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Zhang C, Hu W, Wang R, Wang Y, Li Y, Lv Y, Li W, Si Y, Zhang S. Seroepidemiology of pertussis and diphtheria among healthy adults in Shaanxi Province, northwest China: A large - scale cross-sectional study. Hum Vaccin Immunother 2022; 18:2133913. [PMID: 36255248 DOI: 10.1080/21645515.2022.2133913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To determine the estimated pertussis incidence in adults and the need for a booster dose by detecting pertussis and diphtheria antibody levels in adults in Shaanxi province, China. Blood samples were collected from healthy individuals aged 18-59 years in Shaanxi province in 2017. Serum immunoglobulin G (IgG) antibodies against pertussis toxin (PT) and diphtheria toxin (DT) were determined using enzyme-linked immunosorbent assay. The data on reported pertussis cases in Shaanxi province were collected from the China Information System for Disease Control and Prevention and compared with the results of this study. A total of 4307 subjects were enrolled. The mean concentration of anti-PT IgG was 19.6 IU/mL (95% CI = 18.9-20.3), and the positive rate (≥40 IU/mL) was 11.0% (474/4307), of which recent infections (≥100 IU/mL) accounted for 1.2% (53/4307). Only one adult case of pertussis was reported in 2017, which is much lower than the results of this study. The mean concentration of anti-DT IgG was 0.04 IU/mL (95% CI = 0.04-0.05), and the positive rate (≥0.01 IU/mL) was 82.3% (3543/4307). The mean concentration of anti-DT IgG decreased from 0.07 IU/mL in the 18-29 year-old group to 0.03 IU/mL in the 50-59 year-old-group, and the positivity rate decreased from 86.7% to 78.7%. Our study suggests that pertussis is not uncommon among adults. The existing surveillance system might have underestimated the true incidence of pertussis. The diphtheria antibody levels decreased with age. Booster vaccination against pertussis should be considered for adolescents and young adults.
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Affiliation(s)
- Chao Zhang
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Weijun Hu
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Ruize Wang
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yinan Wang
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yajun Li
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yake Lv
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Weixuan Li
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Yuan Si
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Shaobai Zhang
- Department of Immunization Program, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, China
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Hughes SL, Kwong JC, Schwartz KL, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Mahmud SM, Crowcroft NS. Exploring the reasons for low pertussis vaccine effectiveness in Ontario, Canada, 2006-2008: a Canadian Immunization Research Network study. Canadian Journal of Public Health 2021; 113:155-164. [PMID: 34424508 DOI: 10.17269/s41997-021-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although pertussis vaccines have been widely used for many decades, a burden of illness persists. Resurgences in Ontario, Canada, have not been substantial in the past decade, but an outbreak of pertussis occurred in Toronto between 1 October 2005 and 31 March 2006. Previous Ontario studies found high vaccine effectiveness (VE) in the initial years post-immunization. In order to explore the impact of outbreaks and external factors on VE, we investigated pertussis VE during the period 2006-2008. METHODS We assessed pertussis VE using a frequency-matched case-control study for the period 1 March 2006 to 31 December 2008. We used logistic regression to estimate VE by age, time since last vaccination, and vaccination status according to the Ontario recommended schedule. We compared analyses including and excluding cases from Toronto, and to two recent Ontario pertussis VE studies. RESULTS We included 1797 confirmed cases and 7188 matched controls. Most cases were under 4 years of age during the study period. Pertussis VE was 3.8% (95% CI: - 21.0, 24.0) in the period 15-364 days following the last pertussis vaccine dose, and increased with increasing time since vaccination. Pertussis VE in the first 15-364 days excluding Toronto increased to 57.1% (95% CI: 26.0, 75.1), but the trend of increasing VE with time since vaccination persisted. Although VE was higher in older (6-11 years) than younger (0-5 years) children, it was lower at 12-13 years than after 14 years. CONCLUSION VE was lower in comparison with other studies conducted in Ontario, particularly in younger children. Various factors occurring during the study period may have influenced the results, including clinical testing of asymptomatic contacts, laboratory testing and methods and reporting practice, and a sensitive case definition. Further studies are needed to optimize methods for measuring VE to inform pertussis vaccine policy.
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Affiliation(s)
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,ICES, Toronto, ON, Canada
| | - Cynthia Chen
- Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | | | - Ye Li
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | | | - Shelly Bolotin
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Frances B Jamieson
- Public Health Ontario, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Canadian Blood Services, Ottawa, ON, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health, Edmonton, AB, Canada.,Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.
