JC. Under-reporting of pertussis in Ontario: A Canadian Immunization Research Network (CIRN) study using capture-recapture. PLoS One 2018; 13:e0195984. [PMID: 29718945 PMCID: PMC5931792 DOI: 10.1371/journal.pone.0195984] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Under-reporting of pertussis cases is a longstanding challenge. We estimated the true number of pertussis cases in Ontario using multiple data sources, and evaluated the completeness of each source. Methods We linked data from multiple sources for the period 2009 to 2015: public health reportable disease surveillance data, public health laboratory data, and health administrative data (hospitalizations, emergency department visits, and physician office visits). To estimate the total number of pertussis cases in Ontario, we used a three-source capture-recapture analysis stratified by age (infants, or aged one year and older) and adjusting for dependency between sources. We used the Bayesian Information Criterion to compare models. Results Using probable and confirmed reported cases, laboratory data, and combined hospitalizations/emergency department visits, the estimated total number of cases during the six-year period amongst infants was 924, compared with 545 unique observed cases from all sources. Using the same sources, the estimated total for those aged 1 year and older was 12,883, compared with 3,304 observed cases from all sources. Only 37% of infants and 11% for those aged 1 year and over admitted to hospital or seen in an emergency department for pertussis were reported to public health. Public health reporting sensitivity varied from 2% to 68% depending on age group and the combination of data sources included. Sensitivity of combined hospitalizations and emergency department visits varied from 37% to 49% and of laboratory data from 1% to 50%. Conclusions All data sources contribute cases and are complementary, suggesting that the incidence of pertussis is substantially higher than suggested by routine reports. The sensitivity of different data sources varies. Better case identification is required to improve pertussis control in Ontario.
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Affiliation(s)
- Natasha S. Crowcroft
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | | | | | - Ye Li
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Shelly Bolotin
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kevin Schwartz
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Frances Jamieson
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven Drews
- ProvLab Alberta, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | - Lawrence W. Svenson
- Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kimberley Simmonds
- Alberta Health, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Salaheddin M. Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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19
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Fernandes EG, Sartori AMC, de Soárez PC, Carvalhanas TRMP, Rodrigues M, Novaes HMD. Challenges of interpreting epidemiologic surveillance pertussis data with changing diagnostic and immunization practices: the case of the state of São Paulo, Brazil. BMC Infect Dis 2018. [PMID: 29534683 PMCID: PMC5851154 DOI: 10.1186/s12879-018-3004-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background A significant increase in pertussis incidence occurred in Brazil, from 2011 to 2014, despite high coverage of childhood immunization with whole-cell-pertussis (wP) containing vaccines. This study presents pertussis surveillance data from São Paulo state and discusses the challenges to interpret them considering pertussis cyclic epidemic behavior, the introduction of new diagnostic techniques and new vaccination strategies, and enhanced disease awareness during epidemics. Methods Observational study including pertussis cases reported to the Surveillance System in São Paulo state, from January 2001 to December 2015. Pertussis cases data were retrieved from the National Notifiable Diseases Information System (SINAN) website and from São Paulo state Epidemiological Surveillance Center (CVE/SP) database. Vaccination coverage and homogeneity data were collected from the Unified Health System Department of Informatics (DATASUS). We presented cases distribution by year, age group and diagnostic criteria and calculated pertussis incidence rates. The proportions of cases among different age groups were compared using chi-square test for trend. Results Infants less than 1 year of age were the most affected during the whole period, but the proportions of cases in this age group had a significant decreasing trend, with significant increase in the proportions of cases reported among older age groups (1–4, 5–10 and ≥20 years). Cases among infants aged less than 6 months represented ≥90% of all cases in children less than 1 year of age in all but 2 years (2012 and 2015). A non-significant decrease in the proportion of cases among infants aged < 2 months was observed in parallel to a significant increase in the proportion of cases in infants aged 6–11 months. Conclusions A pertussis outbreak has occurred in a state with universal use of wP vaccine. The disease cyclic behavior has probably had a major role in the increased incidence rates registered in São Paulo state, from 2011 to 2014, as well as in the decreased incidence in 2015. Maternal vaccination cannot explain the drop in the number of cases among all age groups, in 2015, as herd protection is not expected, but may have had an impact on the number of cases in infants aged < 2 months.
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Affiliation(s)
- Eder Gatti Fernandes
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 2°andar, sala 2228, CEP, São Paulo, SP, 01246-903, Brazil. .,Divisão de Imunização, Centro de Vigilância Epidemiológica "Prof. Alexandre Vranjac", Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde de São Paulo, Av. Dr Arnaldo, 351, 6° andar, Pacaembu, São Paulo, SP, 01246-000, Brazil.
| | - Ana Marli Christovam Sartori
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, ICHC,4°andar, sala 4028 Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 2°andar, sala 2228, CEP, São Paulo, SP, 01246-903, Brazil
| | - Telma Regina M P Carvalhanas
- Divisão de Doenças de Transmissão Respiratória, Centro de Vigilância Epidemiológica "Prof. Alexandre Vranjac", Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde de São Paulo, Av. Dr Arnaldo, 351, 6° andar, Pacaembu, São Paulo, SO, 01246-000, Brazil
| | - Marcela Rodrigues
- Divisão de Doenças de Transmissão Respiratória, Centro de Vigilância Epidemiológica "Prof. Alexandre Vranjac", Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde de São Paulo, Av. Dr Arnaldo, 351, 6° andar, Pacaembu, São Paulo, SO, 01246-000, Brazil
| | - Hillegonda Maria Dutilh Novaes
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 2°andar, sala 2228, CEP, São Paulo, SP, 01246-903, Brazil
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20
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Heil J, Ter Waarbeek HLG, Hoebe CJPA, Jacobs PHA, van Dam DW, Trienekens TAM, Cals JWL, van Loo IHM, Dukers-Muijrers NHTM. Pertussis surveillance and control: exploring variations and delays in testing, laboratory diagnostics and public health service notifications, the Netherlands, 2010 to 2013. ACTA ACUST UNITED AC 2018; 22:30571. [PMID: 28749331 PMCID: PMC5545763 DOI: 10.2807/1560-7917.es.2017.22.28.30571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/22/2017] [Indexed: 11/20/2022]
Abstract
Pertussis is most severe among unvaccinated infants (< 1 year of age), and still leads to several reported deaths in the Netherlands every year. In order to avoid pertussis-related infant morbidity and mortality, pertussis surveillance data are used to guide pertussis control measures. However, more insight into the accuracy of pertussis surveillance and control, and into the range of healthcare and public health-related factors that impede this are needed. We analysed a unique combination of data sources from one Dutch region of 1.1 million residents, including data from laboratory databases and local public health notifications between 2010 and 2013. This large study (n = 12,090 pertussis tests) reveals possible misdiagnoses, substantial under-notification (18%, 412/2,301 laboratory positive episodes) and a delay between patient symptoms and notification to the local public health services (median 34 days, interquartile range (IQR): 27–54). It is likely that the misdiagnoses, under-notification and overall delay in surveillance data are not unique to this area of the Netherlands, and are generalisable to other countries in Europe. In addition to preventive measures such as maternal immunisation, based on current findings, we further recommend greater adherence to testing guidelines, standardisation of test interpretation guidelines, use of automatic notification systems and earlier preventive measures.
