[Pertussis immunization within three adult populations concerned by cocoon strategy in Île-de-France]. / Vaccination contre la coqueluche au sein de trois populations d'adultes concernées par le cocooning en Île-de-France.

BACKGROUND: Pertussis is a highly contagious respiratory tract infection with a high morbi-mortality in non or insufficiently immunized infants. Cocoon strategy was implemented in France in 2004 in order to reduce the disease incidence. The main objective of the study was to estimate immunization coverage according to cocoon strategy among eligible adults in three different settings in Île-de-France. METHODS: A descriptive survey was carried out by means of the same questionnaire addressed to relatives of children hospitalized in pediatric wards, to adults living under the same roof as children enrolled in nursery school, and to grandparents who consulted general practitioners. The main outcome was pertussis vaccination of the adult before the child reached 6 months of age. Parent's and grandparent's knowledge about pertussis and medical advice received about cocooning were assessed. The statistical analysis searched for determinants of vaccination according to cocoon strategy. RESULTS: Between August 2014 and March 2015, 383 adults were included within the scope of the survey of whom 250 had a vaccination status that could be verified. Immunization coverage was 59%, 33% and 31% respectively in relatives of children hospitalized in pediatric wards, in adults living with children enrolled in nursery school, and in grandparents who consulted general practitioners offices. In the entire population, knowledge of the risk of pertussis was noted in 60%, 76% and 91% of cases. The main determinant of adequate and documented pertussis vaccination was "having received medical advice" that was present in 54%, 31% and 19% of cases, respectively. CONCLUSION: Cocoon strategy implementation has clearly progressed but remains insufficient. Emphasis needs to be placed on physicians' involvement in pertussis vaccination in adults eligible for cocoon strategy.

Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana.

OBJECTIVES: To assess the extent of socio-economic inequity in coverage and timeliness of key childhood immunisations in Ghana. METHODS: Secondary analysis of vaccination card data collected from babies born between January 2008 and January 2010 who were registered in the surveillance system supporting the ObaapaVita and Newhints Trials was carried out. 20 251 babies had 6 weeks' follow-up, 16 652 had 26 weeks' follow-up, and 5568 had 1 year's follow-up. We performed a descriptive analysis of coverage and timeliness of vaccinations by indicators for urban/rural status, wealth and educational attainment. The association of coverage with socio-economic indicators was tested using a chi-square-test and the association with timeliness using Cox regression. RESULTS: Overall coverage at 1 year of age was high (>95%) for Bacillus Calmette-Guérin (BCG), all three pentavalent diphtheria-pertussis-tetanus-haemophilus influenzae B-hepatitis B (DPTHH) doses and all polio doses except polio at birth (63%). Coverage against measles and yellow fever was 85%. Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. We found substantial health inequity across all socio-economic indicators for all vaccines in terms of timeliness, but not coverage at 1 year. For example, for the last DPTHH dose, the proportion of children delayed more than 8 weeks were 27% for urban children and 31% for rural children (P < 0.001), 21% in the wealthiest quintile and 41% in the poorest quintile (P < 0.001), and 9% in the most educated group and 39% in the least educated group (P < 0.001). However, 1-year coverage of the same dose remained above 90% for all levels of all socio-economic indicators. CONCLUSIONS: Ghana has substantial health inequity across urban/rural, socio-economic and educational divides. While overall coverage was high, most vaccines suffered from poor timeliness. We suggest that countries achieving high coverage should include timeliness indicators in their surveillance systems.

[Prevention of pertussis in newborns: Should pregnant women be vaccinated at each pregnancy?] / Prévention de la coqueluche chez le nouveau-né : faut-il vacciner les femmes enceintes à chaque grossesse ?

Pertussis is a respiratory disease that can be fatal at all ages but especially in infants before their mandatory vaccination. Recent epidemiological data shows a decrease in the number of pertussis cases, but a resurgence cannot be excluded in the coming years due to the cyclic evolution of the disease and the loosening of hygiene measures. Two approaches are used to protect infants before their vaccination: vaccination of the mother during pregnancy and vaccination of all the infant's close relatives (cocooning). The vaccination of the mother during pregnancy is more effective. The uncertain risk of chorioamniotitis associated with vaccination during pregnancy is insufficient to question this strategy.

Non-specific effects of diphtheria-tetanus-pertussis and measles vaccinations? An analysis of surveillance data from Navrongo, Ghana.