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3
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Skirda TA, Borisova OY, Petrova MS, Borisova AB, Kombarova SY. [Serological diagnosis of pertussis in older persons.]. Klin Lab Diagn 2020; 65:492-495. [PMID: 32762191 DOI: 10.18821/0869-2084-2020-65-8-492-495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the work was to assess the effectiveness of serodiagnosis of pertussis in people over 50 who complained of prolonged cough. The study included 30 patients over the age of 50 who applied to the consultative diagnostic center complaining of a prolonged cough in the period from 2015 - 2020. Blood serum samples were investigated in enzyme immunoassay with the definition of antitussive antibodies of three classes - IgM, IgG, IgA in the commercial test system RIDASCREEN (R-Biopharm AG, Germany). It was found that in the serum samples of individuals over the age of 50, IgM antibodies above the threshold level were not detected. Patients were divided into two groups - with IgG and IgA antibodies above the threshold level (group 1) and below the threshold level (group 2). In the first group, in 83.3% and 61.1% of patients, the levels of antibodies of the IgG and IgA class significantly exceeded the threshold level (189.8 ± 16.7 U / ml and 290 ± 20 U / ml, respectively), which indicated a pertussis infection; in 5.6% and 38.9% of patients, IgG and IgA class antibodies slightly exceeded the threshold level (20 U / ml and 43 ± 2.3 U / ml, respectively), which indicated a dying infection. In the second group, in 100% of patients, antibodies of the IgM and IgA classes were determined below threshold levels, and IgG antibodies were detected in 58.3% of individuals at low rates, which corresponded to the natural immunological background of individuals not infected with pertussis pathogen. Therefore, in the presence of a prolonged cough in adults, it is advisable to study blood serum samples for the presence of antitussive antibodies of three classes, which is especially important when people of older age live in families with young children and pregnant women.
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Affiliation(s)
- T A Skirda
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology, 125212, Moscow, Russian Federation
| | - O Y Borisova
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology, 125212, Moscow, Russian Federation
| | - M S Petrova
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology, 125212, Moscow, Russian Federation
| | - A B Borisova
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology, 125212, Moscow, Russian Federation
| | - S Y Kombarova
- G.N. Gabrichevsky Research Institute of Epidemiology and Microbiology, 125212, Moscow, Russian Federation
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Guillot S, Mizrahi A, Armatys N, Chat L, Le Monnier A, Brisse S, Toubiana J. Low Detection Rate of Bordetella pertussis Using the BioFire FilmArray Respiratory Panel 2 plus. Open Forum Infect Dis 2020; 7:ofaa267. [PMID: 32793765 PMCID: PMC7415305 DOI: 10.1093/ofid/ofaa267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Syndromic respiratory panels are increasingly used worldwide. Their performance for detection of Bordetella pertussis needs to be evaluated. We found that the FilmArray Respiratory Panel 2plus (RP2+) assay, which uses the pertussis toxin promoter target for B. pertussis, can only detect highly charged samples. Negative RP2+ results should not be interpreted as an absence of B. pertussis in clinical samples.
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Affiliation(s)
- Sophie Guillot
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Assaf Mizrahi
- Clinical Microbiology Laboratory, Saint Joseph Hospital, Paris, France.,Institut Micalis, UMR1319, Université Paris-Saclay, INRAe, AgroParisTech, Bactéries Pathogènes et Santé, Chatenay-Malabry, France
| | - Nathalie Armatys
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Laureen Chat
- Clinical Microbiology Laboratory, Saint Joseph Hospital, Paris, France
| | - Alban Le Monnier
- Clinical Microbiology Laboratory, Saint Joseph Hospital, Paris, France.,Institut Micalis, UMR1319, Université Paris-Saclay, INRAe, AgroParisTech, Bactéries Pathogènes et Santé, Chatenay-Malabry, France
| | - Sylvain Brisse
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France
| | - Julie Toubiana
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, Institut Pasteur, Paris, France.,General Paediatrics and Paediatric Infectious Diseases Department, Hôpital Necker-Enfants Malades, APHP, Université de Paris, Paris, France
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5
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Wu DX, Chen Q, Yao KH, Li L, Shi W, Ke JW, Wu AM, Huang P, Shen KL. Pertussis detection in children with cough of any duration. BMC Pediatr 2019; 19:236. [PMID: 31299934 PMCID: PMC6626350 DOI: 10.1186/s12887-019-1615-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
Background The diagnosis of pertussis in clinical practice continues to be a challenge worldwide as the symptoms are variable. We aimed to determine the prevalence of pertussis in Chinese children irrespective of cough duration and explore the clinical characteristics of children with pertussis with different cough durations. Methods This was a prospective study of children 1 month to 11 years of age with different cough durations in one large Chinese hospital. Bilateral deep posterior nasopharyngeal swabs and venepuncture for full blood count, CRP and serology and sputum were obtained when possible for investigation. E-test strips were used for testing the susceptibility of the B.pertussis isolates against erythromycin, azithromycin, sulphamethoxazole/trimethoprim, levofloxacin, amoxicillin and doxycycline. Demographic, clinical and laboratory information on culture and antimicrobial susceptibility testing was collected from children, and analyzed using SAS v.10 (SAS Institute Inc., USA). Results After exclusions we analyzed 312 children. Ninety-seven (31.1%) children had laboratory evidence of pertussis. When grouped by cough duration, few characteristics were significant between children with and without pertussis. Of the 36 isolates, 72.2% (26/36)could not be inhibited by erythromycin and azithromycin at all. The MIC50 and MIC90 to amoxicillin were 0.75 mg/L and 1 mg/L respectively, sensitive to amoxicillin by the EUCAST points. Conclusions The “one-size-fits-all” clinical pertussis case definition is no longer optimal to recognize this disease. A large comprehensive study of children with all types of cough is required to make substantial inroads into increasing both the sensitivity and specificity in pertussis diagnosis, which will have a beneficial impact on public health. Amoxicillin maybe an alternative for children with marolide-resistant B.pertussis infection; however, local sensitivities are required to inform clinical practice.
