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BACKGROUND: The purpose of this study was to evaluate the knowledge, attitude, and current practices about prevention of meningococcal disease among general practitioners (GPs) and primary care pediatricians (PCPs) in Italy. METHODS: A cross-sectional survey was carried out between February 2022 and July 2023 among a random sample of GPs and PCPs in Southern Italy. The data were collected using a questionnaire accessible via an internet link with the free software Google Forms®. RESULTS: Regarding the participants' knowledge toward meningococcal vaccinations, 84.2% of the PCPs and more than half of the GPs (55.2%) knew that the meningococcal B (MenB) vaccination is recommended for infants from the second month of life and 84.2% and 82.7% of the PCPs were aware that quadrivalent meningococcal ACWY (MenACWY) vaccine is recommended for children in the second year of life and adolescents, respectively. The GPs and PCPs considered vaccination against meningococcal disease to be very effective and safe with average values of 8.8 and 8.7, respectively, on a scale ranging from 1 to 10. Those with an older age, those who knew the medical conditions that expose patients to a higher risk of contracting meningococcal disease, and those who self-rated their knowledge on meningococcal disease as excellent/very good were more likely to consider the vaccination to be very effective and safe. Only 15.5% of the GPs and more than half of the PCPs (54.3%) administered anti-meningococcal vaccines to their patients. GPs and females were less likely to administer anti-meningococcal vaccines to their patients, whereas those who acquired information on meningococcal vaccinations by scientific journals were more likely to administer meningococcal vaccines. CONCLUSIONS: The findings of the survey highlighted the need of a greater engagement of GPs and PCPs in the immunization campaigns in order to increase meningococcal vaccination coverage.
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Acute hepatic porphyrias (AHPs) are a family of rare, autosomal, dominantly inherited conditions characterized by abnormalities in the production of heme. Advances in molecular engineering have provided new therapeutic possibilities for modifying the heme synthetic pathway in patients with porphyria. In particular, the RNA interference therapeutic givosiran was approved for the treatment of adults and adolescents with AHP aged >12 years based on the positive results of the phase III trial ENVISION. Despite the extended characterization of the activity of givosiran in clinical trials, reports on the long-term effects and effectiveness of the treatment in clinical practice are still scant. To fill this gap, this case series describes a monocentric Italian cohort of AHP patients treated with givosiran. Overall, our real-life experience supports the clinical evidence that long-term treatment with givosiran is well tolerated and able to provide sustained and continuous benefit to patients with acute intermittent porphyria, as reflected by the reduction in the frequency of attacks. In our series, givosiran treatment was also associated with improvement in assessments of quality of life, pain and fatigue.
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BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is one of the leading cause of cancer death worldwide. PDACs are characterized by centrosome aberrations, but whether centrosome-related genes influence patient outcomes has not been tested. METHODS: Publicly available RNA-sequencing data of patients diagnosed with PDAC were interrogated with unsupervised approaches to identify centrosome protein-encoding genes with prognostic relevance. Candidate genes were validated by immunohistochemistry and multiplex immunofluorescence in a set of clinical PDAC and normal pancreatic tissues. RESULTS: Results showed that two genes CEP250 and CEP170, involved in centrosome linker and centriolar subdistal appendages, were expressed at high levels in PDAC tissues and were correlated with prognosis of PDAC patients in independent databases. Large clustered γ-tubulin-labelled centrosomes were linked together by aberrant circular and planar-shaped CEP250 arrangements in CEP250-high expressing PDACs. Furthermore, PDACs displayed prominent centrosome separation and reduced CEP164-centrosomal labelling associated with acetylated-tubulin staining compared to normal pancreatic tissues. Interestingly, in a small validation cohort, CEP250-high expressing patients had shorter disease free- and overall-survival and almost none of those who received gemcitabine plus nab-paclitaxel first-line therapy achieved a clinical response. In contrast, weak CEP250 expression was associated with long-term survivors or responses to medical treatments. CONCLUSIONS: Alteration of the centriolar cohesion and appendages has effect on the survival of patients with PDAC.
