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Li W, Wang H, Teng S, Sun Y, Jia Q, Qi Z, Wang L, Yang Z, Zhao S. Association between real-time polymerase chain reaction cycle threshold value and clinical presentation in children with Bordetella pertussis. Ital J Pediatr 2024; 50:173. [PMID: 39256818 PMCID: PMC11389257 DOI: 10.1186/s13052-024-01753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/31/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND The cycle threshold (Ct) value is inversely proportional to the number of copies of the target region in a sample, suggesting that a low Ct value indicates a high pathogen load. The relationship between Ct value and clinical presentation in children with pertussis is not well-defined. METHODS We investigated the relationships between the Ct value of nasopharyngeal samples positive for Bordetella pertussis deoxyribonucleic acid via real-time polymerase chain reaction (PCR), collected from children on admission and their adult family members between May 2022 and March 2024 at Hangzhou Children's Hospital, China. The study focused on the correlation between Ct value and clinical presentation in children with pertussis. RESULTS The Ct value was positively correlated with age (r = 0.362, P = 0.001). The mean Ct value for children with pertussis was 28.0 (range: 22.0-32.0), which was lower than the 32.0 (range: 30.0-34.0) observed in adults. Ct value was inversely correlated with length of stay, an indicator of disease severity (r = -0.356, P = 0.001). Logistic regression analyses revealed that both Ct value (OR: 0.891, 95% CI: 0.799-0.993, P = 0.036) and white blood cell count (OR: 1.127, 95% CI: 1.005-1.263, P = 0.040) were independently associated with severity of pertussis. CONCLUSIONS Real-time PCR Ct values at initial diagnosis for pertussis may potentially predict severe disease outcomes in children.
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Affiliation(s)
- Wen Li
- Department of Pediatric Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, Zhejiang, China
| | - Huaping Wang
- Department of Pediatric Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, Zhejiang, China
| | - Shu Teng
- Department of Pediatric Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, Zhejiang, China
| | - Yalin Sun
- Department of Pediatric Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, Zhejiang, China
| | - Qi Jia
- Department of Pediatric Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, Zhejiang, China
| | - Zhenghong Qi
- Department of Pediatric Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, Zhejiang, China.
| | - Lingbo Wang
- Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhangnv Yang
- Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Shiyong Zhao
- Department of Pediatric Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, Zhejiang, China
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Thuy Nga DT, Thi Bich Thuy P, Ainai A, Takayama I, Huong DT, Saitoh A, Nakagawa S, Minh Dien T, Nakajima N, Saitoh A. Association Between Real-time Polymerase Chain Reaction Cycle Threshold Value and Clinical Severity in Neonates and Infants Infected With Bordetella pertussis. Pediatr Infect Dis J 2022; 41:388-393. [PMID: 35093999 DOI: 10.1097/inf.0000000000003471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Polymerase chain reaction (PCR) is highly sensitive and is thus the standard method for diagnosing pertussis. Real-time PCR is widely used because of its accuracy and the simplicity of the simultaneous cycle threshold (Ct) value, which represents the copy numbers of the target gene. Little is known of the association of Ct value with pertussis severity in neonates and infants. METHODS This study determined Ct values in neonates and infants diagnosed with pertussis by real-time PCR using nasopharyngeal samples at Vietnam National Children's Hospital in Hanoi in 2017 and 2019. The association of disease severity and clinical parameters were analyzed using univariate and multivariate analyses. RESULTS We evaluated 108 patients with pertussis [median age: 63 days, interquartile range (IQR): 41-92 days]. Only 6/108 (6%) received at least 1 dose of a pertussis-containing vaccine. Among them, 24 (22.2%) had severe disease requiring care in a pediatric intensive care unit, 16 (13.8%) required mechanical ventilation, and 3 (2.6%) died. The median Ct value was lower in patients with severe disease (19.0, IQR: 16.5-22.0, n = 24) than in those without severe disease (25.5, IQR: 20.0-30.0, n = 84) (P = 0.002). Logistic regression analyses demonstrated that PCR Ct value [odds ratio (OR): 1.783, 95% confidence interval (CI): 1.013-3.138, P = 0.045], age (OR: 3.118, 95% CI: 1.643-5.920, P = 0.001), and white blood cell counts (OR: 0.446, 95% CI: 0.261-0.763, P = 0.003) remained significantly associated with severe disease. CONCLUSIONS Real-time PCR Ct values for pertussis might be useful as a predictor of severe disease in neonates and infants.
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Affiliation(s)
- Do Thi Thuy Nga
- From the Division of General Internal Medicine, The Center for Tropical Diseases, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Phung Thi Bich Thuy
- Department of Molecular Biology for Infectious Disease, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Akira Ainai
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ikuyo Takayama
- Center for Influenza and Respiratory Virus Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Do Thu Huong
- Department of Molecular Biology for Infectious Disease, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Aya Saitoh
- Department of Nursing, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoshi Nakagawa
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tran Minh Dien
- Surgical Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Noriko Nakajima
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Jiang W, Chen S, Xu L, Xu X, Huang L, Wang Y, Hao C. Presence of Cytomegalovirus Infection Is Associated With an Unfavorable Outcome in Immunocompetent Infants With Pertussis. Front Cell Infect Microbiol 2022; 12:800452. [PMID: 35252027 PMCID: PMC8895427 DOI: 10.3389/fcimb.2022.800452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background We aimed to examine cytomegalovirus (CMV) infection in immunocompetent infants with pertussis, based on polymerase chain reaction in plasma and broncho alveolar lavage (BAL), and to assess the clinical characteristics and outcomes for these patients. Methods We performed a prospective observational cohort study of consecutive infants with pertussis in Children’s Hospital of Soochow University between Jan 2017 and Jan 2020. We report the burden of CMV PCR in plasma and BAL within this patient group, and evaluate associations between CMV infection and pertussis in these hospitalized infants. Results During the study period, 1,867 infants <1 years were evaluated for pertussis, 190 infants were diagnosed as pertussis. For the 190 pertussis patients, 38 (20.0%) patients had positive CMV PCR in plasma. CMV PCR in plasma had high sensitivity and specificity for CMV PCR in BAL (81.3% and 94.4%, respectively). Children with positive CMV PCR in plasma were 3.67 times more likely to present with severe disease (OR 3.67; CI 1.61-8.36). Comparisons of duration of hospital stay curves using the log-rank test statistic demonstrated that the relative risk of longer hospital stay of positive CMV PCR relative to negative CMV was 1.51 (95% CI: 1.05 to 2.14, P = 0.01). Conclusions Our study reported a high prevalence of CMV reactivation in immunocompetent infants with lower respiratory tract infection. The presence of CMV in plasma may be associated with an unfavorable outcome in infants with pertussis.
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Affiliation(s)
| | | | | | | | | | - Yuqing Wang
- *Correspondence: Yuqing Wang, ; Chuangli Hao,
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Ghasemnejad A, Bazmara S, Shadmani M, Bagheri KP. Designing a New Multi-Epitope Pertussis Vaccine with Highly Population Coverage Based on a Novel Sequence and Structural Filtration Algorithm. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2021; 18:1885-1892. [PMID: 31831431 DOI: 10.1109/tcbb.2019.2958803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pertussis vaccine is produced from physicochemically inactivated toxin for many years. Recent advancements in immunoinformatics [N. Tomar and R. K. De, "Immunoinformatics: an integrated scenario," Immunology, vol. 131, no. 2, pp. 153-168, 2010] and structural bioinformatics can provide a new multidisciplinary approach to overcome the concerns including unwanted antibodies and incomplete population coverage. In this study we focused on solving the challenging issues by designing a multi-epitope vaccine (MEV) using rational bioinformatics analyses. The frequencies of All HLA DP, DQ, and DR alleles were evaluated in almost all countries. Strong binder surface epitopes on the pertussis toxin were selected based on our novel filtration strategy. Finally, the population coverage of MEV was determined in the candidate country. Filtration steps yielded 312 strong binder epitopes. Finally, 8 surface strong binder epitopes were selected as candidate epitopes. The population coverage of the MEV in France and the world was 98 and 100 percent, respectively. Our algorithm successfully filtered many unwanted strong binder epitopes. Considering the HLA type of all individuals in a country, we theoretically provided the maximum chance to all humans to be vaccinated efficiently. Application of a MEV would be led to production of highly efficient target specific antibodies, significant reduction of unwanted antibodies, and avoid possible raising of auto-antibodies as well.
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Zhang X, Pyne S, Kedem B. Multivariate Tail Probabilities: Predicting Regional Pertussis Cases in Washington State. ENTROPY 2021; 23:e23060675. [PMID: 34072055 PMCID: PMC8226468 DOI: 10.3390/e23060675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/23/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
In disease modeling, a key statistical problem is the estimation of lower and upper tail probabilities of health events from given data sets of small size and limited range. Assuming such constraints, we describe a computational framework for the systematic fusion of observations from multiple sources to compute tail probabilities that could not be obtained otherwise due to a lack of lower or upper tail data. The estimation of multivariate lower and upper tail probabilities from a given small reference data set that lacks complete information about such tail data is addressed in terms of pertussis case count data. Fusion of data from multiple sources in conjunction with the density ratio model is used to give probability estimates that are non-obtainable from the empirical distribution. Based on a density ratio model with variable tilts, we first present a univariate fit and, subsequently, improve it with a multivariate extension. In the multivariate analysis, we selected the best model in terms of the Akaike Information Criterion (AIC). Regional prediction, in Washington state, of the number of pertussis cases is approached by providing joint probabilities using fused data from several relatively small samples following the selected density ratio model. The model is validated by a graphical goodness-of-fit plot comparing the estimated reference distribution obtained from the fused data with that of the empirical distribution obtained from the reference sample only.
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Affiliation(s)
- Xuze Zhang
- Department of Mathematics and Institute for Systems Research, University of Maryland, College Park, MD 20742, USA;
| | - Saumyadipta Pyne
- Public Health Dynamics Laboratory, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Health Analytics Network, Pittsburgh, PA 15237, USA
- Correspondence: (S.P.); (B.K.)
| | - Benjamin Kedem
- Department of Mathematics and Institute for Systems Research, University of Maryland, College Park, MD 20742, USA;
- Correspondence: (S.P.); (B.K.)
