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Wang B, Gai X, Han Y, Liu Y, Zhang Y, Sun J, Liu M, Yu H, Peng Z, Wei X, Chang Y, Ma X, Gai Z. Epidemiological characteristics of common respiratory infectious diseases in children before and during the COVID-19 epidemic. Front Pediatr 2023; 11:1212658. [PMID: 37601133 PMCID: PMC10435660 DOI: 10.3389/fped.2023.1212658] [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: 04/26/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
Background Since the outbreak of coronavirus disease 2019 (COVID-19), public's awareness of infection prevention and control has increased overall, and various prevention and control measures have been adopted. These measures may also have a certain impact on the occurrence of other infectious diseases. Therefore, we collected information on children with several respiratory infectious diseases in Jinan Children's Hospital in China from 2016 to 2022 and analyzed their changes. Method We collected data on age, sex and number of cases of pertussis, measles, scarlet fever, pulmonary tuberculosis, mumps and influenza, which were diagnosed by clinical and laboratory criteria, from 1 January 2016 to 31 December 2022 in Jinan Children's Hospital in Jinan, Shandong Province, China. Data on the number of people affected by these diseases in China from the Chinese Center for Disease Control and Prevention were compared. Then, we processed the data by using WPS Excel 2019 and SPSS. Results A total of 12,225 cases were included in this study in Jinan Children's Hospital, which consisted of 3,688 cases of pertussis (2,200 cases before COVID-19 and 1,488 during COVID-19), 680 cases of measles (650 cases before COVID-19 and 30 during COVID-19), 4,688 cases of scarlet fever (4,001 cases before COVID-19 and 687 during COVID-19), 114 cases of tuberculosis (86 cases before COVID-19 and 28 during COVID-19), 449 cases of mumps (340 cases before COVID-19 and 109 during COVID-19) and 2,606 cases of influenza (1,051 cases before COVID-19 and 1,555 during COVID-19). The numbers of children in the hospital with pertussis, measles, scarlet fever, mumps and influenza decreased substantially during COVID-19 in 2020-2022 compared with numbers in 2016-2019, while numbers of patients in China with all six respiratory infectious diseases, including pulmonary tuberculosis, declined during the pandemic. A rebound of pertussis, scarlet fever and influenza was observed in 2021 and 2022. Conclusions The study found that viral pathogens such as those causing measles, mumps and influenza all decreased during the pandemic, after which influenza rebounded. Infection diseases caused by bacteria such as scarlet fever and pertussis also decreased during COVID-19, and then a rebound occurred. However, tuberculosis stayed relatively constant.
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Affiliation(s)
- Bing Wang
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Xiangzhen Gai
- School of Public Health, Shandong University, Jinan, China
| | - Yuling Han
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Yanqin Liu
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Yun Zhang
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Jing Sun
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Miao Liu
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Huafeng Yu
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Zhenju Peng
- Department of Public Health, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Xiaoling Wei
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Yuna Chang
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Xiang Ma
- Department of Respiratory Medicine, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
- Children’s Research Institute, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
| | - Zhongtao Gai
- Children’s Research Institute, Children’s Hospital Affiliated to Shandong, University (Jinan Children’s Hospital), Jinan, China
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Zhang J, Zhang D, Wang X, Wei X, Li H. Macrolide susceptibility and molecular characteristics of Bordetella pertussis. J Int Med Res 2022; 50:3000605221078782. [PMID: 35225710 PMCID: PMC8894965 DOI: 10.1177/03000605221078782] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To analyse macrolide resistance and molecular characteristics of Bordetella pertussis clinical isolates from western China, and to explore the relationship between macrolide-resistance and genotypes. Methods Susceptibilities of B. pertussis clinical isolates to erythromycin, azithromycin and clarithromycin were determined by epsilometer test (E-test). Isolated strains were sequenced to ascertain the presence of the 23S rRNA gene A2047G mutation. Strains were typed using multilocus antigen sequence typing, multilocus variable-number tandem-repeat analysis (MLVA) and pulsed-field gel electrophoresis (PFGE). Results Of 58 B. pertussis strains isolated in this study, 46 were macrolide-resistant and 12 were macrolide sensitive. All macrolide-resistant strains carried the A2047G mutation and were the prn1/ptxP1/ptxA1/fim3-1/fim2-1 genotype; the MLVA types were MT195 (19/58), MT55 (13/58) and MT104 (14/58), and the PFGE profiles were classified into BpSR23 (17/58) and BpFINR9 (29/58) types. None of the macrolide-sensitive strains carried the A2047G mutation; genotypes were (prn9 or prn2)/ptxP3/ptxA1/fim3-1/fim2-1, and all were MT27. PFGE profiles differed from the macrolide-resistant strains. Conclusions B. pertussis clinical isolates from western China were severely resistant to macrolides. Genotypes differed between macrolide-resistant and macrolide-sensitive strains, and there may be a correlation between acquisition of macrolide resistance and changes in specific molecular types.