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In Italy, the measles elimination target has not yet been reached despite a significant reduction in cases. A multicenter study was conducted to estimate the prevalence of anti-measles (MV) IgG antibodies in the Italian population by age, sex and geographical area. To determine the level of MV-specific antibodies in sera, the immunoenzymatic assay ELISA was used (Enzygnost Anti-VZV/IgG, Siemens Healthcare Diagnostic Products GmbH, Germany). Overall, 3746 serum samples collected in the years 2019-20 from healthy subjects aged 6-64 years residing in 13 Italian regions. The overall seroprevalence of anti-MV IgG was 91.2 % (90.6 % male, 91.7 % female). Significantly higher seroprevalence values (p < 0.05) were recorded for the extreme age groups of the study population (6-9 years: 94.2 %; 40-64 years: 97.6 %). Subjects 20-39 and 40-64 years old had significantly higher antibody titers suggesting a protection against measles mainly derived from natural infection. Seroprevalence was significantly higher in the South (93.2 %) than in the Northern-Central Italy (88.9 %). The results indicate an increase in the overall seroprevalence data compared to previous investigations. However, further efforts must be made to implement and maintain high measles vaccination coverage to avoid the risk of future epidemic outbreaks.
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Anticuerpos Antivirales , Inmunoglobulina G , Sarampión , Humanos , Estudios Seroepidemiológicos , Italia/epidemiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Sarampión/epidemiología , Sarampión/inmunología , Adolescente , Anticuerpos Antivirales/sangre , Niño , Adulto Joven , Inmunoglobulina G/sangre , Ensayo de Inmunoadsorción Enzimática , Virus del Sarampión/inmunologíaRESUMEN
Cancer stem cells (CSCs) are a subpopulation of cancer cells within tumors that exhibit stem-like properties and represent a potentially effective therapeutic target toward long-term remission by means of differentiation induction. By leveraging an artificial intelligence approach solely based on transcriptomics data, this study scored a large library of small molecules based on their predicted ability to induce differentiation in stem-like cells. In particular, a deep neural network model was trained using publicly available single-cell RNA-Seq data obtained from untreated human-induced pluripotent stem cells at various differentiation stages and subsequently utilized to screen drug-induced gene expression profiles from the Library of Integrated Network-based Cellular Signatures (LINCS) database. The challenge of adapting such different data domains was tackled by devising an adversarial learning approach that was able to effectively identify and remove domain-specific bias during the training phase. Experimental validation in MDA-MB-231 and MCF7 cells demonstrated the efficacy of five out of six tested molecules among those scored highest by the model. In particular, the efficacy of triptolide, OTS-167, quinacrine, granisetron and A-443654 offer a potential avenue for targeted therapies against breast CSCs.
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Neoplasias de la Mama , Diferenciación Celular , Células Madre Neoplásicas , Humanos , Células Madre Neoplásicas/metabolismo , Células Madre Neoplásicas/efectos de los fármacos , Células Madre Neoplásicas/patología , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Neoplasias de la Mama/tratamiento farmacológico , Diferenciación Celular/efectos de los fármacos , Femenino , Inteligencia Artificial , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Células MCF-7 , Línea Celular Tumoral , Redes Neurales de la Computación , Perfilación de la Expresión GénicaRESUMEN
Sudden cardiac death (SCD) is defined as unexpected death due to a cardiac cause that occurs rapidly. Despite the identification of prevention strategies, SCD remains a serious public health problem worldwide, accounting for 15-20% of all deaths, and is therefore a challenge for modern medicine, especially when it affects young people. Sudden cardiac death in young people affects the population aged ≤ 35 years, including athletes and non-athletes, and it is due to various hereditary and non-hereditary causes. After an autopsy, if the cause remains unknown, it is called sudden unexplained death, often attributable to genetic causes. In these cases, molecular autopsy-post-mortem genetic testing-is essential to facilitate diagnostic and therapeutic pathways and/or the monitoring of family members of the cases. This review aims to elaborate on cardiac disorders marked by genetic mutations, necessitating the post-mortem genetic investigation of the deceased for an accurate diagnosis in order to facilitate informed genetic counseling and to implement preventive strategies for family members of the cases.