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Affiliation(s)
- Dan-Xia Wu
- Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan-Li-Shi Road, Beijing, 100045, China.,Department of Respiratory Medicine, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Qiang Chen
- Department of Respiratory Medicine, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Kai-Hu Yao
- Beijing Institute of Pediatrics, Beijing Children's Hospital, Beijing, China
| | - Lan Li
- Department of Respiratory Medicine, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Wei Shi
- Beijing Institute of Pediatrics, Beijing Children's Hospital, Beijing, China
| | - Jiang-Wei Ke
- Department of Clinical Laboratory, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Ai-Min Wu
- Department of Respiratory Medicine, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Peng Huang
- Department of Respiratory Medicine, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Kun-Ling Shen
- Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan-Li-Shi Road, Beijing, 100045, China.
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6
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Should equivocal Bordetella pertussis PCR results in children be reported to public health? ACTA ACUST UNITED AC 2018; 44:196-200. [PMID: 31015809 DOI: 10.14745/ccdr.v44i09a02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction Real-time polymerase chain reaction (PCR) is the preferred method for the diagnosis of pertussis. In Quebec, positive and equivocal results are reportable to public health; in contrast, in Ontario equivocal results are not reportable. Objective To determine the clinical significance of equivocal, compared with positive results, in children with suspected pertussis. Methods Retrospective cohort of consecutive patients seen at the Centre Hospitalier Universitaire Sainte-Justine in Montréal, Quebec, with suspected pertussis and tested with a bacterial multiplex PCR (including Bordetella pertussis) between 2015 and 2017. Medical records were reviewed using a standardized form. Univariate analyses (Student's t-test and chi-square test) and multivariable logistic regression were used to compare cases of positive and equivocal results. Results Of the 1,526 multiplex PCR performed, 109 were positive and 24 equivocal. Both groups were similar in terms of demographics and disease severity assessments, but patients in the equivocal group had less paroxysmal cough (33.3% vs 79.8%, adjusted odds ratio [aOR] 0.11, 95% confidence interval [CI] 0.04-0.29) and whoop (0% vs 18.3%, p<0.001), lower lymphocyte counts (6.6 vs 11.9 x109/L, p=0.008), were more likely to be diagnosed with a viral co-infection (16.7% vs 3.7%, aOR 5.62, 95% CI 1.17-27.54) and were less likely to receive a macrolide (25% vs 89%, aOR 0.04, 95% CI 0.01-0.11). When admitted, patients with equivocal results had a shorter average length of stay (3.3 vs 12.2 days, p=0.001). Conclusion Although there were similarities in disease severity, children with suspected pertussis who had equivocal PCR results had significantly different clinical presentations compared with those with positive results. In the context of limited public health resources, these results may inform the decision whether or not equivocal results need to be reported to public health by laboratories.
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7
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Ohfuji S, Okada K, Nakano T, Ito H, Hara M, Kuroki H, Hirota Y. Control selection and confounding factors: A lesson from a Japanese case-control study to examine acellular pertussis vaccine effectiveness. Vaccine 2018; 35:4801-4805. [PMID: 28818472 DOI: 10.1016/j.vaccine.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/02/2016] [Accepted: 10/04/2016] [Indexed: 11/19/2022]
Abstract
When using a case-control study design to examine vaccine effectiveness, both the selection of control subjects and the consideration of potential confounders must be the important issues to ensure accurate results. In this report, we described our experience from a case-control study conducted to evaluate the effectiveness of acellular pertussis vaccine combined with diphtheria-tetanus toxoids (DTaP vaccine). Newly diagnosed pertussis cases and age- and sex-matched friend-controls were enrolled, and the history of DTaP vaccination was compared between groups. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of vaccination for development of pertussis. After adjustment for potential confounders, four doses of DTaP vaccination showed a lower OR for pediatrician-diagnosed pertussis (OR=0.11, 95% CI, 0.01-0.99). In addition, the decreasing OR of four doses vaccination was more pronounced for laboratory-confirmed pertussis (OR=0.07, 95%CI, 0.01-0.82). Besides, positive association with pertussis was observed in subjects with a history of steroid treatment (OR=5.67) and those with a recent contact with a lasting cough (OR=4.12). When using a case-control study to evaluate the effectiveness of vaccines, particularly those for uncommon infectious diseases such as pertussis, the use of friend-controls may be optimal due to the fact that they shared a similar experience for exposure to the pathogen as the cases. In addition, to assess vaccine effectiveness as accurately as possible, the effects of confounding should be adequately controlled with a matching or analysis technique.
