Association of sociodemographic factors and internet query data with pertussis infections in Shandong, China.

This study explored how internet queries vary in facilitating monitoring of pertussis, and the effects of sociodemographic characteristics on such variation by city in Shandong province, China. We collected weekly pertussis notifications, Baidu Index (BI) data and yearly sociodemographic data at the city level between 1 January 2009 and 31 December 2017. Spearman's correlation was performed for temporal risk indices, generalised linear models and regression tree models were developed to identify the hierarchical effects and the threshold between sociodemographic factors and internet query data with pertussis surveillance. The BI was correlated with pertussis notifications, with a strongly spatial variation among cities in temporal risk indices (composite temporal risk metric (CTRM) range: 0.59-1.24). The percentage of urban population (relative risk (RR): 1.05, 95% confidence interval (CI) 1.03-1.07), the proportion of highly educated population (RR: 1.27, 95% CI 1.16-1.39) and the internet access rate (RR: 1.04, 95% CI 1.02-1.05) were correlated with CTRM. Higher RRs in the three identified sociodemographic factors were associated with higher stratified CTRM. The percentage of highly educated population was the most important determinant in the BI with pertussis surveillance. The findings may lead to spatially-specific criteria to inform development of an early warning system of pertussis infections using internet query data.

A cross sectional survey of attitudes, awareness and uptake of the parental pertussis booster vaccine as part of a cocooning strategy, Victoria, Australia.

BACKGROUND: The Victorian Government Department of Health funded a diphtheria, tetanus and acellular pertussis vaccine for parents of infants from June 2009 to June 2012 as part of a cocooning strategy for the control of pertussis. The aim of this study was to assess parents' attitudes and awareness of the vaccination program, and to estimate vaccine uptake. METHODS: A cross-sectional survey of 253 families with a child born in the first quarter of 2010 residing within five metropolitan and four rural local government areas in Victoria was conducted. Univariate analyses were performed to describe the relationship between demographic variables, knowledge and awareness of the disease, the vaccine program and vaccine uptake. Multivariate analyses examining predictors for awareness of the vaccine program and for the uptake of vaccination were also conducted. RESULTS: One hundred and five families were surveyed (response rate 43%). Of these, 93% indicated that they had heard of 'pertussis' or 'whooping cough' and 75% of mothers and 69% of fathers were aware the pertussis vaccine was available and funded for new parents. Overall, 70% of mothers and 53% of fathers were vaccinated following their child's birth, with metropolitan fathers less likely to be vaccinated as rural fathers (RR=0.6, p=0.002). Being a younger mother (p=0.02) or father (p=0.047), and being an Australian-born father (RR=1.9, p=0.03) were found to predict uptake of the vaccine in parents. CONCLUSION: Parents indicated a reasonable level of knowledge of pertussis and a willingness to be vaccinated to protect their child. However, vaccine uptake estimates indicated further opportunity for program improvement. Future cocooning strategies would benefit from specifically targeting fathers and metropolitan maternity hospitals to increase vaccine uptake. Wider promotion of the availability of vaccine providers may increase uptake to maximise the success of cocooning programs. Further investigation of the effectiveness of the cocooning strategy in decreasing infant morbidity and mortality is required.

Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children.

Public health analyses suggest that, in spite of the possibility that pertussis vaccine may cause rare cases of neurological injury, catastrophic risks to individual children are lower if they are vaccinated. A number of parents, however, choose not to vaccinate their children. The purpose of this study was to investigate the decision processes of some parents who choose to vaccinate and some parents who choose not to do so. Surveys were mailed to 500 randomly selected subscribers of Mothering magazine. Two hundred and ninety-four completed questionnaires were returned (59%). In addition to well-recognized factors in vaccination decisions, perceived dangers of the vaccine, and of the disease and susceptibility to the disease, several cognitive processes not previously considered in vaccination decision studies were found to be important predictors in this population of parents: perceived ability to control children's susceptibility to the disease and the outcome of the disease; ambiguity or doubts about the reliability of vaccine information; a preference for errors of omission over errors of commission; and recognition that if many other children are vaccinated, the risk to unvaccinated children may be lowered. Although perhaps most cases of undervaccination for pertussis reflect more general problems of health care access, some parents choose to forego vaccination for their children for other reasons. Traditional risk-benefit arguments alone will be unlikely to persuade these parents to reassess their decisions. Efforts to increase childhood vaccination must incorporate an understanding of the cognitive processes that help drive these decisions.

Impact of pertussis on the afflicted child and family.

The effects of pertussis in an unimmunized population were investigated in 61 children consecutively identified by positive culture for Bordetella pertussis. Parents were interviewed twice, at a mean of 3 and 11 weeks after onset of symptoms. All children had a disease duration of more than 3 weeks. Behavioral changes were reported for 84% of the study children. Parents reported negative effects for themselves in 95% and for siblings in 63% of the families. The main problems were disturbance of night sleep, staying home from work and isolation of the family. Parental knowledge of the disease was generally good; a majority had few contacts with the medical services and coped with the disease themselves. Serious concerns for the child were reported by 51% of parents and fears for permanent sequelae by 10%. The attitude to pertussis vaccination was positive in 89% of cases at both interviews. The study has thus shown that pertussis in an unimmunized child population represents a heavy burden.

Cough and fear of sleep: early clinical signs of Bordetella pertussis in an adult.

Pertussis is increasing in frequency among adults, but early diagnosis requires special attention to details in the medical history. We describe a 64 year-old male with classic signs and symptoms of pertussis and documented Bordetella pertussis infection that were overlooked because he presented with a chief complaint of cough and fear of falling asleep. Coughing paroxysms and a feeling of suffocation (30-60 seconds) only occurred at night after short periods of deep sleep (30-45 minutes). The physicians did not observe these episodes during daytime examinations, and the basis of the patient's fear of sleep was not explored. We recommend reassessment of how adults describe symptoms of pertussis, including fear of sleep, and we suggest the use of PCR technology to allow early diagnosis and prompt treatment.

Impact of whooping cough on patients and their families.

The effects of whooping cough were studied in 21 children admitted to hospital with the disease and in their families. The illness caused considerable distress to both child and family. Parents suffered especially from fears for the life and health of their child and from serious loss of sleep. Two months after admission the child's behaviour was still disturbed, but in most cases the rest of the family had returned to normal. There was much misunderstanding and misinformation about whooping cough among both parents and doctors.

An application of Orem's theory to the nursing management of pertussis.

In recent years, there has been a dramatic resurgence of Bordetella pertussis infection in the United States. This infection is affecting all age groups. A case study of one family's experience with pertussis is examined. This paper presents a review of the epidemiology, pathogenesis, clinical features, complications, diagnostic tests, vaccines, and treatment of pertussis. Dorothea Orem's Self-Care Deficit Theory of nursing is the theoretical concept used to characterize the school nurse's approach to the care of this family and school community in regard to pertussis and the vaccines.

Study of intellectual performance of children in ordinary schools after certain serious complications of whooping cough. Swansea Research Unit of the Royal College of General Practitioners.

In a case-control study 27 index children from ordinary schools who had had convulsions or apnoea as a complication of whooping cough about eight years previously were compared with 27 children who had never had whooping cough and 15 who had had whooping cough without complications. Other factors likely to cause intellectual impairment after conception were considered. The index group had a significantly lower median intelligence quotient and poorer school attainment than either of the control groups. The results support the hypothesis that convulsions or apnoea as a complication of whooping cough may be associated with subsequent intellectual impairment.