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BACKGROUND: Osteoarthritis (OA) is a multifactorial, hypertrophic, and degenerative condition involving the whole joint and affecting a high percentage of middle-aged people. It is due to a combination of factors, although the pivotal mechanisms underlying the disease are still obscure. Moreover, current treatments are still poorly effective, and patients experience a painful and degenerative disease course. METHODS: We used an integrative approach that led us to extract a consensus signature from a meta-analysis of three different OA cohorts. We performed a network-based drug prioritization to detect the most relevant drugs targeting these genes and validated in vitro the most promising candidates. We also proposed a risk score based on a minimal set of genes to predict the OA clinical stage from RNA-Seq data. RESULTS: We derived a consensus signature of 44 genes that we validated on an independent dataset. Using network analysis, we identified Resveratrol, Tenoxicam, Benzbromarone, Pirinixic Acid, and Mesalazine as putative drugs of interest for therapeutics in OA for anti-inflammatory properties. We also derived a list of seven gene-targets validated with functional RT-qPCR assays, confirming the in silico predictions. Finally, we identified a predictive subset of genes composed of DNER, TNFSF11, THBS3, LOXL3, TSPAN2, DYSF, ASPN and HTRA1 to compute the patient's risk score. We validated this risk score on an independent dataset with a high AUC (0.875) and compared it with the same approach computed using the entire consensus signature (AUC 0.922). CONCLUSIONS: The consensus signature highlights crucial mechanisms for disease progression. Moreover, these genes were associated with several candidate drugs that could represent potential innovative therapeutics. Furthermore, the patient's risk scores can be used in clinical settings.
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Osteoartritis , Persona de Mediana Edad , Humanos , Osteoartritis/tratamiento farmacológico , Osteoartritis/genéticaRESUMEN
BACKGROUND: The aims of the study were to determine, in the urine and oral samples of young adults, the genotype-specific prevalence of Human Papilloma Virus (HPV) infection, the HPV DNA type-specific prevalence in unvaccinated and vaccinated individuals, and the determinants of HPV infection. METHODS: Selected participants were asked to fill in a self-administered questionnaire and to self-collect urine and saliva samples. RESULTS: Among the 1002 participants, 81 (8.1%) resulted positive for HPV DNA. The most common low-risk genotype was HPV 42 (2.2%), followed by HPV 43 (0.8%), and 40 (0.5%). The HPV 51 was the most common high-risk genotype (1.5%) followed by HPV 66 (1%) and HPV 68 (1%), and no participants were infected with HPV genotypes 18, 33, 45. Females, those who have had one or more occasional sexual partner, those who never/rarely/sometimes used condoms during their sexual activity, those with a previous diagnosis of sexually transmitted infection, and those who were not vaccinated were more likely to be tested positive for HPV infection. CONCLUSIONS: The low prevalence of genital HPV infections has provided evidence of the effectiveness of HPV vaccination both in vaccinated and not yet vaccinated subjects through herd immunity and indicated its decisive role in the changing epidemiology of circulating HPV genotypes in the population.
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Introduction: Aging is a physiological process occurring in all living organisms. It is characterized by a progressive deterioration of the physiological and cognitive functions of the organism, accompanied by a gradual impairment of mechanisms involved in the regulation of tissue and organ homeostasis, thus exacerbating the risk of developing pathologies, including cancer and neurodegenerative disorders. Methods: In the present work, for the first time, the influence of aging has been investigated in the brain cortex of the Podolica cattle breed, through LC-MS/MS-based differential proteomics and the bioinformatic analysis approach (data are available via ProteomeXchange with identifier PXD044108), with the aim of identifying potential aging or longevity markers, also associated with a specific lifestyle. Results and discussion: We found a significant down-regulation of proteins involved in cellular respiration, dendric spine development, synaptic vesicle transport, and myelination. On the other hand, together with a reduction of the neurofilament light chain, we observed an up-regulation of both GFAP and vimentin in the aged samples. In conclusion, our data pave the way for a better understanding of molecular mechanisms underlying brain aging in grazing cattle, which could allow strategies to be developed that are aimed at improving animal welfare and husbandry practices of dairy cattle from intensive livestock.