OBJECTIVES: Studies from low-income countries have suggested that routine vaccinations may have non-specific effects on child mortality; measles vaccine (MV) is associated with lower mortality and diphtheria-tetanus-pertussis (DTP) with relatively higher mortality. We used data from Navrongo, Ghana, to examine the impact of vaccinations on child mortality. METHODS: Vaccination status was assessed at the initiation of a trial of vitamin A supplementation and after 12 and 24 months of follow-up. Within the placebo group, we compared the mortality over the first 4 months and the full 2 years of follow-up for different vaccination status groups with different likelihoods of additional vaccinations during follow-up. The frequency of additional vaccinations was assessed among children whose vaccination card was seen at 12 and 24 months of follow-up. RESULTS: Among children with a vaccination card, more than 75% received missing DTP or MV during the first 12 months of follow-up, whereas only 25% received these vaccines among children with no vaccination card at enrollment. Children without a card at enrollment had a significant threefold higher mortality over the 2-year follow-up period than those fully vaccinated. The small group of children with DTP3-4 but no MV at enrollment had lower mortality than children without a card and had the same mortality as fully vaccinated children. In contrast, children with 1-2 DTP doses but no MV had a higher mortality during the first 4 months than children without a card [MRR = 1.65 (0.95, 2.87)]; compared with the fully vaccinated children, they had significantly higher mortality after 4 months [MRR = 2.38 (1.07, 5.30)] and after 2 years [MRR = 2.41 (1.41, 4.15)]. Children with 0-2 DTP doses at enrollment had higher mortality after 4 months (MRR = 1.67 (0.82, 3.43) and after 2 years [MRR = 1.85 (1.16, 2.95)] than children who had all three doses of DTP at enrollment. CONCLUSIONS: As hypothesised, DTP vaccination was associated with higher child mortality than measles vaccination. To optimise vaccination policies, routine vaccinations need to be evaluated in randomised trials measuring the impact on survival.

Whooping Cough: A Brief History to the 19th Century.

This paper examines the history of whooping cough (pertussis) from its first recorded mention in 1190 to the time when its microbial cause was identified. The historical records of the disease are complicated by the variation in the nomenclature employed and through using the same name for disorders with different symptoms. During the early-modern period it was considered to be a disease new to Europe-contagious, dangerous, and potentially epidemic. Believed to be confined to children, its significance was limited until the 18th century when its incidence increased markedly. This essay argues pertussis may have occurred in the late medieval period in individual, though not epidemical, cases.

[Should French pregnant women be vaccinated against pertussis during pregnancy?] / Faut-il vacciner les femmes enceintes françaises contre la coqueluche ?

Many countries with a high perinatal level have started a policy of vaccination of pregnant women against pertussis. To date, France has not chosen this policy. The objective was to review knowledge on pertussis mortality in infants. Compare the strategies available to protect the infant before his first vaccination, scheduled for two months of age. We proceeded to a litterature analysis, from January 1998 to 2021. Search by the following keywords used ; "Whooping cough, vaccination, pregnancy, strategy, cocooning", on the scientific basis of "Pubmed", as well as French and foreign vaccination recommendations. Currently 90% of whooping cough deaths are concerning infants under six months of age and this mortality represents 2% of mortality in the first year of life. Vaccination at birth is not effective. The cocooning strategy, which consists of vaccinating those around the child, is expensive and difficult to implement. A systematic vaccination policy for pregnant women is effective and reasonably expensive when compared to the cocooning strategy. In England, it was recently accompanied by a 78% reduction in confirmed cases of pertussis in infants under six months of age. In conclusion, compared to cocooning strategy, pertussis vaccination of pregnant women appears more effective and cost-effective, and this with each pregnancy.

Maternity staff immunization coverage against pertussis and maternal vaccination practices: Results of a 2017 cross-sectional survey in five public maternity hospitals.

OBJECTIVES: To conduct an audit of vaccination practices against pertussis in maternity wards to assess immunization practices targeting women, knowledge and awareness among health professionals and their involvement in the vaccination process, and to estimate their vaccine coverage. MATERIALS AND METHODS: 2017 cross-sectional descriptive survey using a data collection sheet of immunization practices targeting women and an anonymous questionnaire for health professionals whose vaccine coverage had been documented by the occupational health service. RESULTS: Five public maternity wards participated: one had a vaccination policy for women; 426 of 822 health professionals completed the questionnaire, 76% (from 50% of all residents to 83% of nurses) declared their vaccination status as up to date. Staff files in occupational health services showed that 69% of 822 health professionals received at least one vaccine booster during adulthood (57% less than 10 years before the survey); documented vaccination coverage rates ranged from 75% for residents to 91% for senior physicians. Occupational physicians and family physicians respectively performed 41% and 34% of vaccinations. While knowledge regarding vaccines was good, only 47% of health professionals declared prescribing them and 18% declared administering the anti-pertussis vaccine "often" or "very often". CONCLUSIONS: Updated data is needed to confirm the reported increase as participating centers are not representative of all birth centers. The active role of health professionals in vaccination-based pertussis prevention needs to be reinforced.