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Wilkinson K, Righolt CH, Elliott LJ, Fanella S, Mahmud SM. Pertussis vaccine effectiveness and duration of protection - A systematic review and meta-analysis. Vaccine 2021; 39:3120-3130. [PMID: 33934917 DOI: 10.1016/j.vaccine.2021.04.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
A comprehensive review of observational pertussis vaccine effectiveness (VE) studies is needed to update gaps from previous reviews. We conducted a systematic review of VE and duration of protection studies for the whole-cell (wP) and acellular (aP) pertussis vaccines and conducted a formal meta-analysis using random effects models. Evidence continues to suggest that receipt of any pertussis vaccine confers protection in the short-term against disease although this protection wanes rapidly for aP vaccine. We detected significant heterogeneity in pooled estimates due, in part, to factors such as bias and confounding which may be mitigated by study design. Our review of possible sources of heterogeneity may help interpretation of other VE studies and aid design decisions in future pertussis VE research.
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Affiliation(s)
- Krista Wilkinson
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence J Elliott
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sergio Fanella
- Department of Pediatric Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Liko J, Cieslak PR. School Exclusions During Selected Pertussis Outbreaks, Oregon, 2017-2018. J Pediatric Infect Dis Soc 2021; 10:188-191. [PMID: 32227187 DOI: 10.1093/jpids/piaa027] [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: 01/09/2020] [Accepted: 03/13/2020] [Indexed: 11/13/2022]
Abstract
Fifteen Oregon schools excluded undervaccinated students when struck by pertussis outbreaks during the 2017-2018 school year. Of 243 under- or unvaccinated, exposed, students in these schools, 134 (55%) accepted vaccination, and 87 (36%) were excluded and missed a total of 975½ school days. No excluded students were subsequently reported as cases.
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Affiliation(s)
- Juventila Liko
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Paul R Cieslak
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
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Hasnain S, Mundodan J, Al Bayat S, Khogali H, Al-Romaihi H. Bordetella pertussis: An agent not to be forgotten in Qatar. Qatar Med J 2021; 2021:10. [PMID: 34604009 PMCID: PMC8475723 DOI: 10.5339/qmj.2021.10] [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: 11/24/2020] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pertussis (whooping cough) is a vaccine-preventable disease caused by the bacterium Bordetella pertussis that is spread by airborne respiratory droplets. Clinical symptoms vary from infants to adults and are most contagious before the onset of symptoms. Infants are at the highest risk of infection, especially before they are old enough to receive at least two doses of pertussis-containing vaccine. There have been no indigenous cases of pertussis in Qatar since 2010 until 2018, due to free pertussis-containing vaccines under the National Immunization Schedule of Qatar, with coverage consistently above 95%. Two cases were reported in 2016 but were found to be imported. In 2019, 20 infants were reported as suspected pertussis to the Health Promotion and Communicable Disease Control (HP-CDC), Ministry of Public Health (MOPH), Qatar; of them, five were laboratory confirmed as pertussis. OBJECTIVE This study aimed to describe the five confirmed cases of pertussis reported to HP-CDC, MOPH, Qatar, between January 1 and December 30, 2019. Summary of Cases: All five confirmed pertussis cases were under one year old, and three were boys. All except one were immunized-for-age, and three had not received any doses of pertussis-containing vaccine and in none of the cases had the mother received tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy. All infants were born in Qatar, and two were Qatari nationals. CONCLUSION There may be a possibility of re-emergence of pertussis in Qatar. Active immunization and coverage maintenance are the best tools to prevent re-emergence. Undiagnosed and untreated pertussis cases are potential sources of infection. The partial or unimmunized groups may be significantly at risk, especially during infancy and before reaching the age to complete the three primary doses of diphtheria, tetanus, and pertussis vaccines. Focus on increasing awareness among those providing antenatal care, regarding the importance of Tdap vaccination during pregnancy, is necessary.
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Affiliation(s)
- Samina Hasnain
- EPI Section, Health Promotion and Communicable Disease Control, Ministry of Public Health, Doha, Qatar
| | - Jesha Mundodan
- EPI Section, Health Promotion and Communicable Disease Control, Ministry of Public Health, Doha, Qatar
| | - Soha Al Bayat
- EPI Section, Health Promotion and Communicable Disease Control, Ministry of Public Health, Doha, Qatar
| | - Hayat Khogali
- EPI Section, Health Promotion and Communicable Disease Control, Ministry of Public Health, Doha, Qatar
| | - Hamad Al-Romaihi
- EPI Section, Health Promotion and Communicable Disease Control, Ministry of Public Health, Doha, Qatar
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唐 琦, 甘 川, 吴 小, 许 红, 张 祯. [Effect of pertussis vaccination on clinical manifestations of infants and young children with pertussis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:138-142. [PMID: 33627207 PMCID: PMC7921537 DOI: 10.7499/j.issn.1008-8830.2008081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the effect of pertussis vaccination on the clinical manifestations of infants and young children with pertussis. METHODS A retrospective analysis was performed to investigate the differences in clinical manifestations and peripheral blood cell levels between pertussis children with different pertussis vaccination status. RESULTS A total of 1 083 children with pertussisat at age of < 3 years were enrolled, with 551 children in the unvaccinated group and 532 in the vaccinated group. Of all the children, 392 had an age of onset of < 3 months (372 were unvaccinated and 20 were vaccinated) and 691 children had an age of onset of ≥ 3 months (179 were unvaccinated and 512 were vaccinated). Compared with the vaccinated group, the unvaccinated group had a longer length of hospital stay and a higher incidence rate of respiratory failure (P < 0.05). Among the children ≥ 3 months of age, the incidence of severe pneumonia in the unvaccinated group was higher than that in the vaccinated group (P < 0.05), and the incidence of severe pneumonia was the highest in the unvaccinated group (10.6%) and the lowest in the 4-dose vaccination group (1.2%). Among the 101 patients with severe pneumonia, 80 (79.2%) were observed in the unvaccinated group and only 21 (20.8%) in the four different doses vaccination groups. For the children with an age of onset of ≥ 3 months, the unvaccinated group had higher white blood cell count, absolute value of lymphocytes, and platelet count than the vaccinated group (P < 0.05). CONCLUSIONS Pertussis vaccination can reduce the incidence of severe pneumonia and respiratory failure and alleviate the severity of respiratory complications in infants and young children with pertussis.
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Affiliation(s)
- 琦钦 唐
- />重庆医科大学附属儿童医院感染科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室, 重庆 400014Department of Infection, Children's Hospital, Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders(Chongqing)/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 川 甘
- />重庆医科大学附属儿童医院感染科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室, 重庆 400014Department of Infection, Children's Hospital, Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders(Chongqing)/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 小英 吴
- />重庆医科大学附属儿童医院感染科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室, 重庆 400014Department of Infection, Children's Hospital, Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders(Chongqing)/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 红梅 许
- />重庆医科大学附属儿童医院感染科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室, 重庆 400014Department of Infection, Children's Hospital, Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders(Chongqing)/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 祯祯 张
- />重庆医科大学附属儿童医院感染科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿童发育重大疾病国家国际科技合作基地/儿科学重庆市重点实验室, 重庆 400014Department of Infection, Children's Hospital, Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders(Chongqing)/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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10
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Virus Coinfection is a Predictor of Radiologically Confirmed Pneumonia in Children with Bordetella pertussis Infection. Infect Dis Ther 2020; 10:335-346. [PMID: 33270206 PMCID: PMC7954939 DOI: 10.1007/s40121-020-00376-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction This study aimed to prospectively investigate the burden of pertussis in southeast Chinese children hospitalized with lower respiratory tract infection (LRTI) during a pertussis outbreak and to compare the outcomes of Bordetella pertussis infection with or without virus coinfections. Methods Children < 24 months of age hospitalized with LRTI were prospectively enrolled from January 2017 to December 2019. Demographic and clinical information were recorded, and respiratory tract samples were tested for the presence of B. pertussis and ten common viruses by polymerase chain reaction (PCR). Results Bordetella pertussis PCR was positive in 6.1% (202/4287) of the patients. Only 146 (72.3%) B. pertussis infections met the Centers for Disease Control and Prevention case definition for pertussis. Among the 202 subjects with B. pertussis infections, 81 (40.1%) were coinfected with at least 1 respiratory virus, with human rhinovirus being the most commonly detected virus (25.7%). No differences in clinical severity were observed between children with single B. pertussis infection and those with virus coinfection [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.39–1.44]. However, children with virus coinfection were significantly more likely to present with radiologically confirmed pneumonia than those with a single B. pertussis infection (OR 2.62; CI 1.39–4.91). Conclusions Bordetella pertussis infection contributed to a high proportion of LRTI hospitalizations among southeast Chinese children. There were no significant differences in clinical severity between children with virus coinfection and single B. pertussis infection, although children coinfected with virus coinfection presented with pneumonia more frequently than those with single B. pertussis infection. Electronic supplementary material The online version of this article (10.1007/s40121-020-00376-5) contains supplementary material, which is available to authorized users.
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11
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Talbird SE, La EM, Carrico J, Poston S, Poirrier JE, DeMartino JK, Hogea CS. Impact of population aging on the burden of vaccine-preventable diseases among older adults in the United States. Hum Vaccin Immunother 2020; 17:332-343. [PMID: 32758069 PMCID: PMC7899694 DOI: 10.1080/21645515.2020.1780847] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Despite vaccination recommendations, the burden of vaccine-preventable diseases remains high in older adults in the United States (US), contributing to substantial morbidity, mortality, and health care resource use and costs. To adequately plan for health care resource needs and to help inform vaccination policies, burden of disease projections that account for population aging over the coming decades are needed. As a first step, this exploratory study projects the burden of influenza, pertussis, herpes zoster, and pneumococcal disease in adults aged 50 y and older in the US, using a population-based modeling framework with separate decision trees for each vaccine-preventable disease. The model uses projected population estimates from the US Census Bureau to account for changes in the US population over time and then calculates expected numbers of cases and associated costs for each disease, keeping current estimates of age-specific disease incidence, vaccine coverage, and efficacy constant over time. This approach was used to focus the exploratory analysis on the burden of disease that may be expected due to population changes alone, assuming that all else remains unchanged. Due to population growth and the shifting age distribution over the next 30 y, the annual societal economic burden for the four vaccine-preventable diseases is projected to increase from approximately $35 billion to $49 billion, resulting in cumulative costs of approximately $1.3 trillion, as well as more than 1 million disease-related deaths. Given such notable burden, further efforts to increase vaccination coverage and effectiveness in older adults are needed.