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Brain aging is a physiological process associated with physical and cognitive decline; however, in both humans and animals, it can be regarded as a risk factor for neurodegenerative disorders, such as Alzheimer's disease. Among several brain regions, hippocampus appears to be more susceptible to detrimental effects of aging. Hippocampus belongs to limbic system and is mainly involved in declarative memories and context-dependent spatial-learning, whose integrity is compromised in an age-dependent manner. In the present work, taking advantage of liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based proteomics, we sought to identify proteins differentially expressed in the hippocampus of the aged grazing milk cows. Our exploratory findings showed that, out of 707 identified proteins, 112 were significantly altered in old cattle, when compared to the adult controls, and functional clusterization highlighted their involvement in myelination, synaptic vesicle, metabolism, and calcium-related biological pathways. Overall, our preliminary data pave the way for the future studies, aimed at better characterizing the role of such a subcortical brain region in the age-dependent cognitive decline, as well as identifying early aging markers to improve animal welfare and husbandry practices of dairy cattle from intensive livestock.
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BACKGROUND: This survey investigated the knowledge, attitudes, and behaviors towards HPV preventive measures among university students in Italy and their associated factors. METHODS: The cross-sectional survey was conducted between November 2022 and April 2023. RESULTS: Only 41.7% knew about HPV infection and the main preventive measures. Multilevel mixed-effects logistic regression analysis showed that females, those aged 25-30 years, those who have had oral sex, those who had received information about HPV infection and preventive measures from physicians, and those who needed additional information about HPV infection and preventive measures were more knowledgeable. Only 39.1% have received at least one HPV vaccination dose, whereas 29.2% and 31.7% had not been vaccinated or did not remember. Multilevel mixed-effects logistic regression analysis identified that female students enrolled in the field of health sciences, those who did not report a prior history of a sexually transmitted infection, and those with a higher knowledge about HPV infection and preventive measures were more willing to receive the HPV vaccination. CONCLUSIONS: Despite some limitations, this was the first detailed survey on this topic conducted in the post-acute phase of COVID-19 among university students in Italy. The survey underlined the need to develop and to implement comprehensive educational programs and health interventions among students, to enhance their knowledge and modify their attitudes and improve the HPV vaccine uptake.
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The objective of this study was to explore the Herpes Zoster (HZ) knowledge and the willingness to receive the HZ vaccination in adults and older people in Italy. The study was conducted on a sample of patients aged ≥65 years and over 50 years with chronic conditions who went to the clinics of general practitioners (GPs) in Campania region, Italy. Data was collected with a questionnaire administered through an interview. Multivariate logistic regression analysis was performed. 427 participants (83.2 %) had heard about HZ infection and correctly knew the main symptoms of the HZ disease, and 196 of them (45.9 %) were aware of the main complications of the infection, such as post-Herpetic Neuralgia (NPE) and Herpes Zoster ophthalmicus (HZO). Only 61 participants (11.8 %) had heard of the availability of a vaccination against HZ in Italy and 39 of them (63.9 %) knew that the vaccination is recommended in at-risk patients aged at least 50 years and for adults aged ≥65 years. 137 participants (26.6 %) had a positive attitude toward the willingness to receive the HZ vaccination. Participants aged 50-64 years, those who have more than one chronic disease, those who have received at least one recommended vaccination, those who had a positive attitude on the usefulness of HZ vaccination, and those who feel the need to receive additional information about HZ vaccination were more likely to have a positive attitude toward the willingness to receive the HZ vaccination. It is needed to implement effective strategies to improve HZ vaccination coverage in order to protect especially frail patients from the most serious complications of the disease.