Acceptance of pregnant women's vaccination against pertussis among French women and health professionals: PREVACOQ-1 and -2 studies.

OBJECTIVES: Protection of French young infants against pertussis only relies on their relatives' vaccination. The alternative is vaccination of pregnant women against pertussis (cocooning strategy), but this strategy is not yet recommended in France. We assessed the acceptance of this strategy among French postpartum women and health professionals. PATIENTS AND METHODS: We performed a multicenter survey in 2016 among postpartum women and health professionals (family physicians, obstetricians-gynecologists, midwives, and medical students) to determine the acceptance of anti-pertussis vaccination. We evaluated knowledge, perception, and attitude towards vaccination to identify factors associated with acceptance. RESULTS: Questionnaires were completed by 52% (1208/2337) of women and 40% (694/1754) of health professionals. Seventy-seven per cent of women (95% CI: 74-79) and 93% of health professionals (95% CI: 91-95) were favorable to anti-pertussis vaccination of pregnant women. Thirty-three per cent (227/687) of health professionals believed that pertussis induced life-long immunity and 20% (136/687) of them were not aware of the cocooning strategy. In multivariate analysis, factors associated with acceptance among women were younger age, higher knowledge, having received advice during pregnancy, being vaccinated against influenza, and having never refused any vaccine; among health professionals, factors associated with acceptance were belief that inactivated vaccines are obstetrically safe, regular practice of influenza vaccination in pregnant women, pertussis cocooning strategy, and never prescribing preventive homeopathy for influenza. CONCLUSION: Vaccination of pregnant women against pertussis should be well-accepted by informed mothers and health professionals. If this strategy were to be implemented in France, efforts should be made towards adequate information.

[Alterations in responses to vaccines in older people]. / Altération des réponses vaccinales avec l'âge.

The aging population raises a number of public health issues including a need to address the severity and frequency of infections observed in older people. Vaccines play an important role in prevention. However, immunosenescence alters the intensity and quality of vaccine responses, thus limiting the impact of recommendations directed after 65 years for vaccination against flu, pneumococci, pertussis, tetanus and zoster. Immunosenescence, aggravated by co-morbidities, varies with age, becoming apparent after 60-65 years and more profound after 85 years. All stages of vaccine responses are affected by immunosenescence, from the innate immunity required to activate these responses to the induction of protective antibody responses and immune memory. Nevertheless, the capacity to develop new responses to primary vaccination is more affected than the ability to respond to recalls, although this is also impaired. Responses to vaccines are differentially altered depending on vaccine and age. Influenza vaccines are modestly immunogenic and several meta-analyses agree an estimate for efficacy of about 50% against virologically-proven flu and 40% against flu-related deaths. The anti-pneumococcal 23-valent non-conjugated vaccine does not induce memory while the 13-valent conjugated one does, but their efficacy are likely to be similar between 70 to 52% before 75 years. A sequential vaccination program with the 13-valent primo-vaccination followed by the 23-valent, recommended in immune-suppressed patients, is currently being studied in France. The waning of immunity to pertussis makes recalls necessary in the elderly who develop good antibody responses. Several research avenues are currently being pursued to try improve the degree of protection conferred by these vaccines in elderly.

[Vaccination During Pregnancy]. / Impfungen in der Schwangerschaft.

Vaccination During Pregnancy Abstract. Vaccinations administered to women during pregnancy can provide protection against serious infectious diseases for the mother, for the newborn, or both. Two vaccines are routinely recommended during pregnancy: Influenza and Pertussis. While the influenza vaccine protects mainly the pregnant mother, who is at an increased risk for severe affection, the pertussis vaccine is an effective protection to infants who are at particularly high risk of pertussis complications and mortality in the first three months of life.

Incidence of pertussis in subjects aged 50years and older in France in 2013-2014.