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Affiliation(s)
- Sandra E Talbird
- Health Economics, RTI Health Solutions , Research Triangle Park, NC, USA
| | - Elizabeth M La
- Health Economics, RTI Health Solutions , Research Triangle Park, NC, USA
| | - Justin Carrico
- Health Economics, RTI Health Solutions , Research Triangle Park, NC, USA
| | - Sara Poston
- US Health Outcomes & Epidemiology, Vaccines, GSK , Philadelphia, PA, USA
| | | | | | - Cosmina S Hogea
- Global Value Evidence and Outcomes, Oncology,GSK, Philadelphia, PA, USA
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12
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Chang AB, Oppenheimer JJ, Irwin RS, Adams TM, Altman KW, Azoulay E, Blackhall F, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lilly C, Lim K, Lown M, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Murad MH, Narasimhan M, Oppenheimer J, Russell RJ, Ryu JH, Singh S, Smith MP, Tarlo SM, Vertigan AE. Managing Chronic Cough as a Symptom in Children and Management Algorithms. Chest 2020; 158:303-329. [DOI: 10.1016/j.chest.2020.01.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
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Jiang W, Mao L, Wang K, Wang Y, Hao C, Shao X, Xu J. Prevalence of B. pertussis infection in children with clinically suspected pertussis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:693-700. [PMID: 32245724 DOI: 10.1016/j.jmii.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 02/08/2020] [Accepted: 03/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pertussis is an important cause of hospitalization in children. Limited data on pertussis have been reported from China. The aim of this study was to characterize clinically suspected pertussis attributable to Bordetella pertussis among children and determine factors associated with longer duration of hospital stay in B. pertussis infection. METHODS Two hundred and seventeen consecutive children with clinically suspected pertussis were prospectively enrolled in the study between Jan 2016 through Aug 2017. Variables assessed included demographics, clinical symptoms and laboratory findings. Cox proportional hazards regression model were used to predict variables associated with longer duration of hospital stay. RESULTS Among the 217 patients with clinically suspected pertussis, B. pertussis was found in 106 (48.8%) patients. Of the 106 children with B. pertussis infection, 63 (59.4%) patients had coinfections with majority due to rhinovirus (HRV) (30.2%), Mycoplasma pneumoniae (29.2%) and human bocavirus (hBoV) (11.3%). Presence of coinfection [odds ratio (OR): 1.73, CI: 1.17-2.54], age ≤ 3 months (OR: 1.51, CI: 1.09 to 2.27), and WBC count ≥30 × 109/L (OR: 1.66, CI: 1.07 to 2.84) were independently associated with a longer hospital stay. CONCLUSIONS B. pertussis infection had a high coinfection rate with the majority of coinfections due to HRV, M. pneumoniae and hBoV. Presence of coinfection, Age ≤3 months and WBC count ≥30 × 109/L were associated with a longer hospital stay. Children admitted with pertussis need close monitoring when they had evidence of coinfection, Age ≤3 months, WBC count ≥30 × 109/L.
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Affiliation(s)
- Wujun Jiang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China; Department of Internal Medicine, Children's Hospital of Wujiang District, Suzhou, China
| | - Luyi Mao
- Department of Pediatrics, Changshu No.2 People's Hospital, China
| | - Kun Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Yuqing Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China.
| | - Chuangli Hao
- Department of Respiratory Medicine, Children's Hospital of Soochow University, China
| | - Xuejun Shao
- Department of Clinical Laboratory, Children's Hospital of Soochow University, China
| | - Jun Xu
- Department of Clinical Laboratory, Children's Hospital of Soochow University, China
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14
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Tong J, Buikema A, Horstman T. Epidemiology and disease burden of pertussis in the United States among individuals aged 0-64 over a 10-year period (2006-2015). Curr Med Res Opin 2020; 36:127-137. [PMID: 31491361 DOI: 10.1080/03007995.2019.1662232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Pertussis incidence has increased in recent decades despite childhood vaccination programs and high vaccination rates. To quantify the burden of pertussis, incidence, healthcare resource utilization, and costs among pertussis patients were estimated in a US managed care setting.Methods: Patients aged 0-64 years with evidence of pertussis (ICD-9-CM codes 033.0, 033.9, 484.3, ICD-10-CM codes A37.0, A37.9) and commercial insurance from 1 January 2006-12 December 2015 were identified. Incidence rates were calculated and standardized to the 2010 US Census on age, sex, and geographic region. Healthcare costs and resource utilization were compared between patients and matched comparators (health plan members without pertussis).Results: From 2006 to 2015, 11,378 pertussis cases were identified. Adjusted pertussis incidence was 15.55 cases per 100,000 person-years. Incidence was highest among infants and children; however, 59.0% of total cases were among adolescents or adults. Average adjusted healthcare costs per episode were 3.17 times higher among pertussis patients versus comparators ($5195 versus $1637, p < .001). Stratifying by age group, adjusted incremental healthcare costs per episode were $5581, $827, $700, $1429, $2530, and $4849 for patients aged <1 year, 1-6 years, 7-10 years, 11-19 years, 20-49 years, and 50-64 years, respectively.Conclusions: Managing pertussis is associated with substantial economic burden. Incidence rate estimates from this study were higher than CDC-reported rates; however, similar overall trends were observed. Although pertussis incidence has been declining since CDC-recommended vaccination for all adults in 2012, this study highlights the importance of continued management and prevention strategies, especially among adolescents and adults as they represent an important source of transmission to infants.
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15
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A nested case-control study measuring pertussis vaccine effectiveness and duration of protection in Manitoba, Canada, 1992–2015: A Canadian Immunization Research Network Study. Vaccine 2019; 37:7132-7137. [DOI: 10.1016/j.vaccine.2019.09.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/05/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
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16
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Tin Tin Htar M, de Ridder M, Braeye T, Correa A, McGee C, de Lusignan S, Duarte-Salles T, Huerta-Alvarez C, Martín-Merino E, Tramontan L, Danieli G, Picelli G, van der Maas N, Berencsi K, Arnheim-Dahlström L, Heininger U, Emborg HD, Weibel D, Bollaerts K, Sturkenboom M. Advance system testing: Vaccine benefit studies using multi-country electronic health data - The example of pertussis vaccination. Vaccine 2019; 38 Suppl 2:B31-B37. [PMID: 31677949 DOI: 10.1016/j.vaccine.2019.08.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022]
Abstract
The Accelerated Development of VAccine benefit-risk Collaboration in Europe (ADVANCE), a public-private consortium, implemented and tested a distributed network system for the generation of evidence on the benefits-risks of marketed vaccines in Europe. We tested the system by estimating the incidence rate (IR) of pertussis and pertussis-related complications in children vaccinated with acellular (aP) and whole-cell (wP) pertussis vaccine. Data from seven electronic databases from four countries (Denmark: AUH and SSI, Spain: SIDIAP and BIFAP, UK: THIN and RCGP RSC and Italy: Pedianet) were included in a retrospective cohort analysis. Exposure was defined as any pertussis vaccination (aP or wP). The follow-up time started 14 days after the first dose. Children who had received any pertussis vaccine from January 1990 to December 2015 were included (those who switched type, or had unknown type were excluded). The outcomes of interest were confirmed or suspected pertussis and pertussis-related pneumonia and generalised convulsions within one month of pertussis diagnosis and death within three months of pertussis diagnosis. The cohort comprised 2,886,367 children ≤5 years of age. Data on wP and aP vaccination were available in three and seven databases, respectively. The IRs (per 100,000 person-years) for pertussis varied largely and ranged between 0.15 (95% CI: 0.12; 0.19) and 1.15 (95% CI: 1.07; 1.23), and the trends over time was consistent with those observed from national surveillance databases for confirmed pertussis. The pertussis IRs decreased as the number of wP and aP vaccine doses increased. Pertussis-related complications were rare (89 pneumonia, 7 generalised convulsions and no deaths) and their relative risk (vs. non-pertussis) could not be reliably estimated. The study demonstrated the feasibility of the ADVANCE system to estimate the change in pertussis IRs following pertussis vaccination. Larger sample sizes would provide additional power to compare the risk for complications between children with and without pertussis. The feasibility of vaccine-type specific effectiveness studies may be considered in the future.
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Affiliation(s)
- Myint Tin Tin Htar
- Clinical Epidemiology, Pfizer, 23-25 Avenue du Dr Lannelongue, 75014 Paris, France.
| | - Maria de Ridder
- Erasmus University Medical Center, PO Box 2014, 3000 CA Rotterdam, the Netherlands.
| | - Toon Braeye
- Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Ana Correa
- University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Chris McGee
- University of Surrey, Guildford, Surrey GU2 7XH, UK; Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, UK.
| | - Simon de Lusignan
- University of Surrey, Guildford, Surrey GU2 7XH, UK; Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, UK.
| | - Talita Duarte-Salles
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Consuelo Huerta-Alvarez
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain.
| | - Elisa Martín-Merino
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain.
| | - Lara Tramontan
- PEDIANET, Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy.
| | - Giorgia Danieli
- PEDIANET, Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy.
| | | | - Nicoline van der Maas
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
| | - Klara Berencsi
- Aarhus University Hospital, Olof Palmes Alle 43-45, DK-8200 Aarhus, Denmark.
| | | | - Ulrich Heininger
- University of Basel Children's Hospital, PO Box, CH 4033 Basel, Switzerland; University of Basel, Basel, Switzerland.
| | | | - Daniel Weibel
- Erasmus University Medical Center, PO Box 2014, 3000 CA Rotterdam, the Netherlands; VACCINE.GRID, Spitalstrasse 33, Basel, Switzerland.
| | | | - Miriam Sturkenboom
- VACCINE.GRID, Spitalstrasse 33, Basel, Switzerland; P95, Epidemiology and Pharmacovigilance, Leuven, Belgium; Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, the Netherlands.
