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1.
Intern Med ; 60(19): 3081-3086, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34602522

RESUMO

Objective This study aimed to elucidate the effects of early macrolide administration on genetically confirmed pertussis-induced cough in adolescents and adults. Methods This single-center, retrospective cohort study examined the effects of the early administration of macrolides and antitussive agents on cough secondary to pertussis. We divided the patients into two groups based on the median duration from the beginning of the cough to the initiation of macrolide administration: early macrolide administration group (EMAG) and non-early macrolide administration group (NEMAG). The clinical improvement of cough was defined as maintaining a cough awareness score of ≤3 points for 3 consecutive days. Patients The medical records of 40 patients diagnosed with pertussis (≥12 years old) who were able to maintain a cough diary and received no other antibiotics aside from macrolides were included in the study. A diagnosis of pertussis was made using the loop-mediated isothermal amplification (LAMP) test. Results The EMAG (24 patients) showed a significantly shorter total cough period than the NEMAG [16 patients; 20.0 (95% confidence interval (CI), 16-28) vs. 30.5 (95% CI, 27-40) days; log-rank test, p=0.002]. There was no significant difference in the post-administration cough periods between the EMAG and NEMAG [11.0 (95% CI, 7-19) vs. 13.0 (95% CI, 5-23) days; log-rank test, p=0.232]. Antitussive agents did not affect the cough. Conclusion The early administration of macrolides, but not antitussive agents, is effective for treating pertussis. Therefore, macrolides should be administered as soon as possible for this disease.


Assuntos
Coqueluche , Adolescente , Adulto , Antibacterianos/uso terapêutico , Bordetella pertussis , Criança , Tosse/tratamento farmacológico , Humanos , Macrolídeos , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , Estudos Retrospectivos , Coqueluche/tratamento farmacológico , Coqueluche/epidemiologia
2.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(5): 839-843, 2021 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-34622602

RESUMO

Objective: To compare the clinical manifestations of pertussis in children of different ages and different immunization statuses in Wenzhou, and to explore the limitations of diagnostic criteria for pertussis. Methods: The clinical data of 288 children diagnosed with pertussis at Yuying Children's Hospital & the Second Affiliated Hospital of Wenzhou Medical University from October 2017 to December 2019 were retrospectively analyzed. The clinical characteristics of children of different ages and different immunization statuses were analyzed. Their clinical data were compared to relevant diagnostic criteria of pertussis in children of different ages according to the Recommendations for Diagnosis and Treatment of Chinese Children with Pertussis and the diagnosis conformity rate was analyzed. Results: Among the 288 children, 124 cases (43.06%) were 3 months old or younger, and 164 cases (288, 56.94%) were >3 months old. Among patients≤3 months of age, cyanosis, three-depression sign, face redness, dyspnea and peripheral blood lymphocyte ratio were significantly higher than those of patients >3 months of age. They also had higher incidence of pneumonia, higher proportion of developing severe pertussis, and longer stay at the hospital. All these findings showed statistically significant difference ( P<0.05). 83 children were fully immunized (receiving the full course of vaccination), and 205 were not fully immunized (not receiving the full course of vaccination or being unvaccinated). The proportion of children presenting cyanosis, shortness of breath, three depression sign and face redness in the incomplete immunization group was higher than that in the complete immunization group. In the incomplete immunization group, the proportion of lymphocytes was higher, the level of C-reactive protein (CRP) was lower, and the length of hospitalization was longer than those of the complete immunization group. All the differences were statistically significant ( P<0.05). Among patients aged ≤3 months, the conformity rate of diagnosis (112/114, 90.32%) upon admission was higher than that among patients aged >3 months (119/164, 72.56%). Among patients aged ≤3 months, 41.94% (52/124, while 54.03% (67/124) of the patients aged ≤3 months had WBC count <20×10 9 L -1. Conclusion: Pertussis in children ≤3 months of age in Wenzhou City were more serious, showing higher rate of diagnosis conforming to the recommended clinical diagnostic criteria than that in children >3 months old. The WBC threshold in routine blood test of ≤3 months old could be lowered appropriately and the current diagnostic criteria still needed improvement.