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Affiliation(s)
- Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Kenji Okada
- Section of Pediatrics, Department of Medicine, Fukuoka Dental College, 2-15-1, Tamura, Sawara-ku, Fukuoka 814-0193, Japan
| | - Takashi Nakano
- Department of Pediatrics, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Hiroaki Ito
- Field Epidemiology Training Program, National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga 849-8501, Japan
| | - Haruo Kuroki
- Sotobo Children's Clinic, Medical Corporation Shigyo-no-kai, 1880-4, Izumi, Misaki-cho, Isumi, Chiba 299-4503, Japan
| | - Yoshio Hirota
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; College of Healthcare Management, 960-4, Takayanagi, Setaka-machi, Miyama-shi, Fukuoka 835-0018, Japan; Clinical Epidemiology Research Center, Medical Co. LTA, 3-5-1, Kashii-Teriha, Higashi-ku, Fukuoka 813-0017, Japan
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8
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Moore A, Ashdown HF, Shinkins B, Roberts NW, Grant CC, Lasserson DS, Harnden A. Clinical Characteristics of Pertussis-Associated Cough in Adults and Children: A Diagnostic Systematic Review and Meta-Analysis. Chest 2017; 152:353-367. [PMID: 28511929 DOI: 10.1016/j.chest.2017.04.186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pertussis (whooping cough) is a highly infective cause of cough that causes significant morbidity and mortality. Existing case definitions include paroxysmal cough, whooping, and posttussive vomiting, but diagnosis can be difficult. We determined the diagnostic accuracy of clinical characteristics of pertussis-associated cough. METHODS We systematically searched CINAHL, Embase, Medline, and SCI-EXPANDED/CPCI-S up to June 2016. Eligible studies compared clinical characteristics in those positive and negative for Bordetella pertussis infection, confirmed by laboratory investigations. Two authors independently completed screening, data extraction, and quality and bias assessments. For each characteristic, RevMan was used to produce descriptive forest plots. The bivariate meta-analysis method was used to generate pooled estimates of sensitivity and specificity. RESULTS Of 1,969 identified papers, 53 were included. Forty-one clinical characteristics were assessed for diagnostic accuracy. In adult patients, paroxysmal cough and absence of fever have a high sensitivity (93.2% [CI, 83.2-97.4] and 81.8% [CI, 72.2-88.7], respectively) and low specificity (20.6% [CI, 14.7-28.1] and 18.8% [CI, 8.1-37.9]), whereas posttussive vomiting and whooping have low sensitivity (32.5% [CI, 24.5-41.6] and 29.8% [CI, 8.0-45.2]) and high specificity (77.7% [CI, 73.1-81.7] and 79.5% [CI, 69.4-86.9]). Posttussive vomiting in children is moderately sensitive (60.0% [CI, 40.3-77.0]) and specific (66.0% [CI, 52.5-77.3]). CONCLUSIONS In adult patients, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children, posttussive vomiting is much less helpful as a clinical diagnostic test.
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Affiliation(s)
- Abigail Moore
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
| | - Helen F Ashdown
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Nia W Roberts
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Daniel S Lasserson
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Anthony Harnden
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
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Schwartz KL, Tu K, Wing L, Campitelli MA, Crowcroft NS, Deeks SL, Wilson SE, Wilson K, Gemmill I, Kwong JC. Validation of infant immunization billing codes in administrative data. Hum Vaccin Immunother 2016; 11:1840-7. [PMID: 26075651 PMCID: PMC4514409 DOI: 10.1080/21645515.2015.1043499] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Ontario has a single payer provincial health insurance program. Administrative data may provide a potentially robust source of information for post-marketing vaccine studies. Vaccine-specific immunization billing codes were introduced in 2011. Our objective was to validate Ontario's universal health care administrative datasets to assess infant immunization status. Electronic medical record data from the Electronic Medical Record Administrative data Linked Database (EMRALD) was used as the reference standard to calculate performance characteristics of the Ontario Health Insurance Plan (OHIP) database vaccine-specific and general immunization codes for 4 primary infant immunizations: diphtheria, tetanus, acellular pertussis, inactivated polio, Haemophilus influenzae type B (DTaP-IPV-Hib) combination vaccine, pneumococcal conjugate vaccine, measles, mumps, rubella (MMR) vaccine, and meningococcal conjugate serogroup C vaccine. OHIP billing claims had specificity ranging from 81% to 92%, sensitivity 70% to 83%, positive predictive value (PPV) 97% to 99%, and negative predictive value (NPV) 13% to 46% for identifying the various specific vaccines in administrative data. For cohorts vaccinated in the new code introduction phase, using both the vaccine-specific and general codes had higher sensitivity than the vaccine-specific codes alone. In conclusion, immunization billing claims from administrative data in Ontario had high specificity and PPV, moderate sensitivity, and low NPV. This study identifies some of the applications of utilizing administrative data for post-marketing vaccine studies. However, limitations of these data decrease their utility for measuring vaccine coverage and effectiveness. Therefore, the establishment of a comprehensive and linkable immunization registry should be a provincial priority.