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17
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Gini R, Dodd CN, Bollaerts K, Bartolini C, Roberto G, Huerta-Alvarez C, Martín-Merino E, Duarte-Salles T, Picelli G, Tramontan L, Danieli G, Correa A, McGee C, Becker BFH, Switzer C, Gandhi-Banga S, Bauwens J, van der Maas NAT, Spiteri G, Sdona E, Weibel D, Sturkenboom M. Quantifying outcome misclassification in multi-database studies: The case study of pertussis in the ADVANCE project. Vaccine 2019; 38 Suppl 2:B56-B64. [PMID: 31677950 DOI: 10.1016/j.vaccine.2019.07.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/28/2019] [Accepted: 07/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public-private collaboration aiming to develop and test a system for rapid benefit-risk (B/R) monitoring of vaccines using European healthcare databases. Event misclassification can result in biased estimates. Using different algorithms for identifying cases of Bordetella pertussis (BorPer) infection as a test case, we aimed to describe a strategy to quantify event misclassification, when manual chart review is not feasible. METHODS Four participating databases retrieved data from primary care (PC) setting: BIFAP: (Spain), THIN and RCGP RSC (UK) and PEDIANET (Italy); SIDIAP (Spain) retrieved data from both PC and hospital settings. BorPer algorithms were defined by healthcare setting, data domain (diagnoses, drugs, or laboratory tests) and concept sets (specific or unspecified pertussis). Algorithm- and database-specific BorPer incidence rates (IRs) were estimated in children aged 0-14 years enrolled in 2012 and 2014 and followed up until the end of each calendar year and compared with IRs of confirmed pertussis from the ECDC surveillance system (TESSy). Novel formulas were used to approximate validity indices, based on a small set of assumptions. They were applied to approximately estimate positive predictive value (PPV) and sensitivity in SIDIAP. RESULTS The number of cases and the estimated BorPer IRs per 100,000 person-years in PC, using data representing 3,173,268 person-years, were 0 (IR = 0.0), 21 (IR = 4.3), 21 (IR = 5.1), 79 (IR = 5.7), and 2 (IR = 2.3) in BIFAP, SIDIAP, THIN, RCGP RSC and PEDIANET respectively. The IRs for combined specific/unspecified pertussis were higher than TESSy, suggesting that some false positives had been included. In SIDIAP the estimated IR was 45.0 when discharge diagnoses were included. The sensitivity and PPV of combined PC specific and unspecific diagnoses for BorPer cases in SIDIAP were approximately 85% and 72%, respectively. CONCLUSION Retrieving BorPer cases using only specific concepts has low sensitivity in PC databases, while including cases retrieved by unspecified concepts introduces false positives, which were approximately estimated to be 28% in one database. The share of cases that cannot be retrieved from a PC database because they are only seen in hospital was approximately estimated to be 15% in one database. This study demonstrated that quantifying the impact of different event-finding algorithms across databases and benchmarking with disease surveillance data can provide approximate estimates of algorithm validity.
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Affiliation(s)
- Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | - Caitlin N Dodd
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands; Julius Global Health, University Medical Center, Utrecht, Heidelberglaan 100, the Netherlands
| | - Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III laan 1, 3001 Heverlee, Belgium.
| | - Claudia Bartolini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | | | - Elisa Martín-Merino
- BIFAP Database, Spanish Agency of Medicines and Medical Devices, Madrid, Spain.
| | - Talita Duarte-Salles
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Gino Picelli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy.
| | - Lara Tramontan
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy.
| | - Giorgia Danieli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy
| | - Ana Correa
- University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - Chris McGee
- University of Surrey, Guildford, Surrey GU2 7XH, UK; Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, UK.
| | - Benedikt F H Becker
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands.
| | | | | | - Jorgen Bauwens
- University Children's Hospital, Basel, Switzerland; University of Basel, Switzerland; Brighton Collaboration Foundation, Switzerland.
| | | | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control, Gustav III's Boulevard 40, 16973 Solna, Sweden.
| | - Emmanouela Sdona
- European Centre for Disease Prevention and Control, Gustav III's Boulevard 40, 16973 Solna, Sweden
| | - Daniel Weibel
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center, Utrecht, Heidelberglaan 100, the Netherlands; P95 Epidemiology and Pharmacovigilance, Koning Leopold III laan 1, 3001 Heverlee, Belgium; VACCINE.GRID Foundation, Spitalstrasse 33, Basel, Switzerland.
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18
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Gil-Prieto R, Walter S, San-Román-Montero J, Marín-García P, González-Escalada A, Gil-de-Miguel A. Paediatric hospitalizations due to whooping cough in Spain (1997-2017). Vaccine 2019; 37:6342-6347. [PMID: 31526619 DOI: 10.1016/j.vaccine.2019.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/01/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
This epidemiological survey estimates the burden of whooping cough in infants up to 12 months old in Spain during a twenty-one-year period (1997-2017). The survey was conducted by reviewing data from the Spanish Surveillance System for Hospital Data. All hospitalizations due to whooping cough for infants, reported during the 1997-2017 period, were analysed. Codes were selected from the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes 033.0-033.9. To explore the latest national outbreak and the implementation of vaccination in pregnant women, analyses were stratified to compare the following periods: 1997-2010, 2011-2015 and 2016-2017. A total of 13,352 hospital discharges for whooping cough in infants up to 12 months old were reported. A total of 6850 discharges in the period 1997-2010, 5271 in the period 2011-2015 and 1231 in 2016-2017 were identified. The annual hospitalization rate prior to 2011 was 131.02 cases per 100,000 infants; in 2011-2015, the rate was significantly higher (250.13 cases per 100,000 infants) and in 2016-2017 it decreased (157.69 cases per 100,000 infants). Most of the cases (n = 11,446) occurred in infants under 4 months of age, with hospitalization rates of 328.80, 670.81 and 385.84 cases per 100,000 infants up to 4 months of age in the periods 1997-2010, 2011-2015 and 2016-17, respectively. Thirty-four deaths occurred in the period 1997-2010, 36 in the period 2011-2015 and 4 in 2016-2017. All of the deaths occurred in infants under 4 months old. The case fatality rate did not vary significantly across the study periods. Whooping cough infections concentrate in infants up to 4 months of age in Spain. Public health measures such as vaccination of pregnant women, caregivers, health care professionals and relatives, especially young parents, could reduce the hospitalization burden during the current outbreak.
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Affiliation(s)
- Ruth Gil-Prieto
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain.
| | - Stefan Walter
- Fundación de Investigación, Hospital Universitario de Getafe, Madrid, Spain; Dept. of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | | | - Angel Gil-de-Miguel
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
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Pertussis Morbidity in Children 12-59 Months of Age: A NSW Public Health Network Study. Pediatr Infect Dis J 2019; 38:553-558. [PMID: 30418359 DOI: 10.1097/inf.0000000000002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pertussis continues to be a significant public health problem despite high levels of vaccination. Although hospitalizations and deaths among children greater than 12 months of age are much less frequent than among infants less than 6 months of age, only limited information is available for this age group on other measures of morbidity. METHODS A cross-sectional study with a 6-week follow-up component was conducted in New South Wales, Australia in 2017 to measure morbidity among children 12-59 months of age notified to health authorities. Measures used included cough duration, cough severity, constitutional symptoms and impacts on the family. Associations between these outcomes and age group, vaccination status, asthma, treatment and family structure were explored. RESULTS Three hundred and five of 472 (65%) notified cases were interviewed at baseline with approximately 20% having a severe cough with no trend in prevalence across age groups. Forty-eight percent of cases had experienced 3 or more constitutional symptoms with rates significantly higher among younger children. Children who had received an 18-month booster vaccination were significantly less likely to experience 3 or more constitutional symptoms (odds ratio: 0.46, 95% confidence interval: 0.22-0.97). Fifty-one percent of cases were still coughing at 6 weeks. One-third of carers initially reported having disrupted sleep 4 or more nights per week with substantial disruption to carers' sleep still recorded at 6 weeks. CONCLUSIONS Substantial morbidity was observed in this age group with some evidence that the reintroduction of an 18-month acellular pertussis booster lessened disease severity.
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Mohd Khalid MKN, Ahmad N, Hii SYF, Abd Wahab MA, Hashim R, Liow YL. Molecular characterization of Corynebacterium diphtheriae isolates in Malaysia between 1981 and 2016. J Med Microbiol 2019; 68:105-110. [DOI: 10.1099/jmm.0.000881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
- Mohd Khairul Nizam Mohd Khalid
- 1Molecular Diagnostics and Protein Unit, Specialised Diagnostics Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Norazah Ahmad
- 2Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Shirley Yi Fen Hii
- 2Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Muhammad Adib Abd Wahab
- 2Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Rohaidah Hashim
- 2Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Yii Ling Liow
- 2Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
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Painter JE, Viana De O. Mesquita S, Jimenez L, Avila AA, Sutter CJ, Sutter R. Vaccine-related attitudes and decision-making among uninsured, Latin American immigrant mothers of adolescent daughters: a qualitative study. Hum Vaccin Immunother 2018; 15:121-133. [PMID: 30199302 PMCID: PMC6363134 DOI: 10.1080/21645515.2018.1514353] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/27/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022] Open
Abstract
Uninsured Latin American immigrant women are at increased risk for vaccine preventable diseases, such as cervical cancer; yet gaps in vaccine coverage persist. The purpose of this study was to explore vaccine-related knowledge, attitudes and decision-making for tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, meningococcal conjugate vaccine (MenACWY), and human papillomavirus (HPV) vaccine among uninsured Latin American immigrant mothers of adolescent daughters. A purposive sample of 30 low-income, uninsured, predominantly Latin-American immigrant mothers of adolescent daughters aged 13-17 were recruited from two academic-community managed health clinics in Virginia. From March-September 2016, data were collected through in-person, semi-structured interviews, in English or Spanish. For data analysis, conventional content analysis was employed. The majority of participants self-identified as Hispanic and had less than a high-school level education. Key themes included: general acceptance of vaccines; associating vaccines with prevention/protection; minimal vaccine hesitancy; and lack of knowledge regarding vaccine-preventable diseases, vaccines recommended for adolescents, and adolescent daughters' vaccination history. Doctors' recommendation, school requirements, and the media were key influencers of vaccination. Mothers were the primary decision-maker regarding vaccine uptake among their adolescent daughters. Findings highlight the need for efforts to help uninsured Latin American immigrant mothers better understand vaccines, and provide linkages to affordable, accessible vaccines among under-resourced populations.