Assuntos
Coqueluche , Criança , Pré-Escolar , Hospitalização , Humanos , Incidência , Lactente , Estudos Retrospectivos , Vacinação , Coqueluche/diagnóstico , Coqueluche/epidemiologia
3.
Euro Surveill ; 26(37)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34533118

RESUMO

BackgroundBordetella pertussis is the main agent of whooping cough. Vaccination with acellular pertussis vaccines has been largely implemented in high-income countries. These vaccines contain 1 to 5 antigens: pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN) and/or fimbrial proteins (FIM2 and FIM3). Monitoring the emergence of B. pertussis isolates that might partially escape vaccine-induced immunity is an essential component of public health strategies to control whooping cough.AimWe aimed to investigate temporal trends of fimbriae serotypes and vaccine antigen-expression in B. pertussis over a 23-year period in France (1996-2018).MethodsIsolates (n = 2,280) were collected through hospital surveillance, capturing one third of hospitalised paediatric pertussis cases. We assayed PT, FHA and PRN production by Western blot (n = 1,428) and fimbriae production by serotyping (n = 1,058). Molecular events underlying antigen deficiency were investigated by genomic sequencing.ResultsThe proportion of PRN-deficient B. pertussis isolates has increased steadily from 0% (0/38) in 2003 to 48.4% (31/64) in 2018 (chi-squared test for trend, p < 0.0001), whereas only 5 PT-, 5 FHA- and 9 FIM-deficient isolates were found. Impairment of PRN production was predominantly due to IS481 insertion within the prn gene or a 22 kb genomic inversion involving the prn promoter sequence, indicative of convergent evolution. FIM2-expressing isolates have emerged since 2011 at the expense of FIM3.ConclusionsB. pertussis is evolving through the rapid increase of PRN-deficient isolates and a recent shift from FIM3 to FIM2 expression. Excluding PRN, the loss of vaccine antigen expression by circulating B. pertussis isolates is epidemiologically insignificant.


Assuntos
Bordetella pertussis , Coqueluche , Proteínas da Membrana Bacteriana Externa/genética , Bordetella pertussis/genética , Criança , França/epidemiologia , Humanos , Toxina Pertussis , Vacina contra Coqueluche , Fatores de Virulência de Bordetella/genética , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
4.
Indian Pediatr ; 58(8): 709-717, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34465657

RESUMO

OBJECTIVE: To estimate the disease and economic burden of pertussis amongst hospitalised infants in India. DESIGN: Multicentric hospital-based surveillance study. PARTICIPANTS: Hospitalised infants with clinical suspicion of pertussis based on predefined criteria. OUTCOME MEASURES: Proportion of infants with laboratory-confirmed pertussis, economic burden of pertussis amongst hospitalised infants. RESULTS: 693 clinically suspected infants were recruited of which 32 (4.62%) infants had laboratory-confirmed pertussis. Progressive cough with post-tussive emesis (50%) and pneumonia (34%) were the common clinical presentations; apnea in young infants was significantly associated with pertussis. Infants with pertussis were more likely to be younger (median age 102.5 days vs.157 days) and born preterm (42.9% vs 24.5%). Almost 30% infants with pertussis had not received vaccine for pertussis with 50% of these infants aged less than 2 months. Pertussis was associated with higher costs of hospitalisation, pharmacy and loss of working days by caregivers as compared to non-pertussis cases. CONCLUSIONS: Younger infants, those born preterm and those inadequately immunised against pertussis are at higher risk of pertussis infection. Timely childhood immunisation and introduction of maternal immunisation for pertussis can help in reducing the disease burden.


Assuntos
Coqueluche , Idoso de 80 Anos ou mais , Criança , Hospitalização , Hospitais , Humanos , Lactente , Recém-Nascido , Vacina contra Coqueluche , Atenção Terciária à Saúde , Vacinação , Coqueluche/diagnóstico , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
5.
Wiad Lek ; 74(7): 1628-1633, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34459763