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Affiliation(s)
- Jeanne Heil
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Henriëtte L G Ter Waarbeek
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Peter H A Jacobs
- Department of Infectious Diseases Control, North Limburg Public Health Service, Venlo, the Netherlands
| | - Dirk W van Dam
- Department of Medical Microbiology and Infection Prevention, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Thera A M Trienekens
- Department of Medical Microbiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Jochen W L Cals
- Department of General Practice, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Inge H M van Loo
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.,Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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21
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Campbell PT, McVernon J, McIntyre P, Geard N. Influence of Population Demography and Immunization History on the Impact of an Antenatal Pertussis Program. Clin Infect Dis 2017; 63:S213-S220. [PMID: 27838675 PMCID: PMC5106613 DOI: 10.1093/cid/ciw520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background. Antenatal pertussis vaccination is being considered as a means to reduce the burden of infant pertussis in low- and middle-income countries (LMICs), but its likely impact in such settings is yet to be quantified. Methods. An individual-based model was used to simulate the demographic structure and dynamics of a population with characteristics similar to those of LMICs. Transmission of pertussis within this population was simulated to capture the incidence of infection in (1) the absence of vaccination; (2) with a primary course only (three doses of diphtheria, tetanus, and pertussis vaccines [DTP3] commencing in 1985, 1995, or 2005 at 20%, 50%, or 80% coverage); and (3) with the addition of an antenatal pertussis program. Results. Modeled annual incidence averaged over the period 2015–2024 reduced with increasing DTP3 coverage, regardless of the year childhood vaccination commenced. Over the same period, the proportion of infants born with passive protection did not change substantially compared with the prevaccination situation, regardless of DTP3 coverage and start year. We found minimal impact of antenatal vaccination on infection in all infants when mothers were eligible for a single antenatal dose. When mothers were eligible for multiple antenatal doses, incidence in infants aged 0–2 months was reduced by around 30%. This result did not hold for the full 0- to 1-year age group, for whom antenatal vaccination did not reduce infection levels. Conclusions. While antenatal vaccination could potentially reduce infant mortality in LMICs, broader gains at the population level are likely to be achieved by focusing efforts on increasing DTP3 coverage.
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Affiliation(s)
- Patricia Therese Campbell
- Melbourne School of Population and Global Health, University of Melbourne.,Infection and Immunity, Murdoch Childrens Research Institute, Royal Children's Hospital
| | - Jodie McVernon
- Melbourne School of Population and Global Health, University of Melbourne.,Infection and Immunity, Murdoch Childrens Research Institute, Royal Children's Hospital.,Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, New South Wales, Australia
| | - Nicholas Geard
- Melbourne School of Population and Global Health, University of Melbourne
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22
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Nunes MC, Soofie N, Downs S, Tebeila N, Mudau A, de Gouveia L, Madhi SA. Comparing the Yield of Nasopharyngeal Swabs, Nasal Aspirates, and Induced Sputum for Detection of Bordetella pertussis in Hospitalized Infants. Clin Infect Dis 2017; 63:S181-S186. [PMID: 27838671 PMCID: PMC5106614 DOI: 10.1093/cid/ciw521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background. Advances in molecular laboratory techniques are changing the landscape of Bordetella pertussis illness diagnosis. Polymerase chain reaction (PCR) assays have greatly improved the sensitivity detection and the turnaround time to diagnosis compared to culture. Moreover, different respiratory specimens, such as flocked nasopharyngeal swabs (NPSs), nasopharyngeal aspirates (NPAs), and induced sputum, have been used for B. pertussis detection, although there is limited head-to-head comparison to evaluating the PCR yield from the 3 sampling methods. Methods. Hospitalized infants <6 months of age who fulfilled a broad syndromic criteria of respiratory illness were tested for B. pertussis infection by PCR on paired NPSs and NPAs; or paired NPSs and induced sputum. An exploratory analysis of B. pertussis culture was performed on induced sputum specimens and in a subset of NPSs. Results. From November 2014 to May 2015, 484 infants with paired NPSs and NPAs were tested; 15 (3.1%) PCR-confirmed pertussis cases were identified, 13 of which were PCR positive on both samples, while 1 each were positive only on NPS or NPA. From March to October 2015, 320 infants had NPSs and induced sputum collected, and 11 (3.4%) pertussis cases were identified by PCR, including 8 (72.7%) positive on both samples, 1 (9.1%) only positive on NPS, and 2 (18.2%) only positive on induced sputum. The 3 types of specimens had similar negative predictive value >99% and sensitivity >83%. Compared to PCR, culture sensitivity was 60% in induced sputum and 40% in NPSs. Conclusions. Flocked nasopharyngeal swabs, nasopharyngeal aspirates, and induced sputum performed similarly for the detection of B. pertussis infection in young infants by PCR.
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Affiliation(s)
- Marta C Nunes
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand
| | - Nasiha Soofie
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand
| | - Sarah Downs
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand
| | - Naume Tebeila
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand
| | - Azwi Mudau
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand
| | - Linda de Gouveia
- National Institute for Communicable Diseases, National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Shabir A Madhi
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.,National Institute for Communicable Diseases, National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
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23
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Fedele G, Leone P, Bellino S, Schiavoni I, Pavia C, Lazzarotto T, Stefanelli P. Diagnostic performance of commercial serological assays measuring Bordetella pertussis IgG antibodies. Diagn Microbiol Infect Dis 2017; 90:157-162. [PMID: 29221733 DOI: 10.1016/j.diagmicrobio.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/26/2017] [Accepted: 11/08/2017] [Indexed: 11/24/2022]
Abstract
Due to their specificity to B. pertussis antigens, immunoglobulin G (IgG) antibodies should be measured primarily for diagnosing pertussis. We compared the diagnostic performance of commercially available enzyme-linked immunosorbent assays (ELISAs) and chemiluminescent immunoassays (CLIAs) measuring IgG to B. pertussis antigens. An in-house ELISA with purified pertussis toxin (PT) was used as reference system. Commercial assays using PT only as coating antigen showed better performance as compared to those using a mixture of different antigens. The best diagnostic performances were achieved by CLIAs. Results were analyzed using a dual cutoff of either ≥125IU/mL anti-PT IgG or ≥62IU/mL anti-PT IgG for the in-house ELISA and accordingly to package inserts for commercial assays. Using the in-house ELISA at a 62 IU/mL cutoff, as the gold standard for interpretation of results from the commercial kits, resulted in lower sensitivity and higher specificity as compared to 125IU/mL, thus, it may be especially useful in outbreak situations when high specificity is required.
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Affiliation(s)
- Giorgio Fedele
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Pasqualina Leone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Bellino
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Schiavoni
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Claudia Pavia
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Tiziana Lazzarotto
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi Polyclinic, Bologna, Italy; Department of Specialized, Experimental, and Diagnostic Medicine, St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
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24
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Campbell PT, McVernon J, Geard N. Determining the Best Strategies for Maternally Targeted Pertussis Vaccination Using an Individual-Based Model. Am J Epidemiol 2017; 186:109-117. [PMID: 28453607 DOI: 10.1093/aje/kwx002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/08/2016] [Indexed: 12/13/2022] Open
Abstract
Rising pertussis incidence has prompted a number of countries to implement maternally targeted vaccination strategies to protect vulnerable infants, but questions remain about the optimal design of such strategies. We simulated pertussis transmission within an individual-based model parameterized to match Australian conditions, explicitly linking infants and their mothers to estimate the effectiveness of alternative maternally targeted vaccination strategies (antenatal delivery vs. postnatal delivery) and the benefit of revaccination over the course of multiple pregnancies. For firstborn infants aged less than 2 months, antenatal immunization reduced annual pertussis incidence by 60%, from 780 per 100,000 firstborn children under age 2 months (interquartile range (IQR), 682-862) to 315 per 100,000 (IQR, 260-370), while postnatal vaccination produced a minimal reduction, with an incidence of 728 per 100,000 (IQR, 628-789). Subsequent infants obtained limited protection from a single antenatal dose, but revaccinating mothers during every pregnancy decreased incidence for these infants by 58%, from 1,878 per 100,000 subsequent children under age 2 months (IQR, 1,712-2,076) to 791 per 100,000 (IQR, 683-915). Subsequent infants also benefited from household-level herd immunity when antenatal vaccination for every pregnancy was combined with a toddler booster dose at age 18 months; incidence was reduced to 626 per 100,000 (IQR, 548-691). Our approach provides useful information to aid consideration of alternative maternally targeted vaccination strategies and can inform development of outcome measures for program evaluation.