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Key Words
- CIC, Citizen and Immigration Canada
- CIHI-DAD, Canadian Institute of Health Information Discharge Abstract Database
- COC, continuity of care
- DTaP-IPV-Hib, diphtheria, tetanus, acellular pertussis, inactivated polio, Haemophilus influenzae type B vaccine
- EMR, electronic medical records
- EMRALD, Electronic Medical Record Administrative data Linked Database
- ICES, Institute for Clinical Evaluative Sciences
- MMR, measles, mumps, rubella vaccine
- MenC, meningococcal conjugate serogroup C vaccine
- NPV, negative predictive value
- OHIP, Ontario Health Insurance Plan
- PC, pneumococcal conjugate vaccine
- PPV, positive predictive value
- RPDB, Registered Persons Database
- diphtheria-tetanus-pertussis vaccine
- health services
- measles-mumps-rubella vaccine
- meningococcal vaccines
- pneumococcal vaccines
- vaccine combined
- validation studies
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Affiliation(s)
- Kevin L Schwartz
- a Institute for Clinical Evaluative Sciences ; Toronto , Ontario , Canada
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Naeini AE, Zaman N, Khorvash F, Naeini SE, Khodadadi HAD, Mokhtari M, Koushki AM. Does working in hospital increases seroprevalence and carrier state against Bordetella pertussis? Adv Biomed Res 2015; 4:194. [PMID: 26605233 PMCID: PMC4617007 DOI: 10.4103/2277-9175.166155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/04/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Health care environments have been the setting for a number of pertussis outbreaks. Immunity after vaccination wanes overtime leading to a growing population of susceptible adolescents and adults. A number of pertussis outbreaks have occurred in hospitals resulting in transmission to health care workers (HCWs), and other patients. The aim of this study was to assess immunity status of a group of basic medical students and interns who worked in hospitals for about 4 years. Materials and Methods: In a cross-sectional study, we measured the serum antibody titer of cases by enzyme-linked immunosorbent assay test. All 70 subjects have received pertussis vaccine in the routine childhood vaccination schedule. All cases were healthy and had no symptoms of any respiratory diseases. We also obtained a pharyngeal culture on Bordet-Gengou Agar for isolating Bordetella pertussis. Results: The results of B. pertussis pharyngeal culture was positive for 5 (7.1%) cases and negative for 65 (92.9%). The IgM, IgA, and IgG serum antibody was positive in 1.4%, 7.1%, and 11.4% of cases, respectively. The mean age of cases had no significant effect on serum antibody titers (P = 0.23). Conclusions: This study showed that majority of cases do not have protective serum antibody against B. pertussis. Working in hospitals does not affect seroprevalence and carrier state of B. pertussis. Immunization schedules that include no booster doses are at increased risk of pertussis. Due to the importance of the transmission in health care settings, vaccination of HCWs is a priority.
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Affiliation(s)
- Alireza Emami Naeini
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Zaman
- Department of Infectious Diseases and Tropical Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzin Khorvash
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Emami Naeini
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hesam-Al-Din Khodadadi
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Mokhtari
- Department of Pathology, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mehrabi Koushki
- Department of Epidemiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Bolotin S, Deeks SL, Marchand-Austin A, Rilkoff H, Dang V, Walton R, Hashim A, Farrell D, Crowcroft NS. Correlation of Real Time PCR Cycle Threshold Cut-Off with Bordetella pertussis Clinical Severity. PLoS One 2015; 10:e0133209. [PMID: 26186564 PMCID: PMC4505870 DOI: 10.1371/journal.pone.0133209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 06/24/2015] [Indexed: 11/18/2022] Open
Abstract
Bordetella pertussis testing performed using real-time polymerase chain reaction (RT-PCR) is interpreted based on a cycle threshold (Ct) value. At Public Health Ontario Laboratories (PHOL), a Ct value <36 is reported as positive, and Ct values ≥36 and <40 are reported as indeterminate. PHOL reported indeterminate results to physicians and public health units until May 2012, after which these results were only reported to physicians. We investigated the association between Ct value and disease symptom and severity to examine the significance of indeterminate results clinically, epidemiologically and for public health reporting. B. pertussis positive and indeterminate RT-PCR results were linked to pertussis cases reported in the provincial Integrated Public Health Information System (iPHIS), using deterministic linkage. Patients with positive RT-PCR results had a lower median age of 10.8 years compared to 12.0 years for patients with indeterminate results (p = 0.24). Hospitalized patients had significantly lower Ct values than non-hospitalized patients (median Ct values of 20.7 vs. 31.6, p<0.001). The proportion of patients reporting the most indicative symptoms of pertussis did not differ between patients with positive vs. indeterminate RT-PCR results. Taking the most indicative symptoms of pertussis as the gold-standard, the positive predictive value of the RT-PCR test was 68.1%. RT-PCR test results should be interpreted in the context of the clinical symptoms, age, vaccination status, prevalence, and other factors. Further information on interpretation of indeterminate RT-PCR results may be needed, and the utility of reporting to public health practitioners should be re-evaluated.
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Affiliation(s)
- Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alex Marchand-Austin
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Vica Dang
- Public Health Ontario, Toronto, Ontario, Canada
| | - Ryan Walton
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - David Farrell
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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12
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Emerging technologies for the clinical microbiology laboratory. Clin Microbiol Rev 2015; 27:783-822. [PMID: 25278575 DOI: 10.1128/cmr.00003-14] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In this review we examine the literature related to emerging technologies that will help to reshape the clinical microbiology laboratory. These topics include nucleic acid amplification tests such as isothermal and point-of-care molecular diagnostics, multiplexed panels for syndromic diagnosis, digital PCR, next-generation sequencing, and automation of molecular tests. We also review matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) and electrospray ionization (ESI) mass spectrometry methods and their role in identification of microorganisms. Lastly, we review the shift to liquid-based microbiology and the integration of partial and full laboratory automation that are beginning to impact the clinical microbiology laboratory.
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Ohfuji S, Okada K, Nakano T, Ito H, Hara M, Kuroki H, Hirota Y. Effectiveness of acellular pertussis vaccine in a routine immunization program: A multicenter, case-control study in Japan. Vaccine 2015; 33:1027-32. [DOI: 10.1016/j.vaccine.2015.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/22/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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Abstract
In all vaccinated populations, infections with Bordetella pertussis and Bordetella parapertussis continue to cause infections in unvaccinated infants and children, as well as in adolescents and adults with waning immunity. Thus in patients with longer lasting coughs a diagnosis of pertussis should be entertained irrespective of their vaccination status. Due to the non-specific clinical symptoms, clinically suspected cases of pertussis must be verified by laboratory methods. Hyperleukocytosis may be helpful in diagnosis for young infants, but in most cases, nonspecific laboratory tests have no role in pertussis diagnosis. Specific laboratory tests include direct detection of the bacteria or their DNA by culture or PCR, whereas serology serves as an indirect method to diagnose pertussis in those patients who present late in the development of the disease. Serology results can be interpreted in relation to reference values for different populations, but serology is unable to distinguish between vaccination and infection.