OBJECTIVE: To assess the incidence of pertussis (whooping cough) in subjects aged 50years and older in France. METHODS: Participating family physicians (FPs) using the patient record management software AxiSanté® included patients aged 50years and older, who had signed an informed consent form, presenting with persistent cough for 7 to 21days. Bordetella genetic material was detected by polymerase chain reaction (PCR) on nasopharyngeal samples collected at the FP's discretion. RESULTS: A total of 42 FPs included 129 patients from June 2013 to August 2014 (large cities: 38; medium-sized cities: 57; rural areas: 34); 106 samples were analyzed. Overall, 30 pertussis cases were diagnosed: 10 cases confirmed by PCR, 18 purely clinical cases, and two direct epidemiological cases. The crude incidence rate per 100,000 patients aged≥50years was 103.6 (95% CI: 69.9-47.9): 77.1 in large cities, 103.1 in medium-sized cities, and 143.9 in rural areas. The extrapolated incidence rate per 100,000 persons aged≥50years was 187.1 (95% CI: 126.2-67.1): 131.1 in large cities, 256.1 in medium-sized cities, and 242.2 in rural areas. CONCLUSION: The population aged 50years and older can serve as a reservoir. Its role in Bordetella pertussis circulation should be taken into account for pertussis booster vaccination programs.

Analysis of the time series of pertussis in Brazil from 2010 to 2019 / Análise da série temporal da coqueluche no Brasil no período de 2010 a 2019

Abstract Objectives: to analyze a decade of spatio-temporal behavior of pertussis in Brazil and its epidemiological characteristics. Methods: ecological time series study of pertussis cases and deaths from the Notifable Diseases Information System in Brazil (2010-2019). The method of generalized linear analysis of Prais-Winsten and the Kernel analysis were used. Results: 32,849 cases were reported, of which 466 (1.42%) evolved to death, with a prevalence of 1.63/100,000 inhabitants and a mortality rate of 0.023/100,000 inhabitants. In the temporal analysis, the cyclical behavior of pertussis was evidenced, with trend variations in the period in 2014. Most cases occurred in children under 1 year of age (60.16%, p<0.01), sex female (55.28%, p=0.066) and white (48.42%, p=0.14). The largest share of deaths was in children aged <1 year (98.07, p<0.01), females (56.01%, p=0.066) and whites (43.78%, p=0.14). In the Kernel of prevalence, the South, Southeast and Northeast regions stood out with high density; while for mortality, the Southeast and Northeast stood out. Conclusions: the cyclical behavior of pertussis was observed, with a decreasing trend in recent years and the concentration of cases in children. This reinforces the importance of strengthening the population's immunization process.

Resumo Objetivos: analisar uma década do comportamento espaço-temporal da coqueluche no Brasil e as suas características epidemiológicas. Métodos: estudo ecológico de série temporal dos casos e óbitos por coqueluche do Sistema de Informação de Agravos de Notificação no Brasil (2010-2019). Utilizou-se o método de análise linear generalizada de Prais-Winsten e a análise de Kernel. Resultados: notificaram-se 32.849 casos, desses 466 (1,42%) evoluíram para óbito, com prevalência de 1,63/100.000 habitantes e coeficiente de mortalidade de 0,023/100.000 habitantes. Na análise temporal, evidenciou-se o comportamento cíclico da coqueluche com variações de tendência no período em 2014. A maioria dos casos ocorreu em menores de 1 ano (60,16%, p<0,01), sexo feminino (55,28%, p=0,066) e brancos (48,42%, p=0,14). A maior parcela dos óbitos foi em crianças <1 ano (98,07, p<0,01), sexo feminino (56,01%, p=0,066) e brancos (43,78%, p=0,14). No Kernel da prevalência, destacaram-se as regiões Sul, Sudeste e Nordeste com alta densidade; enquanto para mortalidade, sobressaíram-se Sudeste e Nordeste. Conclusão: observou-se o comportamento cíclico da coqueluche, com tendência de decréscimo nos últimos anos e a concentração de casos no público infantil. O que reforça a importância de fortalecer o processo de imunização da população.