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25
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Pertussis diagnosis in Belgium: results of the National Reference Centre for Bordetella anno 2015. Epidemiol Infect 2017; 145:2366-2373. [PMID: 28578723 DOI: 10.1017/s0950268817001108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2015, the Belgian National Reference Centre for Bordetella analyzed 4110 respiratory samples by qPCR and 4877 serum samples by serology. Whereas about 50% of respiratory samples were from infants and children below the age of five, serum samples were distributed among all age categories. A total of 394 (9·6%) cases was diagnosed as positive for Bordetella pertussis by qPCR and 844 (17·3%) cases were diagnosed as acute infection by serology (anti-pertussis toxin (PT) IgG > 125 IU/ml). Another 1042 (21·4%) sera had anti-PT IgG between 55 and 125 IU/ml reflecting a vaccination or pertussis infection during the last 1-2 years. Seventy per cent of the pertussis cases diagnosed by qPRC were in infants and children younger than 14 years old, whereas the highest number of sera with anti-PT levels >125 IU/ml was in the age group of 10-14 years old. Based on the limited data of the last vaccination (reported for only 15% of the samples), recent booster vaccination in the teenager group may have contributed only minimally to these elevated anti-PT levels. The highest number of sera with anti-PT titers between 55 and 125 IU/ml was found in the age category 50-59 years old. It is clear that pertussis continues to be a problem in Belgium and that other vaccination strategies (maternal vaccination, cocoon vaccination) and ultimately better vaccines will be needed to control this highly infectious respiratory disease.
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26
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Moore A, Ashdown HF, Shinkins B, Roberts NW, Grant CC, Lasserson DS, Harnden A. Clinical Characteristics of Pertussis-Associated Cough in Adults and Children: A Diagnostic Systematic Review and Meta-Analysis. Chest 2017; 152:353-367. [PMID: 28511929 DOI: 10.1016/j.chest.2017.04.186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pertussis (whooping cough) is a highly infective cause of cough that causes significant morbidity and mortality. Existing case definitions include paroxysmal cough, whooping, and posttussive vomiting, but diagnosis can be difficult. We determined the diagnostic accuracy of clinical characteristics of pertussis-associated cough. METHODS We systematically searched CINAHL, Embase, Medline, and SCI-EXPANDED/CPCI-S up to June 2016. Eligible studies compared clinical characteristics in those positive and negative for Bordetella pertussis infection, confirmed by laboratory investigations. Two authors independently completed screening, data extraction, and quality and bias assessments. For each characteristic, RevMan was used to produce descriptive forest plots. The bivariate meta-analysis method was used to generate pooled estimates of sensitivity and specificity. RESULTS Of 1,969 identified papers, 53 were included. Forty-one clinical characteristics were assessed for diagnostic accuracy. In adult patients, paroxysmal cough and absence of fever have a high sensitivity (93.2% [CI, 83.2-97.4] and 81.8% [CI, 72.2-88.7], respectively) and low specificity (20.6% [CI, 14.7-28.1] and 18.8% [CI, 8.1-37.9]), whereas posttussive vomiting and whooping have low sensitivity (32.5% [CI, 24.5-41.6] and 29.8% [CI, 8.0-45.2]) and high specificity (77.7% [CI, 73.1-81.7] and 79.5% [CI, 69.4-86.9]). Posttussive vomiting in children is moderately sensitive (60.0% [CI, 40.3-77.0]) and specific (66.0% [CI, 52.5-77.3]). CONCLUSIONS In adult patients, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children, posttussive vomiting is much less helpful as a clinical diagnostic test.
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Affiliation(s)
- Abigail Moore
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
| | - Helen F Ashdown
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Nia W Roberts
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Daniel S Lasserson
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Anthony Harnden
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
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27
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Prevalence, diagnosis, and disease course of pertussis in adults with acute cough: a prospective, observational study in primary care. Br J Gen Pract 2016; 65:e662-7. [PMID: 26412843 PMCID: PMC4582879 DOI: 10.3399/bjgp15x686917] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Most cases of adult pertussis probably remain undiagnosed. Aim To explore the prevalence, diagnosis, and disease course of acute pertussis infection in adult patients presenting with acute cough. Design and setting Prospective observational study between 2007 and 2010 in primary care in 12 European countries. Method Adults presenting with acute cough (duration of ≤28 days) were included. Bordetella pertussis infection was determined by polymerase chain reaction (from nasopharyngeal flocked swabs and sputa) and by measurement of immunoglobulin G antibodies to pertussis toxin (PT) in venous blood at day 28. An antibody titre to PT of ≥125 IU/ml or PCR positive result in a respiratory sample defined recent infection. Patients completed a symptom diary for 28 days. Results Serum and/or respiratory samples were obtained in 3074 patients. Three per cent (93/3074) had recent B. pertussis infection. Prior cough duration >2 weeks discriminated to some extent between those with and without pertussis (adjusted odds ratio 1.89, 95% confidence interval = 1.17 to 3.07; P = 0.010). Median cough duration after presentation was 17 and 12 days in patients with and without pertussis, respectively (P = 0.008). Patients with pertussis had longer duration of phlegm production (P = 0.010), shortness of breath (P = 0.037), disturbed sleep (P = 0.013) and interference with normal activities or work (P = 0.033) after presentation. Conclusion Pertussis infection plays a limited role among adults presenting with acute cough in primary care, but GPs should acknowledge the possibility of pertussis in uncomplicated lower respiratory tract infection. As in children, pertussis also causes prolonged symptoms in adults. However, pertussis is difficult to discern from other acute cough syndromes in adults at first presentation.
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28
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Abstract
BACKGROUND The increase in the incidence of whooping cough (pertussis) in many countries with high vaccination coverage is alarming. Maternal pertussis immunization has been proposed as an effective means of protecting newborns during the interval between birth and the first routine dose. However, there are concerns regarding potential interference between maternal antibodies and the immune response elicited by the routine schedule, with possible long-term population-level effects. METHODS We formulated a transmission model comprising both primary routine and maternal immunization. This model was examined to evaluate the long-term epidemiological effects of routine and maternal immunization, together with consequences of potential immune interference scenarios. RESULTS Overall, our model demonstrates that maternal immunization is an effective strategy in reducing the incidence of pertussis in neonates prior to the onset of the primary schedule. However, if maternal antibodies lead to blunting, incidence increases among older age groups. For instance, our model predicts that with 60% routine and maternal immunization coverage and 30% blunting, the incidence among neonates (0-2 months) is reduced by 43%. Under the same scenario, we observe a 20% increase in incidence among children aged 5-10 years. However, the downstream increase in the older age groups occurs with a delay of approximately a decade or more. CONCLUSIONS Maternal immunization has clear positive effects on infant burden of disease, lowering mean infant incidence. However, if maternally derived antibodies adversely affect the immunogenicity of the routine schedule, we predict eventual population-level repercussions that may lead to an overall increase in incidence in older age groups.