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Marchand-Austin A, Memari N, Patel SN, Tang P, Deeks SL, Jamieson FB, Crowcroft NS, Farrell DJ. Surveillance of antimicrobial resistance in contemporary clinical isolates of Bordetella pertussis in Ontario, Canada. Int J Antimicrob Agents 2014; 44:82-4. [PMID: 24837412 DOI: 10.1016/j.ijantimicag.2014.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Alex Marchand-Austin
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, 6th Floor, Toronto, Ontario, Canada M5S 1A8; Public Health Ontario Laboratories, Public Health Ontario, 81 Resources Road, Toronto, Ontario, Canada M9P 3T1.
| | - Nader Memari
- Public Health Ontario Laboratories, Public Health Ontario, 81 Resources Road, Toronto, Ontario, Canada M9P 3T1
| | - Samir N Patel
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, 6th Floor, Toronto, Ontario, Canada M5S 1A8; Public Health Ontario Laboratories, Public Health Ontario, 81 Resources Road, Toronto, Ontario, Canada M9P 3T1
| | - Patrick Tang
- Public Health Ontario Laboratories, Public Health Ontario, 81 Resources Road, Toronto, Ontario, Canada M9P 3T1
| | - Shelley L Deeks
- Surveillance and Epidemiology, Public Health Ontario, 480 University Avenue, Toronto, Ontario, Canada M5G 1V2; Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, Canada M5T 3M7
| | - Frances B Jamieson
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, 6th Floor, Toronto, Ontario, Canada M5S 1A8; Public Health Ontario Laboratories, Public Health Ontario, 81 Resources Road, Toronto, Ontario, Canada M9P 3T1
| | - Natasha S Crowcroft
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, 6th Floor, Toronto, Ontario, Canada M5S 1A8; Surveillance and Epidemiology, Public Health Ontario, 480 University Avenue, Toronto, Ontario, Canada M5G 1V2; Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, Canada M5T 3M7
| | - David J Farrell
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, 6th Floor, Toronto, Ontario, Canada M5S 1A8; Public Health Ontario Laboratories, Public Health Ontario, 81 Resources Road, Toronto, Ontario, Canada M9P 3T1
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Abstract
BACKGROUND The classic clinical features of paroxysmal pertussis are often absent in older children and adults and after vaccination. The California pertussis epidemic of 2010 occurred in a highly vaccinated population. METHODS All pediatric patients (0-18 years) with positive pertussis polymerase chain reaction from July to December 2010 were identified retrospectively from the Kaiser SCAL database. Information extracted by chart review included age at diagnosis, vaccine history, race, cough duration, number of clinic visits before diagnosis, presence of paroxysms, post-tussive emesis or wheezing, treatment for asthma during the course of illness and exposure to confirmed or suspected pertussis cases. RESULTS Overall 501 pediatric patients (mean age = 8.4 years) with positive pertussis nasopharyngeal polymerase chain reaction were identified. Complete DTaP series and Tdap vaccine had been received by 93% and 38% of eligible patients, respectively. Paroxysms, post-tussive emesis and wheezing on physical examination were present in 34%, 30% and 8% of patients, respectively. Each was associated with a longer duration of symptoms at diagnosis. Wheezing was associated with a delay in diagnosis (60% requiring >1 clinic visit for diagnosis vs. 29% in the overall population, P < 0.0001). Documented exposures were associated with a more timely pertussis diagnosis (after 9.4 days vs. 14.5 days; P < 0.0001). CONCLUSIONS Wheezing is present on examination of some patients with pertussis in a highly vaccinated pediatric population and appears to delay the diagnosis of pertussis. The presence of wheezing should not be used to exclude this diagnosis in children with chronic cough or other reasons to suspect pertussis.
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Riffelmann M, Mohr J, Hellenbrand W, Wirsing von Koenig CH. Time since last vaccine dose in PCR-positive and PCR-negative children with suspected pertussis to monitor pertussis vaccine effectiveness. Eur J Clin Microbiol Infect Dis 2013; 33:805-8. [DOI: 10.1007/s10096-013-2016-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 11/06/2013] [Indexed: 10/26/2022]
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Tarr GAM, Eickhoff JC, Koepke R, Hopfensperger DJ, Davis JP, Conway JH. Using a bayesian latent class model to evaluate the utility of investigating persons with negative polymerase chain reaction results for pertussis. Am J Epidemiol 2013; 178:309-18. [PMID: 23735308 DOI: 10.1093/aje/kws465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pertussis remains difficult to control. Imperfect sensitivity of diagnostic tests and lack of specific guidance regarding interpretation of negative test results among patients with compatible symptoms may contribute to its spread. In this study, we examined whether additional pertussis cases could be identified if persons with negative pertussis test results were routinely investigated. We conducted interviews among 250 subjects aged ≤18 years with pertussis polymerase chain reaction (PCR) results reported from 2 reference laboratories in Wisconsin during July-September 2010 to determine whether their illnesses met the Centers for Disease Control and Prevention's clinical case definition (CCD) for pertussis. PCR validity measures were calculated using the CCD as the standard for pertussis disease. Two Bayesian latent class models were used to adjust the validity measures for pertussis detectable by 1) culture alone and 2) culture and/or more sensitive measures such as serology. Among 190 PCR-negative subjects, 54 (28%) had illnesses meeting the CCD. In adjusted analyses, PCR sensitivity and the negative predictive value were 1) 94% and 99% and 2) 43% and 87% in the 2 types of models, respectively. The models suggested that public health follow-up of reported pertussis patients with PCR-negative results leads to the detection of more true pertussis cases than follow-up of PCR-positive persons alone. The results also suggest a need for a more specific pertussis CCD.