Incidência de coqueluche em crianças menores de 1 ano e relação com a vacinação materna no Brasil, 2008 a 2018 / Incidencia de tos ferina en niños menores de 1 año y relación con la vacunación materna en Brasil, 2008 a 2018 / Pertussis incidence in children under 1 year old and relation with maternal vaccination in Brazil, 2008-2018

Objetivo: Analisar o impacto da vacina adsorvida difteria, tétano e coqueluche (pertússis acelular), tipo adulto (dTpa), materna, na incidência de coqueluche em crianças menores de 1 ano no Brasil, de 2008 a 2018. Métodos: Estudo de tipo ecológico, descritivo de tendência temporal, utilizando-se de dados dos sistemas de vigilância do Departamento de Informática do Sistema Único de Saúde (Datasus). Foram calculadas taxas de incidência e razão das taxas de incidência (IRR), com respectivos intervalos de confiança de 95% (IC95%). Resultados: O número de casos de coqueluche foi de 20.650. Houve redução na incidência de coqueluche no período pós-vacinal, de 26,6% (IRR = 0,73; IC95% 0,66;0,82) nas crianças de 3 meses a 1 ano incompleto, e de 63,6% (IRR = 0,36; IC95% 0,15;0,58) nas crianças de zero a 2 meses. Conclusão: O aumento da cobertura da vacinação com dTpa materna correspondeu à redução na incidência de coqueluche, principalmente na faixa etária de zero a 2 meses.

Objetivo: Analizar la incidencia de tos ferina en menores de 1 año y su relación con la cobertura de vacunación materna por la vacuna adsorbida contra la difteria, el tétanos y la tos ferina (tos ferina acelular) tipo adulto (dTpa), de 2008 a 2018, en Brasil. Métodos: Estudio ecológico descriptivo de tendencia temporal utilizando datos de los sistemas de vigilancia del Departamento de Informática do Sistema Único de Saúde (Datasus). Se calcularon los tasas de incidencia y las razones de tasas de incidencia (RTI) con los respectivos intervalos de confianza del 95% (IC95%). Resultados: El número de casos de tos ferina en el período de estudio fue de 20,650. Hubo una reducción en la incidencia de tos ferina en el período post-vacunación. En los niños de 3 meses a 1 año incompleto, la reducción fue del 26,6% (RTI = 0,73; IC95% 0,66;0,82), mientras que en el otro grupo la diferencia relativa fue del 63,6% (RTI = 0,36; IC95% 0,15;0,58)]. Conclusión: La vacunación materna con dTpa coincide con una reducción en la incidencia de tos ferina, especialmente en el grupo de edad de cero a 2 meses.

Objetive: To analyze the impact of maternal vaccination coverage with diphtheria-tetanus-acellular pertussis (Tdap) adsorbed vaccine for adults on pertussis incidence in children under 1 year old in Brazil from 2008 to 2018. Methods: This was a descriptive ecological temporal trend study using data from surveillance systems managed by the Brazilian National Health System Information Technology Department (DATASUS). Incidence rates and incidence rate ratios (IRR) were calculated with respective 95% confidence intervals (95%CI). Results: There were 20,650 pertussis cases in the study period. In the post-vaccination period there was a 26.6% reduction (IRR = 0.73; 95%CI 0.66;0.82) in pertussis incidence among children aged from 3 months up to but not including 1 year old, and a 63.6% reduction (IRR = 0.36; 95%CI 0.15;0.58) among children from birth to 2 months old. Conclusion: The increase in maternal Tdap vaccination coverage coincided with a reduction in pertussis incidence, especially in the birth to two-month-old age group.

[Pertussis: Where do we stand 10years after the introduction of cocooning vaccination strategy in France?] / Coqueluche : où en est-on en France 10ans après la mise en place de la stratégie vaccinale du cocooning ?

The goals of this article are to review the pertussis cocooning strategy, which has been recommended in France since 2004 to protect infants not yet vaccinated from becoming infected by vaccinating their immediate entourage, and to present room for improvement. The analysis of the literature between 2004 and 2015 shows that pertussis vaccine coverage in new parents is lower than 50% and that attempts that have already been implemented to increase it are effective. Pertussis vaccine coverage improvement requires all health actors to collaborate and be trained in informing and motivating parents to get vaccinated before, during and after pregnancy (the parents then will act as relays to their relatives); generalization in maternity wards of systematic checking of the vaccination card; extension to the midwives of the right to prescribe and administer pertussis vaccine to spouses; vaccination facilitation in maternity wards with the support of health organizations. Exchange and sharing of experiences between health care professionals are essential. Pregnancy is the ideal period to promote pertussis vaccination.

Pertussis vaccination coverage among French parents of infants after 10years of cocoon strategy.