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Affiliation(s)
- Ana I Bento
- Odum School of Ecology
- Center for the Ecology of Infectious Diseases
| | - Pejman Rohani
- Odum School of Ecology
- Center for the Ecology of Infectious Diseases
- Department of Infectious Diseases, University of Georgia, Athens
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29
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Blackwood JC, Cummings DAT, Iamsirithaworn S, Rohani P. Using age-stratified incidence data to examine the transmission consequences of pertussis vaccination. Epidemics 2016; 16:1-7. [PMID: 27663785 PMCID: PMC5292824 DOI: 10.1016/j.epidem.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 02/09/2016] [Accepted: 02/16/2016] [Indexed: 11/27/2022] Open
Abstract
Pertussis is a highly infectious respiratory disease that has been on the rise in many countries worldwide over the past several years. The drivers of this increase in pertussis incidence remain hotly debated, with a central and long-standing hypothesis that questions the ability of vaccines to eliminate pertussis transmission rather than simply modulate the severity of disease. In this paper, we present age-structured case notification data from all provinces of Thailand between 1981 and 2014, a period during which vaccine uptake rose substantially, permitting an evaluation of the transmission impacts of vaccination. Our analyses demonstrate decreases in incidence across all ages with increased vaccine uptake - an observation that is at odds with pertussis case notification data in a number of other countries. To explore whether these observations are consistent with a rise in herd immunity and a reduction in bacterial transmission, we analyze an age-structured model that incorporates contrasting hypotheses concerning the immunological and transmission consequences of vaccines. Our results lead us to conclude that the most parsimonious explanation for the combined reduction in incidence and the shift to older age groups in the Thailand data is vaccine-induced herd immunity.
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Affiliation(s)
- J C Blackwood
- Department of Mathematics and Statistics, Williams College, Williamstown, MA 01267, USA.
| | - D A T Cummings
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - S Iamsirithaworn
- Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Thailand
| | - P Rohani
- Odum School of Ecology, University of Georgia, Athens, GA 30606, USA; Department of Infectious Diseases, School of Veterinary Medicine, University of Georgia, Athens, GA 30606, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
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30
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Damm O, Witte J, Wetzka S, Prosser C, Braun S, Welte R, Greiner W. Epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany: a systematic review. Int J Public Health 2016; 61:847-60. [PMID: 27488917 PMCID: PMC5002040 DOI: 10.1007/s00038-016-0842-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/21/2016] [Accepted: 06/02/2016] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Despite the availability of vaccines and the existence of public vaccination recommendations, outbreaks of vaccine-preventable childhood diseases still cause public health debate. The objective of this systematic review was to provide an overview of the current epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany. METHODS We systematically reviewed studies published since 2000. The literature search was conducted using PubMed and EMBASE. Also, we used German notification data to give an up-to-date overview of the epidemiology of the four diseases under consideration. RESULTS Thirty-six studies were included in our review. Results suggest that there is still considerable morbidity due to childhood diseases in Germany. Studies providing cost estimates are scarce. Comparative analyses of different data sources (notification data vs. claims data) revealed a potential underestimation of incidence estimates when using notification data. Furthermore, several studies showed regional differences in incidence of some of the diseases under consideration. CONCLUSIONS Our findings underline the need for improved vaccination and communication strategies targeting all susceptible age and risk groups on a national and local level.
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Affiliation(s)
- Oliver Damm
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Julian Witte
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Stefanie Wetzka
- GlaxoSmithKline Germany, Prinzregentenplatz 9, 81675, Munich, Germany
| | | | | | - Robert Welte
- GlaxoSmithKline Germany, Prinzregentenplatz 9, 81675, Munich, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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31
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Wu DX, Chen Q, Shen KL. [Recent progress in clinical research on pertussis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:897-902. [PMID: 27655551 PMCID: PMC7389973 DOI: 10.7499/j.issn.1008-8830.2016.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pertussis is a highly contagious respiratory disease. Despite the high vaccination coverage, re-emergence of pertussis has been reported in many countries over the past two decades. With the increase in the incidence of pertussis, there has been a shift in the epidemiological features: an increased incidence of pertussis has been noted in older children and adults, who normally lack typical clinical manifestations, and who may be easily missed according to current diagnostic references for pertussis. In order to achieve better prevention and treatment of pertussis, this review article summarized the recent research progress in the epidemiology, clinical features, etiology, diagnosis, treatment, and prevention of pertussis, particularly focusing on the diagnosis of pertussis in older children and adults.
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Affiliation(s)
- Dan-Xia Wu
- Department of Respiratory Diseases, Jiangxi Provincial Children's Hospital, Nanchang 330006, China.
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32
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Incidence and Diagnosis of Pertussis in South African Children Hospitalized With Lower Respiratory Tract Infection. Pediatr Infect Dis J 2016; 35:611-6. [PMID: 26967813 DOI: 10.1097/inf.0000000000001132] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of pertussis in children in low- and middle-income countries is poorly described. This study aimed to prospectively investigate the incidence of pertussis in South African children hospitalized with lower respiratory tract infection (LRTI). METHODS Children hospitalized with LRTI in Cape Town, South Africa were enrolled over 1 year. Clinical data were collected. A nasopharyngeal (NP) swab and induced sputum (IS) were taken, and polymerase chain reaction specific for Bordetella pertussis (IS481+/hIS1001-) and Bordetella parapertussis (IS1001+) was performed. RESULTS A total of 460 children with median age 8 [interquartile range (IQR), 4-18] months were studied. B. pertussis was detected in 17 (3.7%) while total Bordetella spp. were identified on 23 (5.0 %) of 460 NP. Adding IS testing increased the identification of B. pertussis to 32 of 460 cases (7.0%; 95% confidence interval, 4.8%-9.7%); P = 0.028 and total Bordetella to 41 of 460 (8.9%; 95% confidence interval, 4-10%); P = 0.020. Shorter duration of symptoms [median 2 (IQR, 2-3) days versus 5 (IQR, 3-7) days; P = 0.0008] was associated with detection of B. pertussis on IS versus NP. B. pertussis was detected in 15.8% (n=3/19) of HIV-infected children, 10.9% (n = 10/92) of HIV exposed uninfected and 5.4% (n = 19/349) of HIV-unexposed uninfected children. Risk of B. pertussis decreased with each additional dose of diphtheria, tetanus and acellular pertussis vaccine [0 doses = 17.9%; 1 dose = 7.0%; 2 doses = 6.9%; and >3 doses = 6.2%]. CONCLUSIONS Pertussis is common in South African children hospitalized with LRTI particularly if HIV exposed or infected but decreases sequentially with vaccination doses. Polymerase chain reaction on IS specimen provides confirmation earlier than NP while increasing overall diagnostic yield.