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Affiliation(s)
- Juansheng Zhang
- Microbiology laboratory, Xi'an Centre for Disease Control and Prevention, Xi'an, Shaanxi Province, China
| | - Diqiang Zhang
- Department of Obstetrics and Gynaecology, Pingchuan District People's Hospital, Baiyin, Gansu Province, China
| | - Xiaoqiang Wang
- Microbiology laboratory, Xi'an Centre for Disease Control and Prevention, Xi'an, Shaanxi Province, China
| | - Xiaoguang Wei
- Microbiology laboratory, Xi'an Centre for Disease Control and Prevention, Xi'an, Shaanxi Province, China
| | - Hao Li
- Microbiology laboratory, Xi'an Centre for Disease Control and Prevention, Xi'an, Shaanxi Province, China
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Cimolai N. Pharmacotherapy for Bordetella pertussis infection. I. A synthesis of laboratory sciences. Int J Antimicrob Agents 2020; 57:106258. [PMID: 33310116 DOI: 10.1016/j.ijantimicag.2020.106258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 11/09/2020] [Accepted: 11/28/2020] [Indexed: 11/15/2022]
Abstract
There is considerable history and practice experience both with laboratory susceptibility testing for Bordetella pertussis and clinical treatment. This two-part narrative review provides a synthesis of the laboratory and clinical sciences as they apply to this bacterium and the clinical consequences of treating infection. It is generally held that antibiotic susceptibility testing for B. pertussis is not sufficiently standardised, but there has not been an urgent need to consolidate the same given the lack global experience with major resistance profiles. Experience in China, however, has provided concern for high-level macrolide resistance. The nature of and frequency of such resistance has raised the bar for reconsideration of susceptibility testing given that first-line treatment may be regionally compromised. Disk diffusion and Etest susceptibility testing can be recommended for screening resistance among individual isolates of B. pertussis and on an ad hoc manner. Disk diffusion, Etest and/or critical agar dilution testing can be recommended for large-scale studies. Standards for inoculum, growth atmosphere, timing of interpretation, preferred testing media and controls can be extrapolated from the publications to date. Such methods should be able to detect high-level resistance to several antibiotics, but especially macrolides. Concern for intermediate-susceptible categories requires consideration as well as the correlation with bacteriological and clinical outcomes. Provisional standards can be applied at this time, and modification or fine-tuning of any such standards are open to future investigation.
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Affiliation(s)
- Nevio Cimolai
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, British Columbia, V6H3V4 Canada.
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Zhang JS, Wang HM, Yao KH, Liu Y, Lei YL, Deng JK, Yang YH. Clinical characteristics, molecular epidemiology and antimicrobial susceptibility of pertussis among children in southern China. World J Pediatr 2020; 16:185-192. [PMID: 31493136 DOI: 10.1007/s12519-019-00308-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Increasing numbers of pertussis cases have been reported in recent years. The reported cases from Shenzhen Children's Hospital were close to one tenth of all cases in China. The epidemiology of antigenic genotype and antibiotic resistance of circulating strains in children have been unknown in Shenzhen, southern China. The aim of this study was to describe the clinical features and explore the genotypes and antimicrobial susceptibility of circulating Bordetella pertussis among children in Shenzhen. METHODS Data of hospitalized children with pertussis in Shenzhen Children's Hospital from August 2015 to April 2017 were collected. The genetic variability of isolates was investigated and Etest was performed for phenotypic susceptibility to erythromycin, azithromycin, clarithromycin, clindamycin, and trimethoprim/sulfamethoxazole. RESULTS 469 children with pertussis confirmed by real-time quantitative polymerase chain reaction were hospitalized and strains were isolated from 105 patients. White blood cell count ≥ 20 × 109/L and lymphocyte proportion ≥ 60% were observed in 39.29% of infants younger than 3 months. The two predominant profiles of virulence-associated allelic genes were ptxA1/ptxC1/ptxP1/prn1 (48.6%) and ptxA1/ptxC2/ptxP3/prn2 (44.8%). Among the isolates, 48.6% (51/105) were found resistant to macrolides. CONCLUSIONS These findings indicate that leukocytosis is not a sensitive indicator of pertussis. Isolates with the gene profile ptxP3/prn2 were highly circulating in Shenzhen and less resistant to macrolides, different from patterns observed in other parts of China.