OBJECTIVES: The cocoon strategy against pertussis has been recommended in France since 2004 to indirectly protect young infants who are not yet vaccinated. We aimed to measure vaccination coverage among French parents of infants. METHODS: A representative sample of 300 mothers and 200 fathers of infants aged <12 months completed a self-administered online questionnaire. They all provided their own vaccination records. RESULTS: Overall, 87% of mothers believed vaccination against pertussis to be important; 83% reported being immunized against pertussis but their vaccination records showed that a third of them was wrong (34%). On the basis of our sample, the 2009-2014 vaccination coverage against pertussis among mothers increased from 22 to 61% (P<0.005); over the same period of time, vaccination coverage against diphtheria, tetanus, and polio remained stable (80%). Vaccination coverage against pertussis among fathers increased from 21 to 42% between 2010 and 2013 (P=0.009). In 2013, one couple out of four (26%) was adequately immunized against pertussis. CONCLUSION: The cocoon strategy was implemented 10years ago in France but vaccination coverage remains suboptimal among parents of young infants. Healthcare professionals must recommend vaccination against pertussis to young adults and check that their vaccination status is up to date.

Hospitalizations and deaths due to pertussis in children from 1996 to 2013.

OBJECTIVES: To assess temporal trends of hospitalizations and deaths from pertussis in Brazilian children in the period of 1996-2013. METHODS: This was a descriptive ecological study of temporal trends, based on the DATASUS database. The number of hospitalizations and deaths from pertussis in children up to 19 years of age from January 1996 to December 2013 was obtained. Descriptive statistics were applied for data analysis. RESULTS: During the study period, a total of 19,047 hospital admissions from pertussis were recorded, of which 88.2% occurred in infants younger than 1 year. In the period 1996-2010, the mean annual number of admissions was 755, ranging from a maximum of 1179 in 2004 to a minimum of 400 in 2010. There was an increase of admissions in the last three consecutive years (2011, 2012, and 2013) with 1177, 2954 and 3589 hospitalizations, respectively. There were 498 deaths from pertussis throughout the study period, of which 96.8% occurred in children younger than one year. There was an increase in the number of deaths from pertussis in children in the years 2011, 2012, and 2013, with 40, 93, and 87 recorded deaths, respectively. The increase in hospitalizations and deaths from pertussis in children occurred in all regions of the country, with the highest increase observed in the Southeast, North and Northeast regions. CONCLUSIONS: There was a substantial increase in hospitalizations and deaths from pertussis in children for three consecutive years (2011, 2012, and 2013) in all Brazilian regions. The most affected age group was that of children younger than one year.

Hospitalização por coqueluche em crianças no período pré e pós-implantação da vacina dTpa para gestantes / Hospitalization due to pertussis in children in the pre- and post-implantation periods of the DTaP vaccine for pregnant women

Resumo Introdução A imunização da gestante parece proteger o bebê por meio da transferência passiva de anticorpos e ter um impacto na prevenção da doença em bebês que ainda não iniciaram a vacinação contra coqueluche. Objetivo Analisar o comportamento dos registros de hospitalizações por coqueluche em crianças menores de 1 ano de idade, conforme a cobertura da vacina dTpa para gestantes. Método Trata-se de um estudo ecológico de caráter observacional e quantitativo dos registros de hospitalizações por coqueluche, em crianças menores de 1 ano de idade, no Sul do Brasil, durante o período de 2007 a 2017. Os dados foram obtidos por meio do Sistema de Informação Hospitalar no DATASUS. Resultados No período analisado, foram registradas 342.139 hospitalizações por doenças respiratórias em crianças menores de 1 ano, sendo que 3.062 foram por coqueluche. No período pré-vacinal, a média anual foi de 102,2/100.000/ano e, no período pós-vacinal, foi de 46,8/100.000/ano, representando uma queda de 54,2% no número de registros, variando de 27,8/100.000/ano em 2007 a 139/100.000/ano em 2013, caindo para 47,9/100.000/ano em 2017. Conclusão Houve uma redução no número de registros de hospitalizações por coqueluche após a introdução da vacina dTpa, mesmo com uma cobertura vacinal abaixo de 50%.

Abstract Background Immunization of pregnant women seems to protect infants through passive antibody transfer, and have an impact on disease prevention in infants who have not yet started vaccination for pertussis. Objective Analyze the behavior of hospitalization records for pertussis in children under 1 year of age according to the coverage of the Diphtheria, Tetanus and acellular Pertussis (DTaP) vaccine for pregnant women. Methods This is an ecological, observational, quantitative study conducted with records of hospitalization due to pertussis in children under 1 year of age in southern Brazil from 2007 to 2017. Data were obtained from the hospital information system at DATASUS. Results In the analyzed period, 342.139 children aged ≤1 year were hospitalized as a result of respiratory diseases, and 3.062 of these hospitalizations were due to pertussis. In the pre-vaccination period, the annual average was 102.2/100,000 and, in the post-vaccination period, it was 46.8/100.000, representing a 54.2% decrease in the number of records, varying from 27.8/100.000/year in 2007 to 139.0/100.000/year in 2013, and reducing to 47.9/100.000/year in 2017. Conclusion There was a reduction in the number of hospitalizations due to pertussis after the introduction of the DTaP vaccine, even with vaccination coverage <50%.