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Moore A, Ashdown HF, Harnden A. Pertussis has low prevalence in adults with acute cough and is difficult to distinguish clinically from other causes. EVIDENCE-BASED MEDICINE 2016; 21:116. [PMID: 26849886 DOI: 10.1136/ebmed-2015-110353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Abigail Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Helen F Ashdown
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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He H, Yao P, Zhou Y, Deng X, Pan J. Is Pertussis Infection Neglected in China? Evidence from a Seroepidemiology Survey in Zhejiang, an Eastern Province of China. PLoS One 2016; 11:e0155965. [PMID: 27223467 PMCID: PMC4880341 DOI: 10.1371/journal.pone.0155965] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/07/2016] [Indexed: 11/19/2022] Open
Abstract
Background The resurgence of pertussis has occurred in many countries. However, the epidemiological profiles of pertussis cannot be well understood by the current surveillance system in China. This study was designed to investigate the age specific serologic evidence of antibodies against pertussis, and to offer information regarding the existence of pertussis infection in Zhejiang Province, China. Methods A cross-sectional serosurvey was carried out in 6 counties of Zhejiang Province during September and October of 2014. The immunoglobulin G-pertussis toxin (IgG-PT) levels were measured quantitatively with a commercially available enzyme-linked immunosorbent assay (ELISA). The antibody activities were expressed in the Food and Drug Administration (FDA)-U/ml and a level ≥30 FDA-U/ml was considered seropositive. An IgG-PT >80 FDA-U/ml indicated recent pertussis infection if the patient had not received immunization with the pertussis vaccine within the last year. Results The mean IgG-PT seropositivity rate among the 2107 subjects was 33.32% with a geometric mean concentration of 17.73 (95% confidence interval: 16.90–18.60) FDA-U/ml. The difference in the seropositivity rates reached significant means among the different age groups (waldχ2 = 198.41, P<0.0005), and children aged 3 years had the highest percentage (63.24%) of undetectable IgG-PT level. Of the 1707 subjects ≥3 years of age, 169 (9.90%) had evidence of a recent infection. The highest proportion of IgG-PT levels ≥80 FDA-U/ml was found in ≥60 years age group followed by 11–15 and 16–25 years age groups. Conclusions This study indicates the rather lower IgG-PT level sustained 1 year after the acellular pertussis vaccine booster dose, and substantial proportion of population susceptibility to pertussis in Zhejiang Province, China. Moreover, pertussis infection is not uncommon; it was estimated that 10% of subjects were recently infected approximately within the last 100 days. We highly suggest that the surveillance capacity should be strengthened and consider introducing booster dose that protect against pertussis in 6 years old children.
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Affiliation(s)
- Hanqing He
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Pingping Yao
- Department of Microbiology Lab, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yang Zhou
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xuan Deng
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jinren Pan
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail:
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Caboré RN, Piérard D, Huygen K. A Belgian Serosurveillance/Seroprevalence Study of Diphtheria, Tetanus and Pertussis Using a Luminex xMAP Technology-Based Pentaplex. Vaccines (Basel) 2016; 4:vaccines4020016. [PMID: 27171114 PMCID: PMC4931633 DOI: 10.3390/vaccines4020016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/24/2016] [Accepted: 04/25/2016] [Indexed: 11/22/2022] Open
Abstract
Serosurveillance and seroprevalence studies are an essential tool to monitor vaccine-preventable diseases. We have developed a magnetic bead-based pentaplex immunoassay (MIA) for the simultaneous detection of IgG antibodies against diphtheria toxin (DT), tetanus toxin (TT), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (Prn). The in-house pentaplex MIA showed a good correlation with commercial ELISAs with correlation coefficients between 0.89 for PT and 0.98 for TT. Intra- and inter-assay variability was <10%. A total of 670 anonymized serum samples collected in 2012 in Belgian adults (ages 20–29.9 years) were analyzed. Geometric mean concentrations (GMC) were 0.2 (0.13–0.29) IU/mL for DT, 0.63 (0.45–0.82) IU/mL for TT, 3.9 (2.6–5.8) IU/mL for PT, 16.3 (11.7–22.7) IU/mL for FHA and 15.4 (10.1–23.6) IU/mL for Prn. Antibody concentrations were below the protective level of 0.1 IU/mL in 26.4% of the sera for DT and in 8.6% of the sera for TT. Anti-PT IgG concentrations indicative of recent pertussis infection (>125 IU/mL) were detected in 1.2% of the subjects. High anti-PT antibodies were not correlated with high antibodies against any of the four other vaccine antigens. This pentaplex MIA will be used for a new large-scale Belgian serosurveillance/seroprevalence study of diphtheria, tetanus and pertussis.
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Affiliation(s)
- Raissa Nadège Caboré
- National Reference Centre Bordetella and Toxigenic Corynebacteria, Service Immunology, Scientific Institute of Public Health (WIV-ISP, Site Ukkel), 1180 Brussels, Belgium.
| | - Denis Piérard
- National Reference Centre Bordetella and Toxigenic Corynebacteria, University Hospital VUB, UZ Brussels, 1090 Jette, Belgium.
| | - Kris Huygen
- National Reference Centre Bordetella and Toxigenic Corynebacteria, Service Immunology, Scientific Institute of Public Health (WIV-ISP, Site Ukkel), 1180 Brussels, Belgium.
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Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil. Vaccine 2016; 34:1531-1539. [DOI: 10.1016/j.vaccine.2016.02.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 11/18/2022]
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van Wijhe M, McDonald SA, de Melker HE, Postma MJ, Wallinga J. Effect of vaccination programmes on mortality burden among children and young adults in the Netherlands during the 20th century: a historical analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:592-598. [PMID: 26873665 DOI: 10.1016/s1473-3099(16)00027-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND In the 20th century, childhood mortality decreased rapidly, and vaccination programmes are frequently suggested as a contributing factor. However, quantification of this contribution is subject to debate or absent. We present historical data from the Netherlands that allow us to quantify the reduction in childhood mortality burden for vaccine-preventable diseases in this period as a function of vaccination coverage. METHODS We retrieved cause-specific and age-specific historical mortality data from Statistics Netherlands from 1903 to 2012 (for Dutch birth cohorts born from 1903 to 1992), and data for vaccination coverage since the start of vaccination programmes from the Dutch Health Care Inspectorate and the Dutch National Institute for Public Health and the Environment. We also obtained birth and migration data from Statistics Netherlands. We used a restricted mean life-time method to estimate cause-specific mortality burden among children and young adults for each birth cohort as the years of life lost up to age 20 years, excluding migration as a variable because this did not affect the results. To correct for long-term trends, we calculated the cause-specific contribution to the total childhood mortality burden. FINDINGS In the prevaccination era, the contribution to mortality burden was fairly constant for diphtheria (1·4%), pertussis (3·8%), and tetanus (0·1%). Around the start of mass vaccinations, these contributions to the mortality burden decreased rapidly to near zero. We noted similar patterns for poliomyelitis, mumps, and rubella. The number of deaths due to measles around the start of vaccination in the Netherlands were too few to detect an accelerated rate of decrease after mass vaccinations were started. We estimate that mass vaccination programmes averted 148 000 years of life lost up to age 20 years (95% prediction interval 110 000-201 000) among children born before 1992. This corresponds to about 9000 deaths averted (6000-12 000). INTERPRETATION Our historical time series analysis of mortality and vaccination coverage shows a strong association between increasing vaccination coverage and diminishing contribution of vaccine-preventable diseases to overall mortality. This analysis provides further evidence that mass vaccination programmes contributed to lowering childhood mortality burden. FUNDING Dutch Ministry of Health, Welfare and Sport.