RESUMO

OBJECTIVE: The aim: To improve epidemiological monitoring of pertussis by analyzing the disease morbidity during 1995-2017 in Ukraine, to make a prognosis. PATIENTS AND METHODS: Materials and methods: Analysis of the pertussis morbidity during 1995-2017 using the data of the Ministry of Health of Ukraine. The cyclicity was determined by Fourier spectral analysis. The models of prognosis were constructed using polyharmonic regression and an exponential smoothing algorithm. Cartographic analysis and integrated indicators (multiyear index of the prevalence rate, mean square deviation, mean the multiyear pace of the gain in the prevalence rate) were used to determine the areas of risk. Summarized data were used to calculate the generalized coefficient. RESULTS: Results: The pertussis morbidity cycle has 5 years intervals in Ukraine. The prognosis is for increasing the pertussis morbidity from 4.91-5.54 to 5.48-7.06 per 100.000 people. The generalized coefficient was significantly higher in western part (83.3%) than in central (50.0%) and eastern (16.6%) parts. The study showed that population reproduction rates, natural population increase, and the proportion of people against vaccination were higher in the western part than in other parts of the country. CONCLUSION: Conclusions: The pertussis cyclicity depends on the internal mechanisms of interaction in the ecological system. There is a prognosis of worsening the epidemic situation of pertussis spreading. The risk area is the western part of Ukraine, which is characterized by active demographic processes and a greater number of people who are negative about vaccination.


Assuntos
Coqueluche , Humanos , Morbidade , Prevalência , Ucrânia/epidemiologia , Vacinação , Coqueluche/epidemiologia
6.
Euro Surveill ; 26(26)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34212843

RESUMO

On 1 May 2018, a pertussis outbreak was declared and widespread vaccination recommended at an all-female secondary boarding school in southern England. We conducted a retrospective cohort study to determine the extent of pertussis transmission and identify risk factors in this semi-closed population. Of 504 students and staff assessed before post-exposure vaccination, 48% (n = 240) had evidence of pertussis. A sub-analysis of 409 students found that both residential dormitory (p = 0.05) and school year (p = 0.03) were associated with pertussis, with odds decreasing by 11% for each increase in school year (95% confidence interval: 0.7-20.2). Odds of pertussis were 1.7 times higher in those assumed to have received acellular vaccines for their primary course compared with those assumed to have received whole-cell vaccines (based on date of birth), although this difference was not significant (p = 0.12). Our findings support the need for timely, widespread vaccination following identification of cases among adolescents in a semi-closed United Kingdom (UK) setting and to review the evidence for the introduction of an adolescent pertussis booster to the UK routine vaccination programme.


Assuntos
Coqueluche , Adolescente , Surtos de Doenças , Inglaterra/epidemiologia , Feminino , Humanos , Imunização Secundária , Vacina contra Coqueluche , Estudos Retrospectivos , Instituições Acadêmicas , Vacinação , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
7.
Turk J Pediatr ; 63(3): 355-362, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34254480

RESUMO

BACKGROUND: This study aimed to assess pertussis seroprevalence among healthcare workers (HCWs) of a university children`s hospital and to determine their opinions on whether to get the pertussis vaccine booster dose in adulthood. METHODS: This cross-sectional study was carried out between January 2018 and March 2019. Data recording forms were filled by the face to face interview method. Anti-pertussis toxin IgG (Anti-PT IgG) antibody levels were determined quantitatively from the serum samples using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Anti-PT IgG results were interpreted according to World Health Organization (WHO) recommendations. RESULTS: Of the 169 HCWs included in the study, 67 (39.6%) were seronegative and susceptible to pertussis. Seropositivity was significantly higher among HCWs who worked 40-80 hours per week. Thirty-six (21.3%) HCWs had high anti-PT IgG levels, indicating recent infection in the past few years. High-level positivity was significantly more common among HCWs using macrolide antibiotics due to prolonged cough. Anti-PT IgG levels of three (1.8%) were compatible with acute infection and they were not followed up with suspicion of whooping cough and were not isolated. While 125 (74.0%) of the participants said they could get the pertussis vaccine booster dose, only three (1.8%) had done so. CONCLUSIONS: The fact that 39.6% of HCWs were seronegative, emphasized the need for the pertussis booster dose. More than 20% of HCWs have had the acute infection without pertussis diagnosis in the past few years. Adult vaccination awareness in HCWs has not yet created a change in behavior. The high rate of seropositivity in macrolide users also shows that we cannot prevent its spread despite treatment. These findings highlight the fact that pertussis can occur in adult age groups and that eradication cannot be achieved without effective adult immunization and surveillance.