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Vacuna contra el Herpes Zóster , Herpes Zóster , Neuralgia Posherpética , Humanos , Adulto , Anciano , Estudios Transversales , Herpes Zóster/epidemiología , Herpes Zóster/prevención & control , Neuralgia Posherpética/prevención & control , Herpesvirus Humano 3 , Vacunación , Italia/epidemiologíaRESUMEN
Bubaline alphaherpesvirus-1 (BuAHV-1) and Bovine alphaherpesvirus-1 (BoAHV-1) are respiratory viruses that can cause an infection known as "Infectious Bovine Rhinotracheitis" (IBR) in both water buffalo and bovine species. As the main disease control strategy, vaccination can protect animals from clinical disease through the development of specific humoral and cell-mediated immune responses. In the present study, the time-related circulatory kinetics of hematological profile and bubaline monocyte subsets have been investigated in vaccinated buffalo calves after challenge infections with BuAHV-1. Thirteen buffalo calves were selected and grouped into the VAX-1 group, which received an IBR-live-attenuated gE-/tk-deleted marker vaccine; the VAX-2 group, which received an IBR-inactivated gE-deleted marker vaccine; the CNT group, which remained an unvaccinated control. Fifty-five days after the first vaccination, the animals were infected with 5 × 105.00 TCID50/mL of wild-type BuAHV-1 strain via the intranasal route. Whole blood samples were collected at 0, 2, 4, 7, 10, 15, 30, and 63 days post-challenge (PCDs) for the analysis of hematological profiles and the enumeration of monocyte subsets via flow cytometry. The analysis of leukocyte compositions revealed that neutrophils were the main leukocyte population, with a relative increase during the acute infection. On the other hand, a general decrease in the proportion of lymphocytes was observed early in the post-infection, both for the VAX-1 and VAX-2 groups, while in the CNT group, the decrease was observed later at +30 and +63 PCDs. An overall infection-induced increase in blood total monocytes was observed in all groups. The rise was especially marked in the animals vaccinated with an IBR-live-attenuated gE-/tK-deleted marker vaccine (VAX-1 group). A multicolor flow cytometry panel was used to identify the bubaline monocyte subpopulations (classical = cM; intermediate = intM; and non-classical = ncM) and to investigate their variations during BuAHV-1 infection. Our results showed an early increase in cMs followed by a second wave of intMs. This increase was observed mainly after stimulation with live-attenuated viruses in the VAX-1 group compared with the animals vaccinated with the inactivated vaccine or the non-vaccinated animal group. In summary, the present study characterized, for the first time, the hematological profile and distribution of blood monocyte subsets in vaccinated and non-vaccinated water buffalo in response to experimental infection with BuAHV-1. Although not experimentally proven, our results support the hypothesis of a linear developmental relationship between monocyte subsets.
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The hoarding of animals is a psychiatric disease, characterized by a compulsive collection of animals, with a relevant impact upon the care and welfare of animals, as well as on human society. In Italy, there are neither substantial reports nor information shared about such a phenomenon, making it difficult to draw a clear picture of the hoarder profile. Therefore, in the present work, we sought to detail 29 cases of animal accumulators in Italy, who lived within two areas of the Lazio region, and accumulated a total of 1080 animals from 2019 to 2022. In line with other international studies, we observed a prevalence of middle-aged (in their fifties) women, who lived mainly alone in a high level of social and health degradation. Most of the hoarded animals exhibited severe signs of dehydration and malnutrition, muscle hypotrophy, dermatological injuries, and behavioral disorders. Animal hoarding is not yet fully understood nor recognized as a psychosocial disorder, although it produces a deep suffering for the hoarder themselves, as well as corresponding family members, and the animals accumulated. Therefore, given the crucial impact of animal hoarding upon human and animal welfare, cross-cultural networks aimed at properly raising awareness of the problem could be established.
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Behavioral dysfunctions in dogs represent a critical issue of the human-animal relationship. In particular, aggression can make interspecific coexistence quite complicated within family units, thus exposing all members to greater health risks. In this present study, we documented multiple aggression episodes against one of the two family members caused by a 4-year-old neutered male pure breed Lagotto Romagnolo dog. To minimize impulsivity and anxiety-like behaviors of the patient as much as possible and improve his relationship with the adopting family, we used an interdisciplinary approach, employing specific skilled personnel, including a veterinary behaviorist and a rehabilitating dog instructor. Nine months after fluoxetine treatment (0.8 mg/kg, SID), in combination with oral α-s1 casozepine administration, and behavioral rehabilitation, the owners reported a significant reduction in aggressive events in terms of intensity and frequency. Collectively, our promising data pave the way toward a more detailed characterization of α-s1-casozepine to better evaluate the potential involvement of such a compound in the modulation of aggressive behaviors in dogs affected by relational dysfunctions.
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Compulsive disorder in dogs (CD) is characterized by constant and time-consuming repetition of behaviors, emancipated from the environment, that definitely compromise their everyday life activities. Here, we documented the efficacy of a novel approach to counteract the negative symptoms of CD in a 5-year-old mongrel dog, previously found to be resistant to the conventional antidepressant. The patient underwent an integrated and interdisciplinary approach, based on the cannabis and melatonin co-administration, together with a tailored 5-month-lasting behavioral program. Observational findings showed a lower rate of compulsive episodes and better management of the dog as well, when compared to the previous paroxetine treatment. We followed him for an additional four months of therapy, and the owners reported easier management of the dog, as reduction of abnormal behaviors to a level acceptable to the owners. Overall, our data so far collected in the CD dog may allow us to test more deeply the feasibility and safety of such an off-label approach, at both preclinical and clinical levels.