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Affiliation(s)
- Maarten van Wijhe
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Unit of PharmacoEpidemiology & PharmacoEconomics (PE(2)), Department of Pharmacy, University of Groningen, Groningen, Netherlands.
| | - Scott A McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE(2)), Department of Pharmacy, University of Groningen, Groningen, Netherlands; Institute of Science in Healthy Aging & health caRE (SHARE), University Medical Center Groningen, Groningen, Netherlands
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands
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Sakakibara Y, Ohtani Y, Jinta T, Fujie T, Miyazaki Y, Inase N, Saito R, Akaza M, Sasano T, Sumi Y. Concentrations of Immunoglobulin G Antibodies Against Pertussis Toxin Does Not Decrease Over a Long Period of Time in Japan. Intern Med 2016; 55:3257-3263. [PMID: 27853066 PMCID: PMC5173491 DOI: 10.2169/internalmedicine.55.6973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Adult patients with pertussis rarely show typical symptoms, such as paroxysmal coughing, inspiratory "whoop", or post-tussive vomiting. While a culture is regarded as the gold standard for diagnosis, the sensitivity is very low. Therefore, the diagnosis of pertussis in adults in clinical practice is mostly based on single-sample serology using an enzyme-linked immunosorbent assay (ELISA) with the pertussis toxin antigen. Various cut-off values for the anti-pertussis toxin IgG (PT-IgG) have been proposed. It has been reported that concentrations of PT-IgG fall below the defined cut-off about 4.5 months after infection on average, and within 1 year in most patients. We investigated the distribution and time course of the PT-IgG levels. Methods The data were collected from the medical records. Patients The study retrospectively identified subjects who had visited Ikebukuro Otani Clinic, which is a specialized clinic for patients with cough. We retrospectively reviewed 406 patients with PT-IgG measurements to investigate the age distribution of PT-IgG levels. The changes in PT-IgG levels over time were assessed in the 205 patients who had more than one PT-IgG measurement. Results PT-IgG levels were ≥100 EU/mL in more than 15% of subjects. The PT-IgG levels of a few subjects had diminished over a long period of time. Conclusion A PT-IgG level greater than the defined cut-off value simply indicates past infection or immunization in most subjects. As such, a single measurement of PT-IgG using the cut-off values might lead to overdiagnosis of pertussis. Further data collection and analysis are required.
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Affiliation(s)
- Yumi Sakakibara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
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Lima M, Estay SA, Fuentes R, Rubilar P, Broutin H, Chowell-Puente G. Whooping cough dynamics in Chile (1932-2010): disease temporal fluctuations across a north-south gradient. BMC Infect Dis 2015; 15:590. [PMID: 26714644 PMCID: PMC4696083 DOI: 10.1186/s12879-015-1292-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 11/24/2015] [Indexed: 11/24/2022] Open
Abstract
Background The spatial-temporal dynamics of Bordetella pertussis remains as a highly interesting case in infectious disease epidemiology. Despite large-scale vaccination programs in place for over 50 years around the world, frequent outbreaks are still reported in many countries. Methods Here, we use annual time series of pertussis incidence from the thirteen different regions of Chile (1952–2010) to study the spatial-temporal dynamics of Pertussis. The period 1975–1995 was characterized by a strong 4 year cycle, while the last two decades of the study period (1990–2010) were characterized by disease resurgence without significant periodic patterns. Results During the first decades, differences in periodic patterns across regions can be explained by the differences in susceptible recruitment. The observed shift in periodicity from the period 1952–1974 to the period 1975–1995 across regions was relatively well predicted by the susceptible recruitment and population size. However, data on vaccination rates was not taken into account in this study. Conclusions Our findings highlight how demography and population size have interacted with the immunization program in shaping periodicity along a unique latitudinal gradient. Widespread B. pertussis vaccination appears to lead to longer periodic dynamics, which is line with a reduction in B. pertussis transmission, but our findings indicate that regions characterized by both low birth rate and population size decreased in periodicity following immunization efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1292-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mauricio Lima
- Departamento de Ecología, Pontificia Universidad Católica de Chile, Casilla 114-D, Santiago, 6513677, Chile. .,Center of Applied Ecology and Sustainability (CAPES), Santiago, Chile.
| | - Sergio A Estay
- Center of Applied Ecology and Sustainability (CAPES), Santiago, Chile. .,Inst. de Ecología y Evolución, Facultad de Ciencias. Univ. Austral de Chile, Casilla 567, Valdivia, Chile.
| | - Rodrigo Fuentes
- Departamento de Epidemiologia, Ministerio de Salud, Santiago, Chile.
| | - Paola Rubilar
- Departamento de Epidemiologia, Ministerio de Salud, Santiago, Chile.
| | - Hélène Broutin
- MIVEGEC, UMR CNRS 5290-IRD 224-UM1-UM2, 911, Avenue Agropolis BP 64501, 34394, Montpellier Cédex 5, France.
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Abstract
Pertussis remains a challenging public health problem with many aspects of infection, disease and immunity poorly understood. Initially controlled by mass vaccination, pertussis resurgence has occurred in some countries with well-established vaccination programs, particularly among adolescents and young adults. Several studies have used mathematical models to investigate drivers of pertussis epidemiology and predict the likely impact of different vaccination strategies. We reviewed a number of these models to evaluate their suitability to answer questions of public health importance regarding optimal vaccine scheduling. We critically discuss the approaches adopted and the impact of chosen model structures and assumptions on study conclusions. Common limitations were a lack of contemporary, population relevant data for parameterization and a limited understanding of the relationship between infection and disease. We make recommendations for future model development and suggest epidemiologic data collections that would facilitate efforts to reduce uncertainty and improve the robustness of model-derived conclusions.
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Key Words
- AIC, Akaike information criterion
- E, infected but not yet infectious compartment
- I, infectious compartment
- POLYMOD, European Union funded project
- R, removed/immune compartment
- S, susceptible compartment
- UK, United Kingdom
- US, United States
- W, waned immunity compartment
- WAIFW, who acquires infection from whom
- WHO, World Health Organization
- infectious disease dynamics
- mathematical modeling
- pertussis
- transmission
- vaccines
- λ or FOI, force of infection
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Affiliation(s)
- Patricia T Campbell
- a Melbourne School of Population and Global Health; The University of Melbourne ; Parkville , Australia
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Maertens K, Caboré RN, Huygen K, Hens N, Van Damme P, Leuridan E. Pertussis vaccination during pregnancy in Belgium: Results of a prospective controlled cohort study. Vaccine 2015; 34:142-50. [PMID: 26592142 DOI: 10.1016/j.vaccine.2015.10.100] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/18/2015] [Accepted: 10/23/2015] [Indexed: 11/15/2022]
Abstract
Vaccination during pregnancy has been recommended in some countries as a means to protect young infants from severe infection. Nevertheless, many aspects are still unknown and possible blunting of the infant's immune responses by maternal antibodies, is one of the concerns with maternal vaccination. We report the first prospective controlled cohort study in women and infants on the effects of using Boostrix(®), a combined tetanus, diphtheria and acellular pertussis vaccine, during pregnancy. The primary aim was to measure the influence of this booster dose on the titer and duration of the presence of maternal antibodies in the infants and assess possible interference with infant immune responses. In a controlled cohort study, 57 pregnant women were vaccinated with Tdap vaccine (Tetanus Diphtheria acellular Pertussis, Boostrix, GSK Biologicals), at a mean gestational age of 28.6 weeks. A control group of pregnant women (N=42) received no vaccine. Antibody geometric mean concentrations (GMCs) against tetanus (TT), diphtheria (DT), pertussis toxin (PT), filamentous haemagglutinin (FHA) and pertactin (Prn) were measured with commercial ELISA tests in samples taken preceding maternal vaccination and one month afterwards, at delivery and from the cord blood, and in infants before and 1 month after the primary series of 3 pertussis containing hexavalent vaccines. Infants born to vaccinated women had significantly higher GMC at birth and during the first 2 months of life for all vaccine antigens compared to the offspring of unvaccinated women, thereby closing the susceptibility gap for pertussis in infants. However, blunting was noticed for infant diphtheria and pertussis toxin vaccine responses (p<0.001) in the infants from vaccinated women after the primary vaccination schedule (weeks 8,12 and 16). Since pertussis vaccination has been recommended during pregnancy already, the results of this study support that recommendation and provide additional scientific evidence to document possible interference by maternal antibodies.