Cambios epidemiológicos y actualidades sobre vacunación contra Bordetella pertussis en Latinoamérica / Epidemiologic changes and novelties on vaccination against Bordetella pertussis in Latin America

Resumen A pesar de que la tosferina (coqueluche) es una enfermedad prevenible por vacunas (EPV), la epidemiología latinoamericana muestra que hay persistencia de brotes en la región. Esta persistencia se debe, al menos en parte, a factores tales como la cobertura vacunal, la presencia de movimientos anti vacunas, la diversidad de los sistemas locales de vigilancia y la falta de una definición de caso unificada para la región. Dada la importancia de la tosferina en Latinoamérica y los cambios ocurridos en las recomendaciones para la vacunación, este manuscrito tiene como objetivo revisar los datos epidemiológicos y los cambios recientes en los calendarios de vacunación y su impacto sobre la enfermedad pediátrica por Bordetella pertussis en Latinoamérica. Los datos epidemiológicos más recientes muestran que entre regiones, países, y segmentos dentro de cada país hay heterogeneidad en la cobertura vacunal, con distintos rebrotes. Esfuerzos en la región han tratado de mejorar esta situación al introducir vacunas acelulares (aP), menos reactogénicas que las vacunas de células enteras (wP) en los calendarios vacunales. Además, algunos países han mejorado la definición de caso confirmado, al introducir la reacción de polimerasa en cadena (RPC) como criterio diagnóstico. En respuesta a las heterogeneidades de cada país y a la epidemiología actual de la región, un Comité de Expertos de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE) y la Asociación Latinoamericana de Pediatría (ALAPE) propone una definición unificada de caso y recomendaciones para mejorar la cobertura vacunal y reducir los brotes de tosferina en Latinoamérica.

Abstract Although whooping cough is a vaccine-preventable disease (VPD), its epidemiologic characteristics in Latin America shows persistence of outbreaks in the region. This persistence is due, at least in part, to the presence of antivaccine movements, the diversity of the surveillance systems, and the lack of a uniform case definition for the region. Given the importance of whooping cough in Latin America and the changes in vaccine recommendations, this manuscript aims to review epidemiologic data and recent changes in the vaccination calendars and their impact on the pediatric disease by Bordetella pertussis in Latin America. Recent epidemiological data reveal that between regions, countries, and administrative units within each country there is a marked heterogeneity of vaccine coverage, with different outbreak patterns. Efforts in the region have tried to improve this situation by introducing acellular pertussis vaccines (aP) in the vaccine calendars, which are less reactogenic than whole-cell pertussis vaccines (wP). Moreover, some countries have improved the case definition. Some countries have implemented a confirmed case definition by introducing polymerase chain reaction (PCR) as a diagnostic criterion. As a response to the heterogeneities observed within and between countries and the regional epidemiologic profiles, a Steering Committee from the Latin American Society for Pediatric Infectiology (SLIPE) and the Latin American Association of Pediatrics (ALAPE) propose a unified case definition and recommendations to improve vaccine coverage and reduce the outbreaks of whooping cough in Latin America.

[Vaccination in the early post-partum: Guidelines]. / Les vaccinations dans le post-partum immédiat: recommandations.

OBJECTIVES: To propose guidelines for clinical practice regarding pertussis, influenza, varicella and rubella vaccination in the early post-partum. MATERIALS AND METHODS: Bibliographic searches were performed with PubMed and Cochrane databases, and within national guidelines and their references. RESULTS: Women that have not got vaccinated in the past 10 years should receive a dose of diphtheria-tetanus-acellular pertussis-poliomyelitis vaccine in the early post-partum, and the family and friends should be included in the cocooning strategy (professional consensus). During seasonal influenza epidemic, influenza vaccine should be offered to women, who were not vaccinated during pregnancy, and delivered a vulnerable neonate (professional consensus). For all other women, the vaccination can be discussed on a case-by-case basis (professional consensus). In order to prevent congenital or neonatal varicella in a subsequent pregnancy, scientific data are weak to suggest a systematic screening and vaccination against varicella in women with no history or uncertain status about varicella, excepted in women coming from sub-Saharan Africa, East and Central Europe, more likely to have a negative serology for varicella (professional consensus). In order to prevent severe varicella in adulthood, the vaccination should be discussed with potentially seronegative women as recommended by the French High Council for Public Health (professional consensus). Rubella vaccine is recommended in the early post-partum with women with negative serology during pregnancy with a dose of measles-mumps-rubella vaccine (professional consensus). A new pregnancy should be avoided in the month following rubella and varicella vaccination, but contraception is not obligatory (professional consensus). Breastfeeding, recent rhesus immunoglobulin injection and blood transfusion do not prevent to perform vaccination in the early post-partum (professional consensus).