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Cannabis , Enfermedades de los Perros , Melatonina , Masculino , Perros , Animales , Melatonina/uso terapéutico , Conducta Compulsiva , Enfermedades de los Perros/tratamiento farmacológicoRESUMEN
Patients suffering from different forms of acute hepatic porphyria present a high risk of primary liver cancer, specifically hepatocellular carcinoma and cholangiocarcinoma, determined by the activity of the disease even though an exact mechanism of carcinogenesis has not been recognized yet. Here, we present the clinical case of a 72-year-old woman who, approximately 29 years after the diagnosis of acute intermittent porphyria, presented with intrahepatic cholangiocarcinoma with a histological diagnosis of adenocarcinoma starting from the biliary-pancreatic ducts, which was diagnosed during the clinical and anatomopathological evaluation of a pathological fracture of the femur.
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Composite materials have been used for many years in a wide variety of sectors starting from aerospace and nautical up to more commonly used uses such as bicycles, glasses, and so on. The characteristics that have made these materials popular are mainly their low weight, resistance to fatigue, and corrosion. In contrast to the advantages, however, it should be noted that the manufacturing processes of composite materials are not eco-friendly, and their disposal is rather difficult. For these reasons, in recent decades, the use of natural fibers has gained increasing attention, allowing the development of new materials sharing the same advantages with conventional composite systems while respecting the environment. In this work, the behavior of totally eco-friendly composite materials during flexural tests has been studied through infrared (IR) analysis. IR imaging is a well-known non-contact technique and represents a reliable means of providing low-cost in situ analysis. According to this method, the surface of the sample under investigation is monitored, under natural conditions or after heating, by recording thermal images with an appropriate IR camera. Here, the results achieved for jute- and basalt-based eco-friendly composites through the use of both passive and active IR imaging approaches are reported and discussed, showing the possibilities of use also in an industrial environment.
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During the COVID-19 pandemic, the Prime Minister's decree issued by the Italian government on 9 March 2020, known as "#Iorestoacasa" (I stay at home), required everyone to stay indoors, with a few exceptions, from 11 March to 3 May 2020. This decree had a substantial impact on the mental health of both people and dogs. We carried out a national survey to compare the personalities of adult dogs who were puppies in lockdown (from March to May 2020) with those of adult dogs born after that time (from June 2020 to February 2021). Our results highlighted a significant increase in personality traits related to fear and aggression in dogs who experienced lockdown restrictions during their socialization period, further confirming that the COVID-19 pandemic strongly impacted the behavioral development of dogs. Therefore, it may be advantageous for these dogs to be closely monitored by veterinary behaviorists and receive specialized behavioral rehabilitation therapy to lower the risk of episodes of aggression and fearfulness as well as to increase the wellbeing of dogs raised under social restrictions.
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A study was conducted to assess the degree of pertussis underreporting in Italy. An analysis was performed to compare the frequency of pertussis infections estimated using seroprevalence data with the pertussis incidence based on reported cases among the Italian population. For this purpose, the proportion of subjects who had an anti-PT ≥ 100 IU/mL (indicative of B. pertussis infection within the last 12 months) was compared with the reported incidence rate among the Italian population ≥5 years old, divided into two age groups (6-14 and ≥15 years old), obtained from the European Centre for Disease Prevention and Control (ECDC) database. The pertussis incidence rate in the Italian population ≥5 years old reported by the ECDC in 2018 was 6.75/100,000 in the 5-14 age group and 0.28/100,000 in the ≥15 age group. The proportion of subjects recruited in the present study with an anti-PT ≥ 100 IU/mL was 0.95% in the 6-14 age group and 0.97% in the ≥15 age group. The estimated rate of pertussis infections based on seroprevalence was approximately 141-fold and 3452-fold higher than the reported incidence in the 6-14 age group and in the ≥15 age group, respectively. Quantification of underreporting can allow for the burden of pertussis, as well as the impact of ongoing vaccination, to be better evaluated.