Assuntos
Coqueluche , Adulto , Anticorpos Antibacterianos , Bordetella pertussis , Criança , Estudos Transversais , Pessoal de Saúde , Hospitais Pediátricos , Humanos , Imunoglobulina G , Vacina contra Coqueluche , Estudos Soroepidemiológicos , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
8.
APMIS ; 129(9): 556-565, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34120372

RESUMO

The reported incidence of pertussis in European countries varies considerably. We aimed to study specific Bordetella pertussis seroprevalence in Europe by measuring serum IgG antibody levels to pertussis toxin (anti-PT IgG). Fourteen national laboratories participated in this study including Belgium, Denmark, Finland, Greece, Hungary, Italy, Lithuania, Malta, Norway, Poland, Portugal, Romania, Spain, and Sweden. Each country collected approximately 250 samples (N = 7903) from the age groups 20-29 years (N = 3976) and 30-39 years (N = 3927) during 2010-2013. Samples were anonymous residual sera from diagnostic laboratories and were analyzed at the national laboratories by a Swedish reference method, a commercial ELISA kit, or were sent to Sweden for analysis. The median anti-PT IgG concentrations ranged from 4 to 13.6 IU/mL. The proportion of samples with anti-PT IgG ≥100 IU/mL, indicating a recent infection ranged from 0.2% (Hungary) to 5.7% (Portugal). The highest proportion of sera with anti-PT IgG levels between 50 and <100 IU/mL, indicating an infection within the last few years, was found in Portugal (12.3%) and Italy (13.9%). This study shows that the circulation of B. pertussis is quite extensive in adults, aged 20-39 years, despite well-established vaccination programs in Europe.


Assuntos
Coqueluche/epidemiologia , Adulto , Anticorpos Antibacterianos/sangue , Bordetella pertussis/imunologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Imunoglobulina G/sangue , Incidência , Masculino , Estudos Soroepidemiológicos , Cobertura Vacinal/estatística & dados numéricos , Coqueluche/imunologia , Coqueluche/prevenção & controle , Adulto Jovem
9.
Vaccine ; 39(30): 4153-4159, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34119346

RESUMO

BACKGROUND: While pertussis is notifiable in most countries, notifications typically underestimate the true pertussis burden. We explored the incidence of pertussis in general practice in Australia. METHODS: Using MedicineInsight, a large longitudinal electronic medical record database of general practice (primary care) encounters which includes >1.5 million patients, we first defined a cohort of active patients and then used free-text search algorithms to identify patients with pertussis-related encounters. We defined and identified pertussis-related encounters in four patient categories: pertussis-associated (category 1), potential pertussis (category 2), epidemiologically-linked pertussis (category 3), and symptoms consistent with pertussis (category 4). Incident pertussis-related encounter rates per 100,000 active patients were calculated from Jan 2008 to Aug 2015. RESULTS: Estimated mean annual pertussis incidence increased as definitions were expanded, from 94.3 (category 1 patients only) to 148.8 (categories 1+2+3 patients combined) per 100,000 active patients per year. Monthly time-series corresponding to the first three categories were highly correlated (Pearson's r > 90% for each pair), but each was poorly correlated with category 4. For categories 1+2+3, the highest incidence was among 0-4 and 5-9 year olds. Incidence was 30% higher in females than males (i.e. 184.5 vs 139.8 per 100,00 active patients for categories 1-3 patients combined). Pertussis-associated incidence (category 1) was similar to national pertussis notification rates. Categories 2 and 3 added 25% and 33%, respectively, on average relative to category 1 incidence. The estimated incidence from categories 1+2+3 together were on average 64% higher than national pertussis notification rates. CONCLUSION: We provide comprehensive estimates of pertussis-related incidence in general practice (primary care), well in excess of notified pertussis incidence in Australia. This highlights the utility of MedicineInsight data in providing a greater understanding of the burden of medically-attended pertussis infections.


Assuntos
Medicina Geral , Coqueluche , Austrália/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Atenção Primária à Saúde , Coqueluche/epidemiologia
10.
Vaccine ; 39(32): 4500-4509, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34183204