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Affiliation(s)
- Julia E. Painter
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | | | - Lauren Jimenez
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Arturo A. Avila
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | | | - Rebecca Sutter
- School of Nursing, George Mason University, Fairfax, VA, USA
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Skoff TH, Hadler S, Hariri S. The Epidemiology of Nationally Reported Pertussis in the United States, 2000–2016. Clin Infect Dis 2018; 68:1634-1640. [DOI: 10.1093/cid/ciy757] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/29/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Tami H Skoff
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Stephen Hadler
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
| | - Susan Hariri
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia
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Briere EC, Pondo T, Schmidt M, Skoff T, Shang N, Naleway A, Martin S, Jackson ML. Assessment of Tdap Vaccination Effectiveness in Adolescents in Integrated Health-Care Systems. J Adolesc Health 2018; 62:661-666. [PMID: 29551624 DOI: 10.1016/j.jadohealth.2017.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE Despite high national vaccination coverage with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines among U.S. adolescents, rates of adolescent pertussis disease are increasing. We estimated the duration of protection after Tdap vaccination and the possible effects of the change from whole-cell to acellular childhood pertussis vaccines in the United States during the 1990s. METHODS We conducted a retrospective cohort analysis among 11- to 18-year-olds enrolled in two integrated health-care delivery systems during 2005-2012. Cases met the Council of State and Territorial Epidemiologists' confirmed or probable definition or a polymerase chain reaction-positive suspect definition. We estimated vaccine effectiveness (VE) overall and by time since Tdap receipt. We stratified VE estimates by primary series pertussis vaccine received (based on birth year): mixed-vaccine cohort (1987-1997) and acellular vaccine cohort (1998-2001). RESULTS The overall Tdap VE was 57% (95% confidence interval [CI]: 42%-68%); the VE in the mixed-vaccine and acellular cohorts was 65% (95% CI: 44%-78%) and 52% (95% CI: 30%-68%), respectively. Tdap VE within <2 years post vaccination (69%, 95% CI: 54%-79%) was significantly different from VE ≥2 years post vaccination (34%, 95% CI: 1%-55%, p value < .01). VE was significantly higher <2 years post vaccination compared with ≥2 years post vaccination in both mixed-vaccine (87%, 95% CI: 58%-96%, and 52%, 95% CI: 13%-73%; p value = .04) and acellular cohorts (62%, 95% CI: 41%-76%, and 21%, 95% CI: -30% to 52%; p value = .01). CONCLUSIONS Although Tdap vaccination remains the best pertussis prevention method for adolescents, protection wanes within 2 years regardless of the type of childhood primary vaccine. Vaccines with longer duration of protection could decrease pertussis burden.
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Affiliation(s)
- Elizabeth C Briere
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Mark Schmidt
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Tami Skoff
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nong Shang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Stacey Martin
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
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McNamara LA, Skoff T, Faulkner A, Miller L, Kudish K, Kenyon C, Bargsten M, Zansky S, Sullivan AD, Martin S, Briere E. Reduced Severity of Pertussis in Persons With Age-Appropriate Pertussis Vaccination-United States, 2010-2012. Clin Infect Dis 2018; 65:811-818. [PMID: 29017283 DOI: 10.1093/cid/cix421] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/01/2017] [Indexed: 01/10/2023] Open
Abstract
Background In 2012, >48000 pertussis cases were reported in the United States. Many cases occurred in vaccinated persons, showing that pertussis vaccination does not prevent all pertussis cases. However, pertussis vaccination may have an impact on disease severity. Methods We analyzed data on probable and confirmed pertussis cases reported through Enhanced Pertussis Surveillance (Emerging Infections Program Network) between 2010 and 2012. Surveillance data were collected through physician and patient interview and vaccine registries. We assessed whether having received an age-appropriate number of pertussis vaccines (AAV) (for persons aged ≥3 months) was associated with reduced odds of posttussive vomiting, a marker of more clinically significant illness, or of severe pertussis (seizure, encephalopathy, pneumonia, and/or hospitalization). Adjusted odds ratios were calculated using multivariable logistic regression. Results Among 9801 pertussis patients aged ≥3 months, 77.6% were AAV. AAV status was associated with a 60% reduction in odds of severe disease in children aged 7 months-6 years in multivariable logistic regression and a 30% reduction in odds of posttussive vomiting in persons aged 19 months-64 years. Conclusions Serious pertussis symptoms and complications are less common among AAV pertussis patients, demonstrating that the positive impact of pertussis vaccination extends beyond decreasing risk of disease.
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Affiliation(s)
- Lucy A McNamara
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tami Skoff
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Faulkner
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa Miller
- Colorado Disease Control and Environmental Epidemiology Division, Department of Public Health and Environment, Denver
| | - Kathy Kudish
- Connecticut Department of Public Health, Hartford
| | | | | | | | - Amy D Sullivan
- Communicable Disease Services, Multnomah County Health Department, Portland, Oregon
| | - Stacey Martin
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Briere
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Marked Underreporting of Pertussis Requiring Hospitalization in Infants as Estimated by Capture-Recapture Methodology, Germany, 2013-2015. Pediatr Infect Dis J 2018; 37:119-125. [PMID: 28723872 DOI: 10.1097/inf.0000000000001698] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In Germany, pertussis became notifiable in eastern federal states in 2002 and nationwide in March 2013. Infants are at greatest risk for severe disease, with a high proportion requiring hospitalization. We implemented enhanced hospital-based surveillance to estimate the incidence of pertussis requiring hospitalization among infants in Germany and to determine the proportion of infants hospitalized with pertussis too young to have been vaccinated. METHODS Enhanced surveillance was implemented within a nationwide hospital surveillance network (ESPED). We defined cases as children less than 1 year of age hospitalized due to laboratory-confirmed pertussis with disease onset from 01/07/2013-30/06/2015. We matched cases to those ascertained in the national statutory notification system, and estimated incidence using capture-recapture methodology. RESULTS The estimated annual incidence of pertussis requiring hospitalization in infants was 52/100,000 infants (95% confidence interval [CI] 48-57/100,000), with 39% under-reporting to the national notification system. During the two epidemiologic years under-reporting decreased from 46% to 32% and was lower in eastern than western federal states (21% vs. 40%). Within ESPED, 154 of 240 infants (64%) were younger than or still at the age recommended for the first vaccine dose; 55 (23%) could have received one or more vaccine doses. Median length of hospitalization was 9 days (IQR 5-13 days) and 18% required intensive care treatment. CONCLUSIONS Our study revealed a high burden of pertussis in infants with marked under-reporting, especially in western federal states where notification was only recently established. Strategies for the prevention of severe pertussis.
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Nunes MC, Downs S, Jones S, van Niekerk N, Cutland CL, Madhi SA. Bordetella pertussis Infection in South African HIV-Infected and HIV-Uninfected Mother-Infant Dyads: A Longitudinal Cohort Study. Clin Infect Dis 2017; 63:S174-S180. [PMID: 27838670 PMCID: PMC5106617 DOI: 10.1093/cid/ciw527] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background. There is a paucity of data regarding the burden of Bordetella pertussis in African women and young infants, and particularly the impact of maternal human immunodeficiency virus (HIV) infection thereon. We performed a retrospective analysis of respiratory illness samples from longitudinal cohorts of HIV-uninfected and HIV-infected women and their infants to evaluate the burden of pertussis illness in a black-African community. Methods. The women were followed up for respiratory illness from midpregnancy and together with their infants until 24 weeks postpartum. Respiratory samples obtained at the time of illness visits were tested for B. pertussis by polymerase chain reaction (PCR). Results. The study included 194 HIV-infected and 1060 HIV-uninfected women, and 188 and 1028 infant offspring, respectively. There were 7 PCR-confirmed pertussis cases in the HIV-exposed infants and 30 in HIV-unexposed infants (7.4 vs 5.5 episodes per 1000 infant-months; P = .47), at a mean age of 70.9 days. All infant pertussis cases had a history of cough (mean duration, 6.3 days). Six of 17 (35.3%) pertussis-confirmed cases in infants <2 months of age were admitted to hospital within 21 days of B. pertussis detection, whereas none of the 20 cases ≥2 months of age required hospitalization. Ten PCR-positive pertussis-associated illnesses were detected in HIV-infected women compared with 32 in the HIV-uninfected women (6.8 vs 3.9 episodes per 1000 person-months; P = .12). Conclusions. Bordetella pertussis identification was common among young infants with respiratory illness, most of whom were too young to be fully protected through direct vaccination. Vaccination of pregnant women might be a valuable strategy in a setting such us ours to prevent B. pertussis–associated illness in women and their young infants.
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Affiliation(s)
- Marta C Nunes
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Sarah Downs
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Stephanie Jones
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Nadia van Niekerk
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Clare L Cutland
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Shabir A Madhi
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand.,National Institute for Communicable Diseases, National Health Laboratory Service, Centre for Vaccines and Immunology, Johannesburg, South Africa
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Kovitwanichkanont T. Public health measures for pertussis prevention and control. Aust N Z J Public Health 2017; 41:557-560. [DOI: 10.1111/1753-6405.12732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Chong CY, Yung CF, Tan NWH, Acharyya S, Thoon KC. Risk factors of ICU or high dependency requirements amongst hospitalized pediatric pertussis cases: A 10 year retrospective series, Singapore. Vaccine 2017; 35:6422-6428. [PMID: 29032896 DOI: 10.1016/j.vaccine.2017.09.085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pertussis causes the highest complication rates and deaths in the infant group. Our study explored risk factors for ICU/high dependency (HD) admissions and intubation/non-invasive ventilation (NIV). METHODS A retrospective review of pertussis admissions over 10 years from 2007 to 2016 was done at KK Women's and Children's Hospital, Singapore. To understand risk factors for severe pertussis infection, we compared cases requiring ICU/HD care with controls admitted to the general ward. Risk factors for intubation/NIV were also studied. Vaccine efficacy for protection against ICU/HD admission or intubation/NIV was also calculated. RESULTS There were 200 pertussis patients with a median age of 2.75 months. Sixty-one % were ≤3 months and 14.5% were <6 weeks old. Majority of patients (77%) had no prior pertussis vaccination. After removing 3 patients with missing vaccination records, 20 cases were compared with 177 controls. On univariate analysis, risk factors for ICU/HD admission comprised: Age ≤3 months, contact history, underlying co-morbidity, prematurity, absent DTaP vaccination, lymphocytosis, hyperleukocytosis (wbc ≥50×109/L), thrombocytosis (platelet ≥500×109/L), and pneumonia. Multivariate analysis revealed that age ≤3 months (OR 40, 95% CI 4.57-1111.11, p=.007), co-morbidity (OR 8.46 (95% CI 1.47-56.89, p=.019), pneumonia (OR 18.08, 95% CI 3.22-132.15, p=.002), white cell count (OR 1.07, 95% CI 1.01-1.14, p=.023) and cyanosis (OR 5.09, 95% CI 1.31-24.71, p=.026) were risk factors for ICU/HD admission. Prior DTaP vaccination had a vaccine effectiveness of 86.5% in preventing ICU/HD admission and 82.1% in preventing intubation/NIV. CONCLUSIONS As the majority of pertussis patients were infants ≤3 months old who are at high risk for ICU/HD admission and intubation/NIV, prevention is key to reducing pertussis morbidity. Even though not statistically significant, DTaP vaccination had a role in preventing ICU/HD admission and intubation/NIV.