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Affiliation(s)
- Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
| | - Raïssa Nadège Caboré
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Kris Huygen
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Hasselt University, Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
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Hoang HTT, Leuridan E, Maertens K, Nguyen TD, Hens N, Vu NH, Caboré RN, Duong HT, Huygen K, Van Damme P, Dang AD. Pertussis vaccination during pregnancy in Vietnam: Results of a randomized controlled trial Pertussis vaccination during pregnancy. Vaccine 2015; 34:151-9. [PMID: 26529073 DOI: 10.1016/j.vaccine.2015.10.098] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/14/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
A pertussis vaccination during pregnancy has recently been adopted in several countries to indirectly protect young infants. This study assessed the effect of adding a pertussis component to the tetanus vaccination, in the pregnancy immunization program in Vietnam. A randomized controlled trial was performed. Pregnant women received either a Tdap (tetanus, diphtheria acellular pertussis) vaccine or a tetanus only vaccine between 19 and 35 weeks' gestational age. Immunoglobulin G (IgG) against tetanus (TT), diphtheria (DT), pertussis toxin (PT), filamentous hemaglutinin (FHA) and pertactin (Prn) were measured using commercial ELISA tests, at baseline, 1 month after maternal vaccination, at delivery, and in infants from cord blood and before and after the primary series (EPI: month 2-3-4) of a pertussis containing vaccine. Significantly higher geometric mean concentrations (GMC) were observed for all 3 measured pertussis antigens in the offspring of the Tdap group, up to 2 months of age. One month after completion of the primary infant vaccination schedule, anti-Prn GMC, but not anti-PT and anti-FHA GMCs, was significantly (p=0.006) higher in the control group. Maternal antibodies induced by vaccination during pregnancy close the susceptibility gap for pertussis in young infants. Limited interference with the infant vaccine responses was observed. Whether this interference effect disappears with the administration of a fourth vaccine dose is further studied.
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Affiliation(s)
- Ha Thi Thu Hoang
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam.
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Trung Dac Nguyen
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belguim; Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerpen, Belgium
| | - Ngoc Ha Vu
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Raissa Nadège Caboré
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), 1180 Brussels, Belgium
| | - Hong Thi Duong
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam
| | - Kris Huygen
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), 1180 Brussels, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam.
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Campbell PT, McCaw JM, McIntyre P, McVernon J. Defining long-term drivers of pertussis resurgence, and optimal vaccine control strategies. Vaccine 2015; 33:5794-5800. [PMID: 26392008 DOI: 10.1016/j.vaccine.2015.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/26/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
Pertussis resurgence has been reported from several developed countries with long-standing immunisation programs. Among these, Australia in 2003 discontinued an 18 months (fourth) booster dose in favour of an adolescent (fifth) dose. We developed a model to evaluate determinants of resurgence in Australia and alternative vaccine strategies for mitigation. Novel characteristics of our model included the use of seroepidemiologic data for calibration, and broad investigation of variables relevant to transmission of, and protection against, pertussis. We simulated multiple parameter combinations, retaining those consistent with observed data for subsequent use in predictive models comparing alternative vaccination schedules. Reproducing the early control of pertussis followed by late resurgence observed in Australia required natural immunity to last decades longer than vaccine-acquired immunity, with mean duration exceeding 50 years in almost 90% of simulations. Replacement of the dose at 18 months with an adolescent dose in 2003 resulted in a 40% increase in infections in the age group 18-47 months by 2013. A six dose strategy (2, 4, 6, 18 months, 4 and 15 years) yielded a reduction in infection incidence (pre-school 43%, infants 8%) greater than any alternative strategies considered for timing of five administered doses. Our finding that natural immunity drives long-term trends in pertussis cycles is relevant to a range of pertussis strategies and provides the necessary context in which to consider maternal vaccination. Comparatively short-lived vaccine-acquired immunity requires multiple boosters over the first two decades of life to maximise reduction in infections.
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Affiliation(s)
- Patricia Therese Campbell
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Royal Childrens Hospital, Parkville, Australia.
| | - James Matthew McCaw
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Royal Childrens Hospital, Parkville, Australia; School of Mathematics and Statistics, The University of Melbourne, Parkville, Australia.
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, Australia.
| | - Jodie McVernon
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Royal Childrens Hospital, Parkville, Australia.
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Estimated and reported incidence of pertussis in Estonian adults: A seroepidemiological study. Vaccine 2015; 33:4756-61. [DOI: 10.1016/j.vaccine.2015.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/13/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022]
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Calderón TA, Coffin SE, Sammons JS. Preventing the Spread of Pertussis in Pediatric Healthcare Settings. J Pediatric Infect Dis Soc 2015; 4:252-9. [PMID: 26407429 DOI: 10.1093/jpids/piu056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/09/2014] [Indexed: 11/13/2022]
Abstract
The surge in pertussis incidence in recent years underscores a critical need for effective plans to prevent transmission in pediatric healthcare settings. Adolescents and adults are common sources of infection for unimmunized or incompletely immunized infants and children with waning immunity. Despite documented outbreaks being limited in size, pertussis poses a threat to pediatric healthcare facilities due to the risk for widespread transmission, potentially severe complications among vulnerable patient populations, and high outbreak control-related costs. Healthcare personnel, visitors, and parents have been identified as sources of outbreaks, underscoring the importance of coordinated efforts to prevent transmission in these settings. This comprehensive review demonstrates that the risk of pertussis transmission in pediatric healthcare settings warrants heightened focus on strategies to recognize disease earlier, improve diagnostic evaluation, and facilitate effective contact tracing and post-exposure prophylaxis measures. This review suggests that healthcare personnel can play a significant role in the prevention of healthcare-associated pertussis.
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Affiliation(s)
- Tirza A Calderón
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Susan E Coffin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Pediatrics and Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Pennsylvania
| | - Julia S Sammons
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Pediatrics and Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Pennsylvania
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Seroepidemiology of pertussis among elementary school children in northern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:327-332. [PMID: 26318350 DOI: 10.1016/j.jmii.2015.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/07/2015] [Accepted: 07/23/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE Pertussis has been considered a vaccine-preventable "childhood disease", but a shift in age distribution has been reported worldwide. We conducted a seroepidemiological study in 2013 in Taiwan to elucidate the seroprevalence of pertussis among elementary school children. METHODS With a multilevel randomized method, which included 14 variables (4 population variables, 4 socio-educational variables, and 6 medical facilities' variables), the 29 executive districts of New Taipei City, Taiwan, were categorized into five strata. From each stratum, the number of school children as well as the number of elementary schools were proportionally selected. Enzyme immunoassay was applied for pertussis immunoglobulin-G measurement. RESULTS A total of 936 children from 14 schools were recruited. Most participants (98.89%) received at least three doses of acellular diphtheria-tetanus-pertussis vaccine. The overall seropositive rate for pertussis was 33.97%. The seropositive rate was highest for students in Grade 1 (49.36%) and then declined with time, except for Grade 6 students. Students from Grade 1 to Grade 4 had a significant higher seropositive rate (37.18% vs. 27.56%, p = 0.002) than those from Grade 5 to Grade 6, but a lower geometric mean titer (18.71 NovaTec Unit/mL vs. 20.04 NovaTec Unit/mL, p = 0.20). For the class grades, geometric mean titers were positively correlated with seroprevalence (p < 0.005). CONCLUSION Currently, almost one-third of elementary school children in Taiwan were seropositive for pertussis, a rate lower than expected. Seroprevalence declined with increasing class grades except for Grade 6. The current national immunization program may not provide adequate protection for children against pertussis.