RESUMO

INTRODUCTION: An unexpected resurgence of pertussis cases and infant deaths was observed in some countries that had switched to acellular pertussis vaccines in the primary immunisation schedule. In response to the outbreaks, maternal pertussis vaccination programmes in pregnant women have been adopted worldwide, including the USA in 2011 and the UK in 2012. Following the success of the programme in England, we evaluated the health and economic impact of stopping versus continuing the maternal pertussis immunisation to inform public health policy making. METHODS: We used a mathematical model to estimate the number of infant hospitalisations and deaths related to pertussis in England over 2019-2038. Losses in quality-adjusted life years, QALYs, were considered for infants (aged 0-2 months) who survived or died from pertussis, bereaved parents (of infants who died from pertussis), and women with pertussis (aged 20-44 years). Direct medical costs to the National Health Service included infant hospitalisations, maternal vaccinations, and disease in women. Costs and QALYs were discounted at 3.5%. Changes in the incremental cost-effectiveness ratio, ICER, were explored in sensitivity analyses. RESULTS: The model supports continuing the maternal pertussis immunisation programme as a cost-effective intervention at an ICER of £14,500/QALY (2.5% and 97.5%-quantile: £7,300/QALY to £32,400/QALY). Stopping versus continuing the maternal programme results in an estimated mean of 972 (range 582 to 1489) versus 308 (184 to 471) infant hospitalisations annually. Results were most sensitive to the number of hospitalisations and deaths when stopping the maternal programme. At a cost-effectiveness threshold of £30,000/QALY, the probability of the maternal programme being cost-effective was 96.2%. CONCLUSION: Our findings support continuing the maternal pertussis vaccination programme as otherwise higher levels of disease activity and infant mortality are expected to return. These results have led policy makers to decide to continue the maternal programme in the UK routine immunisation schedule.


Assuntos
Coqueluche , Análise Custo-Benefício , Inglaterra/epidemiologia , Feminino , Humanos , Programas de Imunização , Lactente , Gravidez , Anos de Vida Ajustados por Qualidade de Vida , Medicina Estatal , Vacinação , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
11.
Rev Chilena Infectol ; 38(2): 232-242, 2021 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34184715

RESUMO

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.


Assuntos
Bordetella pertussis , Coqueluche , Criança , Humanos , América Latina/epidemiologia , Vacina contra Coqueluche , Vacinação , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
12.
Artigo em Russo | MEDLINE | ID: mdl-34190491

RESUMO

The causes of epidemic outbreaks of pertussis infection in the Kyrgyz Republic were studied in order to optimize immunological surveillance of this infection. The object of the study was the epidemic process of whooping cough, and the subject of the study was the incidence of pertussis infection in 2009-2018 and official data on the outbreak of pertussis in 2018. To diagnose pertussis the bacteriological method was applied. The bacteriological inoculation of the samples was carried out in the laboratory of the Republican Clinical Infectious Diseases Hospital. The smear from posterior pharyngeal wall was collected from 2153 patients. The level of pertussis antibodies was determined by enzyme-linked immunosorbent assay (ELISA) using the RIDASCREEN Pertussis IgG test system (R-Biopharm, Germany) in various series. The study data testifies that despite the vaccine prevention and high inoculation coverage, the epidemic increases occurred in incidence of whooping cough in 2015 and 2018 with an intensive rate of 4.7 and 9.6 per hundred thousand of population, respectively. The evaluation of vaccination status of patients demonstrated that out of them 80.7% were non-immunized; the percentage of vaccinated patients made up to 13.1%. The analysis of the age structure testifies that the main group of the diseased consisted of children under one year of life (63.1%), the second group consisted of children aged 1-4 years (33.1%). The severe forms of infection were observed among children under one year of age (95.8%). According to the territorial distribution, the largest percentage of cases fall on Bishkek - 70% (426 cases) and Chuyskaya Oblast - 22.4% (137 cases). The sero-epidemiological study revealed high proportion of seronegative individuals in all studied groups, and the highest percentage was observed in the group of children 5-9 years old and adolescents of 15-19 years old - 62.8% and 62%, respectively.


Assuntos
Epidemias , Coqueluche , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Quirguistão/epidemiologia , Vacina contra Coqueluche , Vacinação , Coqueluche/diagnóstico , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adulto Jovem
13.
BMC Infect Dis ; 21(1): 586, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34144678