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Affiliation(s)
- Jiao-Sheng Zhang
- Laboratory of Microbiology and Immunology, Beijing Children's Hospital Affiliated to Capital Medical University, 56 Nanlishi Road, Beijing, 100045, China.,Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Hong-Mei Wang
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Kai-Hu Yao
- Laboratory of Microbiology and Immunology, Beijing Children's Hospital Affiliated to Capital Medical University, 56 Nanlishi Road, Beijing, 100045, China
| | - Ying Liu
- Laboratory of Microbiology and Immunology, Beijing Children's Hospital Affiliated to Capital Medical University, 56 Nanlishi Road, Beijing, 100045, China
| | - Yan-Ling Lei
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Ji-Kui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Yong-Hong Yang
- Laboratory of Microbiology and Immunology, Beijing Children's Hospital Affiliated to Capital Medical University, 56 Nanlishi Road, Beijing, 100045, China. .,Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518038, China.
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Xu Z, Wang Z, Luan Y, Li Y, Liu X, Peng X, Octavia S, Payne M, Lan R. Genomic epidemiology of erythromycin-resistant Bordetella pertussis in China. Emerg Microbes Infect 2019; 8:461-470. [PMID: 30898080 PMCID: PMC6455148 DOI: 10.1080/22221751.2019.1587315] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Macrolides such as erythromycin are the empirical treatment of Bordetella pertussis infections. China has experienced an increase in erythromycin-resistant B. pertussis isolates since they were first reported in 2013. Here, we undertook a genomic study on Chinese B. pertussis isolates from 2012 to 2015 to elucidate the origins and phylogenetic relationships of erythromycin-resistant B. pertussis isolates in China. A total of 167 Chinese B. pertussis isolates were used for antibiotic sensitivity testing and multiple locus variable-number tandem repeat (VNTR) analysis (MLVA). All except four isolates were erythromycin-resistant and of the four erythromycin-sensitive isolates, three were non-ptxP1. MLVA types (MT), MT55, MT104 and MT195 were the predominant types. Fifty of those isolates were used for whole genome sequencing and phylogenetic analysis. Genome sequencing and phylogenetic analysis revealed three independent erythromycin-resistant lineages and all resistant isolates carried a mutation in the 23S rRNA gene. A novel fhaB3 allele was found uniquely in Chinese ptxP1 isolates and these Chinese ptxP1-ptxA1-fhaB3 had a 5-fold higher mutation rate than the global ptxP1-ptxA1 B. pertussis population. Our results suggest that the evolution of Chinese B. pertussis is likely to be driven by selection pressure from both vaccination and antibiotics. The emergence of the new non-vaccine fhaB3 allele in Chinese B. pertussis population may be a result of selection from vaccination, whereas the expansion of ptxP1-fhaB3 lineages was most likely to be the result of selection pressure from antibiotics. Further monitoring of B. pertussis in China is required to better understand the evolution of the pathogen.