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Affiliation(s)
- Gillian A M Tarr
- Department of Pediatrics, School ofMedicine and Public Health, University of Wisconsin–Madison, Madison,WI 53792, USA
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Shuel M, Jamieson FB, Tang P, Brown S, Farrell D, Martin I, Stoltz J, Tsang RSW. Genetic analysis of Bordetella pertussis in Ontario, Canada reveals one predominant clone. Int J Infect Dis 2013; 17:e413-7. [PMID: 23352492 DOI: 10.1016/j.ijid.2012.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/11/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To characterize Bordetella pertussis isolates in Ontario, Canada in order to understand the clonal diversity of strains present in this province. METHODS A total of 521 isolates from the period 1998-2006 were analyzed by serotyping, pulsed-field gel electrophoresis (PFGE), and DNA sequencing of their virulence factors of pertactin, fimbriae 3, pertussis toxin subunit 1, and pertussis toxin gene promoter. Characteristics of the Ontario isolates were compared to those described for isolates from Europe and Australia. RESULTS A single predominant clone was identified in Ontario, Canada, represented by 83.5% of the 521 isolates analyzed. This clone was characterized by the genotype fim3B, prn2, ptxS1A, and ptxP3 (sequence type (ST)-1), and 72.9% of this clone displayed three closely related PFGE profiles of BpSR11, BpSR5, and BpSR12. Pertussis isolates in Europe with these PFGE profiles and virulence factor genotype are reported as common. The Australian epidemic clone was previously reported to have the genotype prn2 and ptxP3. CONCLUSION The finding of one predominant B. pertussis clone in Ontario, Canada, with characteristics identical to strains involved in epidemics in Europe and Australia, suggests a potential link of this strain to the resurgence of pertussis in this province.
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Affiliation(s)
- Michelle Shuel
- Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, 1015 Arlington Street, Winnipeg, Manitoba, Canada R3E 3R2
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21
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Pertussis vaccines. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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McIntyre PB, Sintchenko V. Editorial Commentary: The "How" of Polymerase Chain Reaction Testing for Bordetella pertussis Depends on the "Why". Clin Infect Dis 2012; 56:332-4. [DOI: 10.1093/cid/cis897] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Halperin SA, Scheifele D, De Serres G, Noya F, Meekison W, Zickler P, Larrivée L, Langley JM, McNeil SA, Dobson S, Jordanov E, Thakur M, Decker MD, Johnson DR. Immune responses in adults to revaccination with a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine 10 years after a previous dose. Vaccine 2011; 30:974-82. [PMID: 22115634 DOI: 10.1016/j.vaccine.2011.11.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/03/2011] [Accepted: 11/10/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Although decennial adult boosters of tetanus and diphtheria toxoids are recommended in Canada and the United States, a second dose of pertussis vaccine during adulthood is not currently recommended. METHODS This open-label, multicenter study compared the safety and immunogenicity of a first dose of an adult formulation of tetanus, diphtheria, and acelluar pertussis vaccine (Tdap) with a repeat dose of Tdap in adults who had received Tdap 10 years previously. RESULTS A total of 769 participants ranging in age from 20 to 72 years took part in this study; 92.3% of naïve and 92.7% of repeat-dose participants had at least one solicited adverse event. Injection-site pain (84.4% and 87.8%), erythema (29.7% and 23.1%), and swelling (23.3% and 20.5%), and myalgia (53.5% and 60.1%), headache (37.6% and 40.6%), malaise (29.0% and 29.4%), and fever (4.9% and 4.2%) were the most common solicited adverse events reported in the naïve and repeat-dose groups, respectively. Postvaccination antibody levels ≥0.1 IU/mL were achieved by 99.7% of the naïve-group participants and all of the repeat-dose participants for tetanus and 96.1% of the naïve group and 98.5% of the repeat-dose group for diphtheria, both meeting the predefined noninferiority criteria. For pertussis antibodies, anti-PT (89.2 EU/mL vs. 116 EU/mL) was higher in the repeat-dose group, anti-FHA (249 vs. 214) and anti-PRN (216 vs. 266) were similar, and anti-FIM (1015 vs. 779) was higher in the naïve group. Noninferiority criteria were met for all antigens except for anti-FIM. CONCLUSION A repeat dose of Tdap vaccine 10 years after the first dose was well tolerated and immunogenic in adults (ClinicalTrials.gov identifier: NCT00712959).
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Affiliation(s)
- Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, and Capital Health, Halifax, NS, Canada.