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Bolotin S, Deeks SL, Marchand-Austin A, Rilkoff H, Dang V, Walton R, Hashim A, Farrell D, Crowcroft NS. Correlation of Real Time PCR Cycle Threshold Cut-Off with Bordetella pertussis Clinical Severity. PLoS One 2015; 10:e0133209. [PMID: 26186564 PMCID: PMC4505870 DOI: 10.1371/journal.pone.0133209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 06/24/2015] [Indexed: 11/18/2022] Open
Abstract
Bordetella pertussis testing performed using real-time polymerase chain reaction (RT-PCR) is interpreted based on a cycle threshold (Ct) value. At Public Health Ontario Laboratories (PHOL), a Ct value <36 is reported as positive, and Ct values ≥36 and <40 are reported as indeterminate. PHOL reported indeterminate results to physicians and public health units until May 2012, after which these results were only reported to physicians. We investigated the association between Ct value and disease symptom and severity to examine the significance of indeterminate results clinically, epidemiologically and for public health reporting. B. pertussis positive and indeterminate RT-PCR results were linked to pertussis cases reported in the provincial Integrated Public Health Information System (iPHIS), using deterministic linkage. Patients with positive RT-PCR results had a lower median age of 10.8 years compared to 12.0 years for patients with indeterminate results (p = 0.24). Hospitalized patients had significantly lower Ct values than non-hospitalized patients (median Ct values of 20.7 vs. 31.6, p<0.001). The proportion of patients reporting the most indicative symptoms of pertussis did not differ between patients with positive vs. indeterminate RT-PCR results. Taking the most indicative symptoms of pertussis as the gold-standard, the positive predictive value of the RT-PCR test was 68.1%. RT-PCR test results should be interpreted in the context of the clinical symptoms, age, vaccination status, prevalence, and other factors. Further information on interpretation of indeterminate RT-PCR results may be needed, and the utility of reporting to public health practitioners should be re-evaluated.
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Affiliation(s)
- Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alex Marchand-Austin
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Vica Dang
- Public Health Ontario, Toronto, Ontario, Canada
| | - Ryan Walton
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - David Farrell
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Nataprawira HM, Phangkawira E. A retrospective study of acute pertussis in Hasan Sadikin Hospital–Indonesia. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(15)30025-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pertussis prevalence and its determinants among children with persistent cough in urban Uganda. PLoS One 2015; 10:e0123240. [PMID: 25874411 PMCID: PMC4398436 DOI: 10.1371/journal.pone.0123240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We determined prevalence of pertussis infection and its associated host and environmental factors to generate information that would guide strategies for disease control. METHODS In a cross-sectional study, 449 children aged 3 months to 12 years with persistent cough lasting ≥14 days were enrolled and evaluated for pertussis using DNA polymerase chain reaction (PCR) and ELISA serology tests. RESULTS Pertussis prevalence was 67 (15% (95% Confidence Interval (CI): 12-18)) and 81 (20% (95% CI: 16-24)) by PCR and ELISA, respectively among 449 participating children. The prevalence was highest in children with >59 months of age despite high vaccination coverage of 94% in this age group. Study demographic and clinical characteristics were similar between pertussis and non-pertussis cases. Of the 449 children, 133 (30%) had a coughing household member and 316 (70%) did not. Among 133 children that had a coughing household member, sex of child, sharing bed with a coughing household member and having a coughing individual in the neighborhood were factors associated with pertussis. Children that had shared a bed with a coughing household individual had seven-fold likelihood of having pertussis compared to children that did not (odds ratio (OR) 7.16 (95% CI: 1.24-41.44)). Among the 316 children that did not have a coughing household member, age <23 months, having or contact with a coughing individual in neighborhood, a residence with one room, and having a caretaker with >40 years of age were the factors associated with pertussis. Age <23months was three times more likely to be associated with pertussis compared to age 24-59 months (OR 2.97 (95% CI: 1.07-8.28)). CONCLUSION Findings suggest high prevalence of pertussis among children with persistent cough at a health facility and it was marked in children >59 months of age, suggesting the possibility of waning immunity. The factors associated with pertussis varied by presence or absence of a coughing household member.
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Kovac M, Rathi N, Kuriyakose S, Hardt K, Schwarz TF. Immunogenicity and reactogenicity of a decennial booster dose of a combined reduced-antigen-content diphtheria-tetanus-acellular pertussis and inactivated poliovirus booster vaccine (dTpa-IPV) in healthy adults. Vaccine 2015; 33:2594-601. [PMID: 25882172 DOI: 10.1016/j.vaccine.2015.03.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/24/2015] [Accepted: 03/31/2015] [Indexed: 09/30/2022]
Abstract
BACKGROUND Pertussis in adults and adolescents could be reduced by replacing traditional tetanus and diphtheria (Td) boosters with reduced-antigen-content diphtheria-tetanus-acellular pertussis (dTpa) vaccines. This study evaluated the administration of dTpa-IPV (dTpa-inactivated poliovirus) in adults ten years after they received a booster dose of either dTpa-IPV, dTpa+IPV or Td-IPV in trial NCT01277705. METHODS Open multicentre, phase IV study (www.clinicaltrials.govNCT01323959) in which healthy adults, who had received a previous dose of dTpa-IPV, dTpa+IPV or Td-IPV ten years earlier, received a single decennial booster dose of dTpa-IPV (Boostrix-polio, GlaxoSmithKline Vaccines). Blood samples were collected before and one month after booster vaccination. Antibody concentrations against all vaccine antigens were measured and reactogenicity and safety were assessed. RESULTS A total of 211 subjects (mean age 50.3 years) received vaccination of whom 201 were included in the according-to-protocol cohort for immunogenicity. Before the decennial dTpa-IPV booster, ≥71.0% subjects were seroprotected/seropositive against all vaccine antigens. One month after the booster dose, all subjects were seroprotected against tetanus and poliovirus types 2 and 3; ≥95.7% subjects were seroprotected against diphtheria and ≥98.3% against poliovirus type 1. Anti-pertussis booster responses for the various antigens were observed in ≥76.5% (pertussis toxoid; PT), ≥85.1% (filamentous haemagglutinin; FHA) and ≥63.2% (pertactin; PRN) of subjects. During the 4-day follow-up, the overall incidence of local AEs was 71.6%, 75.0% and 72.2% in dTpa-IPV, dTpa+IPV and Td-IPV groups, respectively. Pain was the most frequent solicited local adverse event (AE; ≥62.7% subjects) and fatigue the most frequent solicited general AE (≥18.5%). No serious AEs were reported during the study. CONCLUSION A booster dose of dTpa-IPV was immunogenic and well tolerated in adults who had received a booster dose of either dTpa-IPV, dTpa+IPV or Td-IPV, ten years previously and supports the repeated administration of dTpa-IPV.
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Affiliation(s)
| | | | | | | | - Tino F Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Würzburg, Germany.
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