Coqueluche na infância: revisão integrativa da doença / Pertussis in children: an integrative review / Tos ferina en la infancia: revisión integrativa de la enfermedad

Justificativa e Objetivos: Apesar dos esforços despendidos pelo Programa Nacional de Imunizações, a coqueluche é um agravo que ainda gera grandes preocupações para a saúde pública. Assim, o objetivo deste estudo foi descrever as evidências na literatura sobre coqueluche na infância que indicassem as práticas de assistência à saúde necessárias para sua prevenção, promoção e controle. Método: Revisão integrativa da literatura nas bases de dados LILACS, MedLine, PubMed, SciELO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) utilizando os descritores Whooping Cough, Epidemiology, Vaccination. A revisão foi realizada em maio de 2020 e abrangeu a literatura disponível na íntegra, publicada em português, inglês ou espanhol, sem delimitação de ano. Resultados: Dentre os 1.248 artigos selecionados apenas nove foram analisados (a maioria norte-americana), dos quais 55% eram estudos realizados para prevenção de coqueluche. Quanto à autoria dos estudos, em 67% das publicações havia participação de um epidemiologista. Conclusão: Esta investigação mostra as evidências científicas sobre a coqueluche na infância, necessárias para prevenir, controlar, promover a assistência e definir o perfil epidemiológico desse agravo nessa população. Os resultados revelaram nível de evidência cinco, sugerindo que as pesquisas desenvolvidas na área não retratam fortes evidências.(AU)

Background and Objectives: Despite the efforts of the National Immunization Program, pertussis remains a serious health problem. Thus, this study described the evidence in the literature on pertussis during childhood, which elucidates the health-care practices necessary for prevention, promotion, and control of the disease. Methods: This is an integrative literature review conducted in the LILACS, MedLine, PubMed, SciELO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, using the following descriptors: "Whooping Cough", "Epidemiology", and "Vaccination". The search was restricted to humanities, in English, Portuguese, or Spanish, without year delimitation. The search was completed on May 2020, Results: in total, 1,248 articles were selected, of which only nine articles were analyzed, mostly from North America, and 55% of the analyzed studies were about preventing pertussis. Regarding the authorship of the studies, epidemiologists participated in 67% of the publications. Conclusion: This study presents the necessary scientific evidence on pertussis during childhood is necessary for prevention, control, promotion, and epidemiological profile of this disease in this population. The results revealed a level of evidence of five, suggesting that the research in this area does not show strong evidence.(AU)

Justificación y Objetivos: La tos ferina todavía es un grave problema de salud a pesar de los esfuerzos realizados por el Programa Nacional de Inmunización. El objetivo de este estudio fue identificar las evidencias científicas en la literatura sobre la tos ferina en la infancia que indican las prácticas de asistencia sanitaria necesarias a la prevención, promoción y control de la enfermedad. Métodos: Revisión integrativa de la literatura en las bases de datos LILACS, MedLine, PubMed, SciELO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) utilizando las palabras clave: Whooping Cough, Epidemiology, Vaccination. Se llevó a cabo en mayo de 2020 la búsqueda de artículos publicados en portugués, inglés y español, disponibles en su totalidad y sin delimitación de año. Resultados: Se seleccionaron un total de 1.248 artículos, de los cuales solo se analizaron nueve, en su mayoría norteamericanos; el 55% de los estudios analizados fueron sobre la prevención de la tos ferina. Respecto de la autoría de los estudios, un epidemiólogo participó en el 67% de las publicaciones. Conclusiones: Esta investigación muestra evidencias científicas sobre la tos ferina en la infancia necesarias para la prevención, el control, la promoción de la asistencia y la definición del perfil epidemiológico de la enfermedad en esa población. Los resultados revelaron que el nivel de evidencia se remite a cinco, lo que sugiere que la investigación en el área no muestra evidencias sólidas.(AU)