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Tolerability and antibody response in adolescents and adults revaccinated with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine adsorbed (Tdap) 4–5 years after a previous dose. Vaccine 2011; 29:8459-65. [DOI: 10.1016/j.vaccine.2011.07.068] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 07/08/2011] [Accepted: 07/17/2011] [Indexed: 11/22/2022]
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Fisman DN, Tang P, Hauck T, Richardson S, Drews SJ, Low DE, Jamieson F. Pertussis resurgence in Toronto, Canada: a population-based study including test-incidence feedback modeling. BMC Public Health 2011; 11:694. [PMID: 21899765 PMCID: PMC3189138 DOI: 10.1186/1471-2458-11-694] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 09/07/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Pertussis continues to challenge medical professionals; recently described increases in incidence may be due to age-cohort effects, vaccine effectiveness, or changes in testing patterns. Toronto, Canada has recently experienced increases in pertussis incidence, and provides an ideal jurisdiction for evaluating pertussis epidemiology due to centralized testing. We evaluated pertussis trends in Toronto using all available specimen data, which allowed us to control for changing testing patterns and practices. METHODS Data included all pertussis culture and PCR test records for Greater Toronto from 1993 to 2007. We estimated incidence trends using Poisson regression models; complex relationships between disease incidence and test submission were explored with vector autoregressive models. RESULTS From 1993 to 2007, 26988 specimens were submitted for testing; 2545 (9.4%) were positive. Pertussis incidence was 2 per 100,000 from 1993 to 2004 and increased to 10 per 100,000 from 2005-2007, with a concomitant 6-fold surge in test specimen submissions after the introduction of a new, more sensitive PCR assay. The relative change in incidence was less marked after adjustment for testing volumes. Bidirectional feedbacks between test positivity and test submissions were identified. CONCLUSIONS Toronto's recent surge in pertussis reflects a true increase in local disease activity; the apparent size of the outbreak has likely been magnified by increasing use of pertussis testing by clinicians, and by improved test sensitivity since 2005. These findings may be applicable to changes in pertussis epidemiology that have been noted elsewhere in North America.
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Affiliation(s)
- David N Fisman
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7, Canada
- Department of Health Policy, Evaluation and Management, University of Toronto, 155 College Street, Toronto, M5T 3M7, Canada
- Department of Medicine, University of Toronto, 1 Kings College Circle, Toronto, M5S 1A8, Canada
| | - Patrick Tang
- Public Health Laboratory--Toronto, Ontario Agency for Health Protection and Promotion, 81 Resources Road, Toronto, M9P 3V6, Canada
| | - Tanya Hauck
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7, Canada
| | - Susan Richardson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 Kings College Circle, Toronto, M5S 1A8, Canada
- Department of Microbiology, Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X5, Canada
| | - Steven J Drews
- Alberta Provincial Public Health Laboratory, 3030 Hospital Drive Northwest, Calgary, T2N 4W4, Canada
| | - Donald E Low
- Public Health Laboratory--Toronto, Ontario Agency for Health Protection and Promotion, 81 Resources Road, Toronto, M9P 3V6, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 Kings College Circle, Toronto, M5S 1A8, Canada
- Department of Microbiology, Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5, Canada
| | - Frances Jamieson
- Public Health Laboratory--Toronto, Ontario Agency for Health Protection and Promotion, 81 Resources Road, Toronto, M9P 3V6, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 Kings College Circle, Toronto, M5S 1A8, Canada
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Abstract
BACKGROUND This multicenter study was undertaken to investigate the serologic evidence of antibodies to Bordetella pertussis toxin (IgG-PT) in children and adolescents. METHODS IgG-PT value in a single serum collected from 1616 children and adolescents was measured by enzyme-linked immunosorbent assay in the Food and Drug Administration (FDA)-units per milliliter from November 2008 to October 2009. The relationship between time since infection and IgG anti-PT levels were analyzed and the estimated age-specific incidences of infection were calculated. RESULTS The sera IgG-PT geometric mean concentrations of the samples were 1.7 FDA-U/mL. The sera protective rates of all the subjects were 6.6% (95% confidential interval [CI]: 5.4%, 7.8%). The rates in the group aged 2 years was 9.2% (95% CI: 3.5%, 14.9%), which was significantly higher than in those aged ≥ 3 years (χ = 1615, P = 0.000). In the group aged ≥ 3 years, 4.0% (95% CI: 3.0%, 5.0%) of the individuals tested showed an IgG-PT level ≥ 40 FDA-U/mL, which was equivalent to an estimated incidence of B. pertussis infection of 7000 (95% CI: 5300, 8800) per 100,000 population per year in the year before serum sampling. There were 2 peaks of estimated incidence. One peak incidence of 9100 (95% CI: 4300, 14000) per 100,000 population per year was found in the population aged >6 to 8 years. Another peak was in the population of 12- to 20-year olds with the estimated incidence of 14,600 (95% CI: 9100, 20100) per 100,000 per year. CONCLUSIONS The levels of protective antibodies against pertussis were very low in the immunized children aged 2 to 20 years. A booster dose of immunization for older children or adolescents should be an urgent priority. Moreover, using enzyme-linked immunosorbent assay to determine the efficiency of vaccines and even to obtain the serodiagnosis would be beneficial in controlling pertussis.
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What is the significance of a high cycle threshold positive IS481 PCR for Bordetella pertussis? Pediatr Infect Dis J 2009; 28:1143; author reply 1143-4. [PMID: 19935278 DOI: 10.1097/inf.0b013e3181bd4e1f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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