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Affiliation(s)
- Zheng Xu
- a School of Biotechnology and Biomolecular Sciences , University of New South Wales , Sydney , Australia
| | - Zengguo Wang
- b Xi'an Center for Disease Prevention and Control , Xi'an , People's Republic of China.,c Department of Infectious Diseases , Xi'an Children's Hospital , Xi'an , People's Republic of China
| | - Yang Luan
- b Xi'an Center for Disease Prevention and Control , Xi'an , People's Republic of China
| | - Yarong Li
- c Department of Infectious Diseases , Xi'an Children's Hospital , Xi'an , People's Republic of China
| | - Xiaoguai Liu
- c Department of Infectious Diseases , Xi'an Children's Hospital , Xi'an , People's Republic of China
| | - Xiaokang Peng
- c Department of Infectious Diseases , Xi'an Children's Hospital , Xi'an , People's Republic of China
| | - Sophie Octavia
- a School of Biotechnology and Biomolecular Sciences , University of New South Wales , Sydney , Australia
| | - Michael Payne
- a School of Biotechnology and Biomolecular Sciences , University of New South Wales , Sydney , Australia
| | - Ruiting Lan
- a School of Biotechnology and Biomolecular Sciences , University of New South Wales , Sydney , Australia
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Fu P, Wang C, Tian H, Kang Z, Zeng M. Bordetella pertussis Infection in Infants and Young Children in Shanghai, China, 2016-2017: Clinical Features, Genotype Variations of Antigenic Genes and Macrolides Resistance. Pediatr Infect Dis J 2019; 38:370-376. [PMID: 30882726 DOI: 10.1097/inf.0000000000002160] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The global resurgence of pertussis in countries with high vaccination coverage has been a concern of public health. METHODS Nasopharyngeal swabs were collected for Bordetella pertussis culture from children with suspected pertussis. Clinical and vaccination information were reviewed through electronic medical chart and immunization record. Antibiotics susceptibility was evaluated using E-test for erythromycin, azithromycin, clarithromycin and sulfamethoxazole/trimethoprim. The MLST genotypes and 7 antigenic genes (ptxP, ptxA, ptxC, Prn, fim3, fim2 and tcfA) of Bordetella pertussis were identified by polymerase chain reaction amplification and sequencing. RESULTS During January 2016 to September 2017, a total of 141 children 1-48 months of age were culture-confirmed with pertussis, of whom 98 (69.5%) were younger than 6 months, 25 (17.7%) had completed at least 3 doses of DTaP and 75 (53.2%) had a clear exposure to household members with persistent cough. Fully vaccinated cases manifested milder disease than unvaccinated and not-fully vaccinated cases. All strains were MLST2. High-virulent strains characteristic of ptxP3/prn2/ptxC2 constituted 41.1% (58/141) and were all susceptible to macrolides while low-virulent strains characteristic of ptxP1/prn1/ptxC1 constituted 58.9% (83/141) and 97.6% (81/83), respectively, were highly resistant to macrolides. CONCLUSIONS Pertussis is resurging among infants and young children in Shanghai, and household transmission is the main exposure pathway. The high-virulent strains harboring ptxP3/prn2/ptxC2 and the macrolide-resistant Bordetella pertussis strains are quite prevalent. These issues impose a public health concern in Shanghai. Our findings are important to modify the DTaP vaccination strategy and the management guideline of pertussis in China.
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Affiliation(s)
- Pan Fu
- From the Department of Clinical Microbiology Laboratory, Clinical Laboratory Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Chuanqing Wang
- From the Department of Clinical Microbiology Laboratory, Clinical Laboratory Medicine, Children's Hospital of Fudan University, Shanghai, China
- Department of Nosocomial Infection Control, Children's Hospital of Fudan University, Shanghai, China
| | - He Tian
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Zhihua Kang
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
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Yao KH, Jia J. [Enhance research, prevention and control of pertussis for protecting public confidence in vaccination: focus on the adverse events of vaccine with insufficient potency and its long-term impacts]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:1-4. [PMID: 29335073 PMCID: PMC7390315 DOI: 10.7499/j.issn.1008-8830.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
On November 3, 2017, the China Food and Drug Administration reported that the potency indexes of two batches of diphtheria-pertussis-tetanus vaccines produced by two companies did not reach the requirements. Insufficient potency could affect the protection effect of these vaccines immunization. Currently, pertussis cases have already showed an increasing trend in China and could last for several years. Such an increase could be linked to these adverse events of vaccine with insufficient potency, which could become an evidence to challenge or deny the effectiveness of vaccination, and brings a persistent inhibition of the public's acceptance for vaccination. The wider global context of pertussis resurgence, previous underestimate on the domestic pertussis, the promotion of detection methods, the change of knowledge about pertussis, the confirmation of pertussis in elder children and adults, the antigenicity variation of pertussis strains could lead to a significant increase of pertussis cases. Health researchers and clinical workers should raise awareness about these factors, and assess rationally the impact of vaccine titer deficiency on pertussis epidemiology for maintaining and promoting public confidence in vaccination.
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Affiliation(s)
- Kai-Hu Yao
- National Center for Children's Health/Beijing Children's Hospital, Capital Medical University/Beijing Pediatric Research Institute/National Key Discipline of Pediatrics (Capital Medical University)/National Clinical Research Center for Respiratory Diseases/Key Laboratory of Major Diseases in Children, Ministry of Education/Beijing Key Laboratory of Pediatric Respiratory Infectious Diseases, Beijing 100045, China.
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