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Affiliation(s)
- Chia-Yin Chong
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Chee-Fu Yung
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Natalie Woon-Hui Tan
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Sanchalika Acharyya
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Koh-Cheng Thoon
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
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Martini H, Detemmerman L, Soetens O, Yusuf E, Piérard D. Improving specificity of Bordetella pertussis detection using a four target real-time PCR. PLoS One 2017; 12:e0175587. [PMID: 28403204 PMCID: PMC5389834 DOI: 10.1371/journal.pone.0175587] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/28/2017] [Indexed: 11/21/2022] Open
Abstract
The incidence of whooping cough, a contagious respiratory disease caused by Bordetella pertussis, is on the rise despite existing vaccination programmes. Similar, though usually milder, respiratory symptoms may be caused by other members of the Bordetella genus: B. parapertussis, B. holmesii, and B. bronchiseptica. Pertussis diagnosis is mostly done using PCR, but the use of multiple targets is necessary in order to differentiate the different Bordetella spp. with sufficient sensitivity and specificity. In this study we evaluate a multiplex PCR assay for the differentiation of B. pertussis from other Bordetella spp., using the targets IS481, IS1001, IS1002, and recA. Moreover, we retrospectively explore the epidemiology of Bordetella spp. infections in Belgium, using the aforementioned assay over a three-year period, from 2013 until 2015.
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Affiliation(s)
- Helena Martini
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Microbiology and Infection Control and Belgian National Reference Centre for Bordetella Pertussis, Brussels, Belgium
- * E-mail:
| | - Liselot Detemmerman
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Microbiology and Infection Control and Belgian National Reference Centre for Bordetella Pertussis, Brussels, Belgium
| | - Oriane Soetens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Microbiology and Infection Control and Belgian National Reference Centre for Bordetella Pertussis, Brussels, Belgium
| | - Erlangga Yusuf
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Microbiology and Infection Control and Belgian National Reference Centre for Bordetella Pertussis, Brussels, Belgium
| | - Denis Piérard
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Microbiology and Infection Control and Belgian National Reference Centre for Bordetella Pertussis, Brussels, Belgium
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Kauhl B, Heil J, Hoebe CJPA, Schweikart J, Krafft T, Dukers-Muijrers NHTM. Is the current pertussis incidence only the results of testing? A spatial and space-time analysis of pertussis surveillance data using cluster detection methods and geographically weighted regression modelling. PLoS One 2017; 12:e0172383. [PMID: 28278180 PMCID: PMC5344341 DOI: 10.1371/journal.pone.0172383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 02/03/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite high vaccination coverage, pertussis incidence in the Netherlands is amongst the highest in Europe with a shifting tendency towards adults and elderly. Early detection of outbreaks and preventive actions are necessary to prevent severe complications in infants. Efficient pertussis control requires additional background knowledge about the determinants of testing and possible determinants of the current pertussis incidence. Therefore, the aim of our study is to examine the possibility of locating possible pertussis outbreaks using space-time cluster detection and to examine the determinants of pertussis testing and incidence using geographically weighted regression models. METHODS We analysed laboratory registry data including all geocoded pertussis tests in the southern area of the Netherlands between 2007 and 2013. Socio-demographic and infrastructure-related population data were matched to the geo-coded laboratory data. The spatial scan statistic was applied to detect spatial and space-time clusters of testing, incidence and test-positivity. Geographically weighted Poisson regression (GWPR) models were then constructed to model the associations between the age-specific rates of testing and incidence and possible population-based determinants. RESULTS Space-time clusters for pertussis incidence overlapped with space-time clusters for testing, reflecting a strong relationship between testing and incidence, irrespective of the examined age group. Testing for pertussis itself was overall associated with lower socio-economic status, multi-person-households, proximity to primary school and availability of healthcare. The current incidence in contradiction is mainly determined by testing and is not associated with a lower socioeconomic status. DISCUSSION Testing for pertussis follows to an extent the general healthcare seeking behaviour for common respiratory infections, whereas the current pertussis incidence is largely the result of testing. More testing would thus not necessarily improve pertussis control. Detecting outbreaks using space-time cluster detection is feasible but needs to adjust for the strong impact of testing on the detection of pertussis cases.
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Affiliation(s)
- Boris Kauhl
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences. Maastricht University, Maastricht, the Netherlands
| | - Jeanne Heil
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Jürgen Schweikart
- Beuth University of Applied Sciences, Department III, Civil Engineering and Geoinformatics, Berlin, Germany
| | - Thomas Krafft
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences. Maastricht University, Maastricht, the Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Geleen, The Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Vittucci AC, Spuri Vennarucci V, Grandin A, Russo C, Lancella L, Tozzi AE, Bartuli A, Villani A. Pertussis in infants: an underestimated disease. BMC Infect Dis 2016; 16:414. [PMID: 27528377 PMCID: PMC4986228 DOI: 10.1186/s12879-016-1710-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/12/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The clinical diagnosis of pertussis is not easy in early infancy since clinical manifestations can overlap with several different diseases. Many cases are often misclassified and underdiagnosed. We conducted a retrospective study on infants to assess how often physicians suspected pertussis and the actual frequency of Bordetella pertussis infections. METHODS We analyzed all infants with age ≤90 days hospitalized from March 2011 until September 2013 for acute respiratory symptoms tested with a Real Time Polymerase Chain Reaction able to detect Bordetella pertussis and with a Real Time Polymerase Chain Reaction for a multipanel respiratory virus. Therefore, we compared patients with pertussis positive aspirate, patients with respiratory virus positive aspirate and patients with negative aspirate to identify symptoms or clinical findings predictive of pertussis. RESULTS Out of 215 patients analyzed, 53 were positive for pertussis (24.7 %), 119 were positive for respiratory virus (55.3 %) and 43 had a negative aspirate (20 %). Pertussis was suspected in 22 patients at admission and 16 of them were confirmed by laboratory tests, while 37 infants with different admission diagnosis resulted positive for pertussis. The sensitivity of clinical diagnosis was 30.2 % and the specificity 96.3 %. Infants with pertussis had more often paroxysmal cough, absence of fever and a higher absolute lymphocyte count than infants without pertussis. CONCLUSIONS Pertussis is a serious disease in infants and it is often unrecognized; some features should help pediatricians to suspect pertussis, but clinical suspicion has a low sensitivity. We suggest a systematic use of Real Time Polymerase Chain Reaction to support the clinical suspicion of pertussis in patients with less than 3 months of age hospitalized with acute respiratory symptoms.
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Affiliation(s)
- Anna Chiara Vittucci
- General Pediatric and Infectious Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Annalisa Grandin
- General Pediatric and Infectious Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina Russo
- Virology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- General Pediatric and Infectious Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Andrea Bartuli
- Rare Disease and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Skoff TH, Baumbach J, Cieslak PR. Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States. Emerg Infect Dis 2016; 21:1568-73. [PMID: 26291475 PMCID: PMC4550149 DOI: 10.3201/eid2109.150023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in understanding the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis.
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Vaccine Timeliness: A Cost Analysis of the Potential Implications of Delayed Pertussis Vaccination in the US. Pediatr Infect Dis J 2016; 35:542-7. [PMID: 26835971 DOI: 10.1097/inf.0000000000001071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pertussis infection remains an important public health problem, particularly in infants. Despite high coverage, pertussis vaccination delays can leave infants at a vulnerable age with less protection than anticipated. METHODS Current diphtheria-tetanus-pertussis (DTaP) vaccination timeliness for the first 3 doses in the US was estimated using National Immunization Survey data. A Markov model estimated the potential impact on outcomes and costs of a hypothetical situation of vaccination at exactly 60, 120 and 180 days, compared with current timeliness. Incidence and unit cost data came from published sources. Age-specific incidence (for month of life) of pertussis and the associated probabilities of hospitalization and death for the US, during 2000-2007, were taken from a recently published US DTaP vaccination cost-effectiveness study. The cost analysis was conducted from the healthcare system's perspective over a 1-year time horizon. A regression analysis was conducted to explore the factors associated with vaccination delay. RESULTS Current DTaP vaccination was estimated to be delayed by 16, 27 and 44 days, for the first, second and third doses, respectively, relative to vaccination at exactly 60, 120 and 180 days. The model estimated that vaccination at exactly age 60, 120 and 180 days could prevent approximately 278 pertussis cases, 103 hospitalizations and 1 death in infants aged <1 year in the US, gaining approximately 38 quality-adjusted life years and saving approximately $1.03 million in healthcare costs. CONCLUSIONS Timely administration of infant pertussis vaccine doses could potentially reduce subsequent pertussis cases, hospitalizations, deaths and medical costs in infants aged <1 year in the US.
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Breakwell L, Kelso P, Finley C, Schoenfeld S, Goode B, Misegades LK, Martin SW, Acosta AM. Pertussis Vaccine Effectiveness in the Setting of Pertactin-Deficient Pertussis. Pediatrics 2016; 137:peds.2015-3973. [PMID: 27244813 DOI: 10.1542/peds.2015-3973] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the United States, the proportion of Bordetella pertussis isolates lacking pertactin, a component of acellular pertussis vaccines, increased from 14% in 2010 to 85% in 2012. The impact on vaccine effectiveness (VE) is unknown. METHODS We conducted 2 matched case-control evaluations in Vermont to assess VE of the 5-dose diphtheria, tetanus, and acellular pertussis vaccine (DTaP) series among 4- to 10-year-olds, and tetanus, diphtheria, and acellular pertussis vaccine (Tdap) among 11- to 19-year-olds. Cases reported during 2011 to 2013 were included. Three controls were matched to each case by medical home, and additionally by birth year for the Tdap evaluation. Vaccination history was obtained from medical records and parent interviews. Odds ratios (OR) were calculated by using conditional logistic regression; VE was estimated as (1-OR) × 100%. Pertactin status was determined for cases with available isolates. RESULTS Overall DTaP VE was 84% (95% confidence interval [CI] 58%-94%). VE within 12 months of dose 5 was 90% (95% CI 71%-97%), declining to 68% (95% CI 10%-88%) by 5-7 years post-vaccination. Overall Tdap VE was 70% (95% CI 54%-81%). Within 12 months of Tdap vaccination, VE was 76% (95% CI 60%-85%), declining to 56% (95% CI 16%-77%) by 2-4 years post-vaccination. Of cases with available isolates, >90% were pertactin-deficient. CONCLUSIONS Our DTaP and Tdap VE estimates remain similar to those found in other settings, despite high prevalence of pertactin deficiency in Vermont, suggesting these vaccines continue to be protective against reported pertussis disease.