RESUMO

BACKGROUND: Pertussis remain a global health concern, especially in infants too young to initiate their vaccination. Effective vaccination and high coverage limit the circulation of the pathogen, yet duration of protection is limited and boosters are recommended during a lifetime. In Iran, boosters are given at 18 months and 6 years old using whole pertussis vaccines for which efficacy is not known, and pertussis surveillance is scant with only sporadic biological diagnosis. Burden of pertussis is not well understood and local data are needed. METHODS: Hospital-based prospective study implementing molecular laboratory testing in infants aged ≤6 months and presenting ≥5 days of cough associated to one pertussis-like symptom in Tehran. Household and non-household contact cases of positive infants were evaluated by comprehensive pertussis diagnosis (molecular testing and serology) regardless of clinical signs. Clinical evaluation and source of infection were described. RESULTS: A total of 247 infants and 130 contact cases were enrolled. Pertussis diagnosis result was obtained for 199 infants and 104 contact cases. Infant population was mostly < 3 months old (79.9%; 157/199) and unvaccinated (62.3%; 124/199), 20.1% (40/199) of them were confirmed having B. pertussis infection. Greater cough duration and lymphocyte counts were the only symptoms associated to positivity. Half of the contact cases (51.0%; 53/104) had a B. pertussis infection, median age was 31 years old. A proportion of 28.3% (15/53) positive contacts did not report any symptom. However, 67.9% (36/53) and 3.8% (2/53) of them reported cough at inclusion or during the study, including 20.8% (11/53) who started coughing ≥7 days before infant cough onset. Overall, only five samples were successfully cultured. CONCLUSION: These data evidenced the significant prevalence of pertussis infection among paucy or poorly symptomatic contacts of infants with pertussis infection. Widespread usage of molecular testing should be implemented to identify B. pertussis infections.


Assuntos
Coqueluche/epidemiologia , Adulto , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Técnicas de Diagnóstico Molecular , Estudos Prospectivos , Coqueluche/diagnóstico
15.
Nat Commun ; 12(1): 2871, 2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001895

RESUMO

Reported incidence of pertussis in the European Union (EU) and the European Economic Area (EEA) varies and may not reflect the real situation, while vaccine-induced protection against diphtheria and tetanus seems sufficient. We aimed to determine the seroprevalence of DTP antibodies in EU/EEA countries within the age groups of 40-49 and 50-59 years. Eighteen countries collected around 500 samples between 2015 and 2018 (N = 10,302) which were analysed for IgG-DTP specific antibodies. The proportion of sera with pertussis toxin antibody levels ≥100 IU/mL, indicative of recent exposure to pertussis was comparable for 13/18 countries, ranging between 2.7-5.8%. For diphtheria the proportion of sera lacking the protective level (<0.1 IU/mL) varied between 22.8-82.0%. For tetanus the protection was sufficient. Here, we report that the seroprevalence of pertussis in these age groups indicates circulation of B. pertussis across EU/EEA while the lack of vaccine-induced seroprotection against diphtheria is of concern and deserves further attention.


Assuntos
Difteria/epidemiologia , Tétano/epidemiologia , Coqueluche/epidemiologia , Adulto , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Bordetella pertussis/efeitos dos fármacos , Bordetella pertussis/imunologia , Bordetella pertussis/fisiologia , Difteria/imunologia , Difteria/prevenção & controle , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Vacina contra Difteria, Tétano e Coqueluche/imunologia , Europa (Continente)/epidemiologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Tétano/imunologia , Tétano/prevenção & controle , Coqueluche/imunologia , Coqueluche/prevenção & controle
16.
Pediatr Crit Care Med ; 22(9): e471-e479, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33813551

RESUMO

OBJECTIVES: Pertussis is an infectious disease that causes epidemics and outbreaks and is associated with a high mortality rate, especially in infants, in both developed and developing countries. We aimed to characterize infants with pertussis with respiratory failure and shock and investigated the factors related to mortality. DESIGN: A retrospective, observational study conducted between January 2015 and October 2020. SETTING: This study was conducted at the Vietnam National Children's Hospital, which is a government hospital that serves as a tertiary care center in Hanoi, Vietnam. PATIENTS: Children who fulfilled the following inclusion criteria were included: 1) admitted to the PICU, 2) less than 16 years old, 3) pertussis confirmed by real-time polymerase chain reaction, and 4) treated with mechanical ventilation due to respiratory failure and shock. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Seventy-three mechanically ventilated children (40 boys; median age, 56 d), whereas 19 patients received extracorporeal membrane oxygenation support. Twenty-six patients (36%) died including 12 who received extracorporeal membrane oxygenation. Those who received extracorporeal membrane oxygenation support had higher leukocyte counts upon admission and were more frequently diagnosed with pulmonary hypertension and stage 3 acute kidney injury. Compared with survivors, nonsurvivors showed increased heart rates, leukocyte and neutrophil counts, and lower systolic and diastolic blood pressure at admission. Increased Vasoactive-Inotropic Score, stage 3 acute kidney injury, fluid overload, the use of renal replacement therapy, and extracorporeal membrane oxygenation use were prevalent among nonsurvivors. CONCLUSIONS: In this study, around one third of mechanically ventilated patients with pertussis died. Those who received extracorporeal membrane oxygenation had higher leukocyte counts, a higher prevalence of pulmonary hypertension, and advanced stages of acute kidney injury. Higher Vasoactive-Inotropic Score and advanced stages of acute kidney injury were associated with a greater risk of mortality.