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Affiliation(s)
- Lucy Breakwell
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, and
| | - Patsy Kelso
- Vermont Department of Health, Burlington, Vermont
| | | | | | - Brant Goode
- Vermont Department of Health, Burlington, Vermont Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Lara K Misegades
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, and
| | - Stacey W Martin
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, and
| | - Anna M Acosta
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, and
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Brotons P, de Paz HD, Toledo D, Villanova M, Plans P, Jordan I, Dominguez A, Jane M, Godoy P, Muñoz-Almagro C. Differences in Bordetella pertussis DNA load according to clinical and epidemiological characteristics of patients with whooping cough. J Infect 2016; 72:460-7. [PMID: 26850358 DOI: 10.1016/j.jinf.2016.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/23/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify associations between nasopharyngeal Bordetella pertussis DNA load and clinical and epidemiological characteristics and evaluate DNA load prognostic value in pertussis severity. METHODS Prospective observational multi-centre study including nasopharyngeal samples positive to pertussis DNA by real-time PCR collected from children and adult patients in more than 200 health centres of Catalonia (Spain) during 2012-2013. RESULTS B. pertussis load was inversely correlated with age (rho = -0.32, p < 0.001), time to diagnosis (rho = -0.33, p < 0.001) and number of symptoms (rho = 0.13, p = 0.002). Median bacterial load was significantly higher in inpatients versus outpatients (4.91 vs. 2.55 log10 CFU/mL, p < 0.001), patients with complications versus those without (6.05 vs. 2.82 log10 CFU/mL, p < 0.001), disease incidence in summer and autumn versus spring and winter (3.50 vs. 2.21 log10 CFU/mL, p = 0.002), and unvaccinated-partially vaccinated patients versus vaccinated (4.20 vs. 2.76 log10 CFU/mL, p = 0.004). A logistic regression model including bacterial load and other candidate prognostic factors showed good prediction for hospital care (AUC = 0.94) although only age and unvaccinated status were found to be prognostic factors. CONCLUSIONS We observed strong positive associations of nasopharyngeal bacterial load with severity outcomes of hospitalisation and occurrence of complications. Bacterial load and other independent variables contributed to an accurate prognostic model for hospitalisation.
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Affiliation(s)
- Pedro Brotons
- Molecular Microbiology Department, University Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, 08950, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Hector D de Paz
- Molecular Microbiology Department, University Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, 08950, Spain
| | - Diana Toledo
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Marta Villanova
- Molecular Microbiology Department, University Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, 08950, Spain
| | - Pedro Plans
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, 28029, Spain; Public Health Agency of Catalonia, Barcelona, 08005, Spain
| | - Iolanda Jordan
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, 28029, Spain; Pediatric Intensive Care Unit, Molecular Microbiology Department, University Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, 08950, Spain
| | - Angela Dominguez
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, 28029, Spain; Department of Public Health, University of Barcelona, Barcelona, 08005, Spain
| | - Mireia Jane
- Public Health Agency of Catalonia, Barcelona, 08005, Spain
| | - Pere Godoy
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, 28029, Spain; Public Health Agency of Catalonia, Barcelona, 08005, Spain
| | - Carmen Muñoz-Almagro
- Molecular Microbiology Department, University Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, 08950, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, 28029, Spain.
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Varan AK, Harriman KH, Winter K, Thun MD, McDonald EC. Economic and Social Impact of Pertussis Among Adolescents in San Diego County. J Adolesc Health 2016; 58:241-4. [PMID: 26802995 PMCID: PMC11382229 DOI: 10.1016/j.jadohealth.2015.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE During recent pertussis epidemics, adolescents have experienced a large burden of disease. We assessed the impact of pertussis among San Diego adolescents and their households. METHODS Parents of pertussis patients aged 13-17 years were surveyed about health care utilization, missed work and school, and other factors. Costs of medical visits, medication use, and lost wages were estimated. RESULTS The parents of 53 (of 108 [49%]) eligible 2013 pertussis patients were interviewed; 51 (96%) of these patients previously received tetanus, diphtheria, and acellular pertussis vaccine. Medical visits included primary care (81%), urgent care (11%), and emergency department (9%); all patients received antibiotics. Forty-seven households (89%) received a post-exposure prophylaxis recommendation, and five (9%) reported ≥1 unpaid parental leave day. Thirty-eight patients (72%) missed ≥1 school day (mean = 5.4 days). Societal costs were estimated at $315.15 per household and $236,047.35 in San Diego during 2013-2014. CONCLUSIONS Even among vaccinated adolescents, pertussis can result in considerable societal costs.
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Affiliation(s)
- Aiden K Varan
- CDC/CSTE Applied Epidemiology Fellowship, Atlanta, Georgia; County of San Diego Health and Human Services Agency, San Diego, California; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, San Diego, California.
| | | | - Kathleen Winter
- California Department of Public Health, Richmond, California
| | - Melissa D Thun
- County of San Diego Health and Human Services Agency, San Diego, California
| | - Eric C McDonald
- County of San Diego Health and Human Services Agency, San Diego, California
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Infant vaccination timing: Beyond traditional coverage metrics for maximizing impact of vaccine programs, an example from southern Nepal. Vaccine 2016; 34:933-41. [PMID: 26788880 PMCID: PMC4744084 DOI: 10.1016/j.vaccine.2015.12.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/11/2015] [Accepted: 12/23/2015] [Indexed: 11/22/2022]
Abstract
We prospectively examined, via weekly recall, the timing of EPI immunizations in infants less than 6 months in rural Nepal. The majority of infants less than 6 months received immunizations on a delayed schedule. National immunization coverage estimates do not capture delay in the first 6 months of life.
Background Immunization programs currently measure coverage by assessing the proportion of children 12–24 months who have been immunized but this does not address the important question of when the scheduled vaccines were administered. Data capturing the timing of vaccination in first 6 months, when severe disease is most likely to occur, are limited. Objective To estimate the time to Bacillus Calmette–Guérin (BCG) (recommended at birth), diphtheria-tetanus-pertussis-H, influenza b-hepatitis B (DTP-Hib-HepB), and oral polio vaccine (OPV) (recommended at 6, 10, and 14 weeks) vaccinations and risk factors for vaccination delay in infants <6 months of age in a district in southern Nepal where traditional coverage metrics are high. Design/methods Infants enrolled in a randomized controlled trial of maternal influenza vaccination were visited weekly at home from birth through age 6 months to ascertain if any vaccinations had been given in the prior week. Infant, maternal, and household characteristics were recorded. BCG, DTP-Hib-HepB, and OPV vaccination coverage at 4 and 6 months was estimated. Time to vaccination was estimated through Kaplan–Meier curves; Cox-proportional hazards models were used to examine risk factors for delay for the first vaccine. Results The median age of BCG, first OPV and DTP-Hib-HepB receipt was 22, 21, and 18 weeks, respectively. Almost half of infants received no BCG by age 6 months. Only 8% and 7% of infants had received three doses of OPV and DTP-Hib-HepB, respectively, by age 6 months. Conclusion A significant delay in receipt of infant vaccines was found in a prospective, population-based, cohort in southern Nepal despite traditional coverage metrics being high. Immunization programs should consider measuring time to receipt relative to the official schedule in order to maximize benefits for disease control and child health.
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Differences in Pertussis Incidence by Income among Oregon Teens during an Outbreak. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/593819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
That disease and poverty are connected is a cornerstone of public health thought. In the case of pertussis, however, it is possible that the expected relationship to poverty is reversed. Grounds exist for considering that increases in income are associated with increases in pertussis rates, both in terms of real risk through social and network features and through the possibility of greater likelihood of care seeking and detection based on income. Using reported adolescent pertussis cases from a 2012 outbreak in Oregon, pertussis incidence rates were determined for areas grouped by zip code into higher, middle, and lower median household income. Adolescents of ages 13–16 years in higher income areas were 2.6 times (95% CI 1.8–3.8) more likely as all others to have reported pertussis during the 2012 outbreak and 3.1 (95% CI 1.4–6.5) times as likely as those in lower income areas. The higher pertussis rates associated with higher income areas were observed regardless of Tdap rate differences. These results suggest that income may be associated with disease risk, likelihood of diagnosis and reporting, or both. Further evaluation of this finding is warranted.
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Crespo I, Toledo D, Soldevila N, Jordán I, Solano R, Castilla J, Caylà JA, Godoy P, Muñoz-Almagro C, Domínguez Á. Characteristics of Hospitalized Cases of Pertussis in Catalonia and Navarra, Two Regions in the North of Spain. PLoS One 2015; 10:e0139993. [PMID: 26440655 PMCID: PMC4595087 DOI: 10.1371/journal.pone.0139993] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022] Open
Abstract
Pertussis causes a large number of cases and hospitalizations in Catalonia and Navarra. We made a study of household cases of pertussis during 2012 and 2013 in order to identify risk factors for hospitalization in pertussis cases. Each primary case reported triggered the study of their contacts. Close contacts at home and people who were in contact for >2 hours during the transmission period of cases were included. The adjusted OR and 95% confidence intervals (CI) was calculated using logistic regression. A total of 1124 pertussis cases were detected, of which 14.9% were hospitalized. Inspiratory whoop (aOR: 1.64; CI: 1.02-2.65), apnoea (aOR: 2.47; CI: 1.51-4.03) and cyanosis (aOR: 15.51; CI: 1.87-128.09) were more common in hospitalized than in outpatient cases. Hospitalization occurred in 8.7% of correctly-vaccinated cases, 41.1% of non-vaccinated cases and 9.4% of partially-vaccinated cases. In conclusion, inspiratory whoop, apnoea and cyanosis were associated factors to hospitalization while vaccination reduced hospitalizations due to pertussis.
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Affiliation(s)
- Inma Crespo
- CIBER Epidemiology and Public Health. Barcelona, Spain
- Public Health Department, University of Barcelona, Barcelona, Spain
- * E-mail:
| | - Diana Toledo
- Public Health Department, University of Barcelona, Barcelona, Spain
- Public Health Agency, Barcelona, Spain
| | - Núria Soldevila
- CIBER Epidemiology and Public Health. Barcelona, Spain
- Public Health Department, University of Barcelona, Barcelona, Spain
| | - Iolanda Jordán
- Paediatric Intensive Care Medicine, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rubén Solano
- CIBER Epidemiology and Public Health. Barcelona, Spain
- Public Health Department, University of Barcelona, Barcelona, Spain
- Public Health Agency, Barcelona, Spain
| | - Jesús Castilla
- CIBER Epidemiology and Public Health. Barcelona, Spain
- Public Health Institute, Navarra Institute for Health Research, Pamplona, Spain
| | - Joan A. Caylà
- CIBER Epidemiology and Public Health. Barcelona, Spain
- Public Health Agency, Barcelona, Spain
| | - Pere Godoy
- CIBER Epidemiology and Public Health. Barcelona, Spain
- Agency of Public Health of Catalonia, Barcelona, Spain
| | | | - Ángela Domínguez
- CIBER Epidemiology and Public Health. Barcelona, Spain
- Public Health Department, University of Barcelona, Barcelona, Spain
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Abstract
Despite implementation of a successful vaccination program, pertussis remains a significant health problem. Although the incidence of pertussis in the United States is reduced by approximately 80% compared with incidence before the introduction of vaccination in the 1940s, deaths still occur and the unrecognized disease burden remains high, with 1 million Bordetella pertussis infections annually in the United States estimated by serologic surveys. Reasons for the resurgence and current prevalence of pertussis may be multifactorial and include waning vaccine-induced protection as well as lower vaccine effectiveness, failure to vaccinate, and changes in the organism itself.
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Affiliation(s)
- Emily Souder
- Section of Infectious Diseases, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA 19134, USA.
| | - Sarah S Long
- Section of Infectious Diseases, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA 19134, USA
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Goldstein ND, Newbern EC, Evans AA, Drezner K, Welles SL. Choice of measures of vaccination and estimates of risk of pediatric pertussis. Vaccine 2015; 33:3970-5. [PMID: 26093200 DOI: 10.1016/j.vaccine.2015.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection. METHODS City-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis. RESULTS Being UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group. CONCLUSION Examining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.
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Affiliation(s)
- Neal D Goldstein
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19104, United States.
| | - E Claire Newbern
- Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA 19146, United States
| | - Alison A Evans
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19104, United States
| | - Kate Drezner
- Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA 19146, United States
| | - Seth L Welles
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19104, United States
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Abstract
PURPOSE OF REVIEW To provide a clinically relevant synopsis of the latest research and recommendations regarding adolescent immunizations. RECENT FINDINGS Immunization is an important and effective strategy for preventing morbidity and mortality in adolescents. Although there has been progress in recent years, coverage rates in the US remain suboptimal, particularly for the human papillomavirus vaccine. Much work has been done to better understand and address the barriers to adolescent immunization, so that all teens may be protected against serious vaccine-preventable diseases. In addition, several recent studies have focused on the effectiveness of current adolescent vaccines and the development of new vaccines to protect against additional types of human papillomavirus and serotype B Neisseria meningitidis. Decreased pertussis vaccine effectiveness has led to new recommendations for pregnant women, including adolescents, to protect them and their young infants. The present review highlights selected literature on acellular pertussis, meningococcal, and human papillomavirus vaccines. Research findings on various strategies to improve adolescent vaccine uptake are also discussed in this review. SUMMARY Research on adolescent immunizations and their delivery continues to have an impact on clinical practice and will shape future guidelines. Through this work, we can learn how best to protect adolescents against vaccine-preventable diseases.
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Abstract
BACKGROUND Australia recently experienced its worst pertussis epidemic since introduction of pertussis vaccine into the National Immunisation Program. This study aimed to determine factors associated with severe pertussis in hospitalized children during an epidemic using a novel pertussis severity scoring (PSS) system. METHODS This prospective, observational, multicenter study enrolled children hospitalized with laboratory confirmed pertussis from 8 tertiary pediatric hospitals during a 12 month period (May 2009-April 2010). Variables assessed included demographics, clinical symptoms and relevant medical and immunization history. Cases were scored using objective clinical findings with cases classified as either severe (PSS > 5) or not severe (PSS ≤ 5). Logistic regression models were used to predict variables associated with severe disease. RESULTS One hundred twenty hospitalized children 0-17 years of age were enrolled with a median PSS of 5 (interquartile range 3-7). Most (61.7%) were classified as not severe with 38.3% (46/120) severe. Most severe cases (54.3%) were <2 months of age. Presence of coinfection [odds ratio (OR): 4.82, CI: 1.66-14.00], <2 months old (OR: 4.76, CI: 1.48-15.32), fever >37.5°C (OR: 5.97, CI: 1.19-29.96) and history of prematurity (OR: 5.00, CI: 1.27-19.71) were independently associated with severe disease. A total of 70 cases in children ≥2 months of age, almost a third (n = 23) had not received pertussis vaccine. CONCLUSIONS Most severe pertussis occurred in young, unimmunized infants, although severe disease was also observed in children >12 months of age and previously vaccinated children. Children admitted with pertussis with evidence of coinfection, history of prematurity or fever on presentation need close monitoring.
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van den Brink G, Wishaupt JO, Douma JC, Hartwig NG, Versteegh FGA. Bordetella pertussis: an underreported pathogen in pediatric respiratory infections, a prospective cohort study. BMC Infect Dis 2014; 14:526. [PMID: 25267437 PMCID: PMC4261543 DOI: 10.1186/1471-2334-14-526] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/24/2014] [Indexed: 01/11/2023] Open
Abstract
Background The incidence of pertussis has been increasing worldwide. In the Netherlands, the seroprevalence has risen higher than the reported cases, suggesting that laboratory tests for pertussis are considered infrequently and that even more pertussis cases are missed. The objective of our study was to determine the frequency of pertussis in clinically unsuspect cases compared to suspect cases with the intention of finding clinical predictors. Methods The present prospective cohort study was part of a controlled clinical trial evaluating the impact of molecular diagnostics on clinical decision making in pediatric respiratory infections, performed during 2 winter seasons. For this study, in the first season pertussis was only tested in case of clinical suspicion, in the second season, pertussis was also tested without clinical suspicion. Multivariate and univariate analysis were performed using SPSS 18 and Statistical software ‘R’. Results In the two seasons respectively 22/209 (10,5%) and 49/373 (13,1%) cases were clinically suspected of pertussis. Bordetella pertussis was detected by real time RT-PCR in respectively 2/22 (9,1%) and 7/49 (14,3%) cases. In the second season an additional 7 cases of pertussis were found in clinically unsuspected cases (7/257 = 2,7%). These additional cases didn’t differ in clinical presentation from children without a positive test for pertussis with respect to respiratory symptoms. Conclusions Pertussis in children sometimes mimics viral respiratory tract infections. If pertussis diagnostics are based on clinical suspicion alone, about 1 in 5 cases (19%) is missed. Despite widely accepted clinical criteria, paroxysmal cough is not a good predictor of pertussis. To prevent spreading, physicians should include B. pertussis in routine diagnostics in respiratory tract infections. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-526) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gertrude van den Brink
- Department of Pediatrics, ErasmusMC-Sophia, Wytemaweg 80 3015 CN, Rotterdam, The Netherlands.
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Warfel JM, Merkel TJ. The baboon model of pertussis: effective use and lessons for pertussis vaccines. Expert Rev Vaccines 2014; 13:1241-52. [DOI: 10.1586/14760584.2014.946016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wang K, Fry NK, Campbell H, Amirthalingam G, Harrison TG, Mant D, Harnden A. Whooping cough in school age children presenting with persistent cough in UK primary care after introduction of the preschool pertussis booster vaccination: prospective cohort study. BMJ 2014; 348:g3668. [PMID: 24961836 PMCID: PMC4069283 DOI: 10.1136/bmj.g3668] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination. DESIGN Prospective cohort study (November 2010 to December 2012). SETTING General practices in Thames Valley, UK. PARTICIPANTS 279 children aged 5 to 15 years who presented in primary care with a persistent cough of two to eight weeks' duration. Exclusion criteria were cough likely to be caused by a serious underlying medical condition, known immunodeficiency or immunocompromise, participation in another clinical research study, and preschool pertussis booster vaccination received less than one year previously. MAIN OUTCOME MEASURES Evidence of recent pertussis infection based on an oral fluid anti-pertussis toxin IgG titre of at least 70 arbitrary units. Cough frequency was measured in six children with laboratory confirmed pertussis. RESULTS 56 (20%, 95% confidence interval 16% to 25%) children had evidence of recent pertussis infection, including 39 (18%, 13% to 24%) of 215 children who had been fully vaccinated. The risk of pertussis was more than three times higher (21/53; 40%, 26% to 54%) in children who had received the preschool pertussis booster vaccination seven years or more previously than in those who had received it less than seven years previously (20/171; 12%, 7% to 17%). The risk of pertussis was similar between children who received five and three component preschool pertussis booster vaccines (risk ratio for five component vaccine 1.14, 0.64 to 2.03). Four of six children in whom cough frequency was measured coughed more than 400 times in 24 hours. CONCLUSIONS Pertussis can still be found in a fifth of school age children who present in primary care with persistent cough and can cause clinically significant cough in fully vaccinated children. These findings will help to inform consideration of the need for an adolescent pertussis booster vaccination in the United Kingdom. STUDY REGISTRATION UK Clinical Research Network portfolio ID 8361.
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Affiliation(s)
- Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Norman K Fry
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5HT, UK
| | - Helen Campbell
- Immunisation, Hepatitis and Blood Safety Department, Public Health England
| | | | - Timothy G Harrison
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5HT, UK
| | - David Mant
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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Mertsola J. Editorial commentary: pertussis is less severe in vaccinated than in unvaccinated patients. Clin Infect Dis 2014; 58:1530-2. [PMID: 24633682 DOI: 10.1093/cid/ciu161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jussi Mertsola
- Department of Pediatrics, Turku University Hospital and Turku University, Finland
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