Assuntos
Oxigenação por Membrana Extracorpórea , Coqueluche , Adolescente , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Estudos Retrospectivos , Vietnã/epidemiologia , Coqueluche/complicações , Coqueluche/epidemiologia , Coqueluche/terapia
17.
CMAJ Open ; 9(2): E349, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33849984

RESUMO

BACKGROUND: In February 2018, Canada's National Advisory Committee on Immunization recommended maternal vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy to prevent severe pertussis infection in young infants. This study assessed the relation between maternal Tdap vaccination and obstetric and perinatal outcomes in Ontario. METHODS: We performed a population-based cohort study of all births from April 2012 to March 2017 using multiple linked health administrative databases. We used Cox regression with a time-dependent exposure variable to estimate adjusted hazard ratios (HRs) for preterm birth (< 37 wk), very preterm birth (< 32 wk) and stillbirth. We assessed remaining outcomes (gestational hypertension, chorioamnionitis, postpartum hemorrhage, severe postpartum hemorrhage, being small for gestational age, neonatal intensive care unit stay > 24 h, composite neonatal morbidity) using log-binomial regression to generate adjusted risk ratios (RRs). We adjusted estimates for potential confounding using propensity score weighting. RESULTS: Of 615 213 infants (live births and stillbirths), 11 519 were exposed to Tdap vaccination in utero. There was no increased risk for preterm birth (adjusted HR 0.98, 95% confidence interval [CI] 0.91-1.06), very preterm birth (adjusted HR 1.10, 95% CI 0.86-1.41), stillbirth (adjusted HR 1.15, 95% CI 0.82-1.60) or being small for gestational age (adjusted RR 0.96, 95% CI 0.90-1.02). The risks of a neonatal intensive care unit stay exceeding 24 hours (adjusted RR 0.82, 95% CI 0.76-0.88) and neonatal morbidity (adjusted RR 0.81, 95% CI 0.75-0.87) were decreased. There was no association with chorioamnionitis (adjusted RR 1.17, 95% CI 0.99-1.39), postpartum hemorrhage (adjusted RR 1.01, 95% CI 0.91-1.13) or severe postpartum hemorrhage (adjusted RR 0.79, 95% CI 0.55-1.13), but we observed a reduced risk of gestational hypertension (adjusted RR 0.87, 95% CI 0.78-0.96). INTERPRETATION: Our results complement evidence that maternal Tdap vaccination is not associated with adverse outcomes in mothers or infants. Ongoing evaluation in Canada is needed as maternal Tdap vaccination coverage increases in coming years.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/uso terapêutico , Doenças do Recém-Nascido , Serviços de Saúde Materna , Resultado da Gravidez/epidemiologia , Vacinação , Coqueluche , Canadá/epidemiologia , Corioamnionite/epidemiologia , Corioamnionite/etiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Recém-Nascido Pequeno para a Idade Gestacional , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Natimorto/epidemiologia , Vacinação/métodos , Vacinação/estatística & dados numéricos , Cobertura Vacinal/tendências , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
18.
Vaccine ; 39(18): 2555-2560, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33814232

RESUMO

INTRODUCTION: In 2014, there was an epidemic of pertussis in Brazil that caused the death of 129 infants. To control the disease amongst infants under 6 months of age, and especially those under 2 months, the Brazilian Ministry of Health introduced Tdap immunization for all pregnant women. METHODS: This study aimed to describe the morbidity and mortality variables of pertussis cases in 969 infants aged under 6 months, comparing the periods before and after the introduction of Tdap vaccine in pregnant women. Data was extracted from the Information System on Notifiable Diseases (SINAN) including every case of pertussis that occurred in the metropolitan region of Recife-Brazil in infants under 6 months from January 2009 to October 2018. In order to analyze the variables, patients were divided into two groups Pre-Tdap(2009-2014), and Post-Tdap (2016-2018). RESULTS: There were no significant differences between the age groups and gender distribution in the period compared. In the Post- Tdap group compared with the Pre-Tdap group, the clinical presentation of pertussis in infants differed with more paroxysmal cough, and more vomiting, less apnea, and cyanosis. During this period, there were fewer complications and no deaths occurred. CONCLUSIONS: Maternal immunization with Tdap decreased disease severity, complication rates, and no deaths occurred in infants under 6 months of age diagnosed with pertussis.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Coqueluche , Idoso , Brasil , Feminino , Humanos , Imunização , Lactente , Gravidez , Gestantes , Vacinação , Coqueluche/epidemiologia , Coqueluche/prevenção & controle
19.
Vaccine ; 39(20): 2772-2779, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33875270

RESUMO

BACKGROUND: Pertussis remains poorly controlled relative to other diseases targeted by childhood vaccination programs. We combined estimates from four population-based studies of pertussis vaccine effectiveness (VE) in three Canadian provinces using a meta-analytic approach to improve precision and explore regional variation in VE and durability of protection. METHODS: Studies were conducted in Alberta, Manitoba, and Ontario over periods ranging from 1996 to 2015. Adjusted log odds ratios (OR; VE = 100*[1-OR]) of the effect of vaccination on pertussis risk were estimated by time since last vaccination in each study and pooled using DerSimonian and Laird random-effects models. We used the I2 statistic to estimate between-study heterogeneity and assessed methodological and clinical heterogeneity through subgroup analyses of study design and age. RESULTS: Data on 3,270 pertussis cases and 23,863 controls were available. Pertussis VE declined from 86% (95% CI 79%-90%, I2 = 81.5%) at < 1 year since last vaccination to 51% (11%-74%, I2 = 80.9%) by ≥ 8 years. Effect estimates were the most heterogeneous in the least and most elapsed time periods since last vaccine dose. This was attributable mostly to variation between provinces in the distribution of age groups and number of vaccine doses received within time periods, as well as study design and small numbers in the most elapsed time period. INTERPRETATION: Consistent trends of decreasing pertussis VE with increasing time since last vaccination across three Canadian provinces indicate the need for immunization schedules and vaccine development to optimize protection for all individuals, especially for adolescents and young adults at greatest risk of infection.


Assuntos
Vacina contra Coqueluche , Coqueluche , Adolescente , Alberta , Humanos , Manitoba/epidemiologia , Ontário , Vacinação , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adulto Jovem
20.
Int J Infect Dis ; 106: 421-428, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33794378

RESUMO

BACKGROUND: Pertussis is an acute respiratory tract disease caused by Bordetella pertussis. In 2014, 24.1 million pertussis cases, resulting in 160,700 deaths, were estimated to have occurred worldwide. This study aimed to determine the epidemiology of pertussis among patients with clinically compatible illness who visited selected hospitals in the Amhara Regional State of Ethiopia. METHODS: A cross-sectional study design was used to review pertussis patients with clinically compatible illness. Nasopharyngeal swabs were collected from 515 patients from July 2018 through February 2019. DNA was extracted from all nasopharyngeal swabs and samples were analyzed using real-time (RT-) PCR. Crude and adjusted odds ratios with corresponding 95% confidence intervals were estimated using bivariable and multivariable logistic regression analysis, respectively. RESULTS: The overall prevalence of Bordetella species among the study participants was 156 of 515 (30.3%) [95% CI = 26.4-34.6] as determined by Bordetella RT-PCR, including: 65 (41.7%) B. pertussis, 89 (57.1%) indeterminate B. pertussis, one (0.6%) Bordetella holmesii and one (0.6%) Bordetella parapertussis. CONCLUSIONS: This study found that pertussis is potentially endemic and a common health problem among patients visiting health institutions in the Amhara Regional State of Ethiopia. More data regarding pertussis in Ethiopia could inform development of effective prevention strategies.


Assuntos
Coqueluche/epidemiologia , Adulto , Bordetella pertussis , Estudos Transversais , Testes Diagnósticos de Rotina , Etiópia/epidemiologia , Humanos , Masculino , Prevalência , Reação em Cadeia da Polimerase em Tempo Real/métodos
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