Pertussis in Latin America: Recent epidemiological data presented at the 2017 Global Pertussis Initiative meeting

The Global Pertussis Initiative (GPI) is an expert scientific forum that publishes consensus recommendations for pertussis monitoring, prevention, and treatment across many regions of the world. Here, we report on the regional 2017 GPI meeting on the Americas, focusing on Latin America. Information on current pertussis epidemiology, surveillance, vaccine strategies, diagnostic capabilities, disease awareness, and major local obstacles was presented by researchers from Argentina, Brazil, Colombia, Costa Rica, El Salvador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela. Pertussis outbreaks have occurred during the last decade in the majority of participant countries and have been followed by improvements in surveillance. In the countries that introduced maternal immunization during pregnancy, a reduction in the infant case fatality rate has been detected. All countries need to maintain and improve pertussis surveillance to reach primary vaccination coverage >90%. Moreover, countries without maternal immunization programs should strongly consider them.     

Pertussis in Asia: Recent country-specific data and recommendations

The Global Pertussis Initiative (GPI) Roundtable Meeting held in 2019, which preceded the COVID-19 pandemic, focused on the incidence, surveillance, and immunization practices for pertussis in the Asian region. Participants from China, India, Indonesia, Malaysia, Pakistan, Philippines, South Korea, Taiwan, and Thailand presented country-specific information on pertussis prevalence, diagnosis, surveillance, vaccine administration and schedules, maternal and neonatal disease rates, and policies and practice of vaccination during pregnancy. In recent years, many Asian countries have seen an increase in pertussis cases, although underreporting of the disease is a concern. Currently, most Asian countries have only passive surveillance for pertussis in place. There is a need for improved surveillance to determine the disease burden and justify vaccination policies and recommendations, such as essential vaccination, boosters, and vaccination during pregnancy. Better awareness of the disease in adolescents and adults is necessary, and infant and childhood vaccination schedules need to be improved in many countries. Differences between private versus public sector vaccination schedules and between whole-cell and acellular pertussis vaccines should continue to be examined. It can be anticipated that unmet needs in the prevention and management of pertussis will continue as the COVID-19 pandemic evolves and that key recommendations highlighted in this meeting report will be of ongoing importance.     

榆林市百日咳流行病学分析及危险因素研究

目的研究百日咳在高发地区的影响因素,为采取有效的控制措施提供依据。方法通过描述流行病学方法对百日咳流行病学特征和疫苗接种情况进行分析,通过病例对照研究对有关的危险因素进行统计学检验。结果所调查地区的百日咳发病水平显著高于陕西省全省平均水平,周期性流行特征明显。病例集中在小年龄儿童,≤1岁发病率最高,≤9岁的病例占95%。不同年份出生儿童的累计发病率与疫苗接种率呈负相关(r=-0.54,P<0.05)。通过多渠道信息推算,当地近年出生儿童百白破联合疫苗(DPT)接种率<80%,且接种及时性较差。接触传播是重要的危险因素(χ2=8.22,P=0.016),针对病例和疫区未能采取有针对性的控制措施。结论接种率低是造成百日咳局部高发的主要因素,对疫区缺乏规范的处理措施是重要的因素,建议提高DPT覆盖率,制定相应技术规范和建立以实验室为基础的监测系统。     

The Global Pertussis Initiative: report from a round table meeting to discuss the epidemiology and detection of pertussis, Paris, France, 11-12 January 2010

Pertussis remains endemic worldwide and is an important public health problem, even in countries with sustained high vaccination coverage. Resurgence of pertussis in the post-vaccination era has been reported in many areas of the world. The Global Pertussis Initiative (GPI) was established in 2001 to evaluate the ongoing problem of pertussis worldwide and to recommend appropriate pertussis control strategies. In addition to primary vaccinations, the GPI currently recommends a pertussis booster vaccination to pre-school children, adolescents and those adults at risk of transmitting Bordetella pertussis infection to infants. At a meeting in Paris, France, in January 2010, GPI members discussed pertussis surveillance and testing then prepared recommendations on the implementation and utilisation of these activities. Issues and projects discussed included: national surveillance systems and their suitability for other countries; seroprevalence studies; ideal surveillance methodologies; ongoing efforts in obtaining biological samples; standardisation of sample treatment; culture; real-time polymerase chain reaction (PCR); and likely future advances such as antibody detection in saliva. Previous regional meetings of the GPI have confirmed that many countries have limited laboratory facilities for the detection of pertussis. The GPI hopes that the future introduction of increased laboratory capabilities and greater harmonisation of clinical definitions and detection methods will lead to enhanced surveillance and a better estimate of the burden of pertussis infection worldwide. This article provides a current guide on the appropriate use of laboratory diagnostics and optimal surveillance methodologies to assist countries in the control of pertussis disease.     

Pertussis vaccine for adults: Knowledge,attitudes, and vaccine receipt among adults with children in the household

BackgroundPertussis is a highly contagious vaccine preventable disease resulting in significant infant morbidity and mortality. Despite the recommendations for pertussis vaccine (Tdap) in adults, coverage rates in this age group remain suboptimal. We sought to determine factors associated with Tdap receipt among adults with children in the household who live in central New York.MethodsThe study team surveyed Tdap immunization status of adults who accessed medical services for their children provided by Golisano Children's Hospital, Syracuse, New York. Adults who did not know their Tdap vaccine status were excluded. Each participant was asked a standard set of questions to determine factors associated with Tdap receipt. Logistic regression was used to calculate simple and adjusted odds ratios for Tdap receipt in relation to adults’ demographic characteristics, knowledge of Tdap and physician recommendations.ResultsEight hundred twenty four participants were included in this study; 34% had received Tdap in the past 5 years; 58% reported that their provider or child's pediatrician recommended adult Tdap vaccination. Tdap receipt was associated with knowing the symptoms of pertussis infection, female gender, younger age, and provider recommendation (p < 0.05). Participants whose provider recommended Tdap vaccine were 24.6 times more likely to receive vaccine when compared to those whose providers did not recommend vaccine (95% CI: 16.3, 37.2, p < 0.05).ConclusionTdap coverage rates are low among this study population, with provider recommendation most strongly associated with Tdap receipt. Future steps to improve vaccine coverage should include both increasing community awareness and determining barriers to provider recommendation.     

城市中老年居民血脂异常影响因素研究

目的探讨城市社区中老年居民血脂异常状况。方法采用现况研究,用分层抽样的方法抽取年龄在35~74岁的居民进行调查。结果男性高甘油三酯(TG)、高总胆固醇(CHO)和低高密度脂蛋白胆固醇(HDL-c)检出率分别为44.87%、13.39%和28.13%,女性高TG、高CHO和低HDL-c检出率分别为36.94%、13.91%和30.15%,男性高TG检出率显著高于女性。男性高TG,女性高TG、高CHO的检出率随年龄增加而增加,女性低HDL-c出现明显的低龄化趋势。体重、腰围(WC)、臀围(HC)、体质指数(BMI)、文化程度和经常饮用绿茶是男性高TG的危险因素;年龄是高CHO的危险因素,体力强度是其保护因素;经常食用豆类是低HDL-c的危险因素,年龄、文化程度和经常饮用牛奶是其保护因素。年龄、体重、收缩压(SBP)、舒张压(DBP)、WC、HC、BMI、吸烟是女性高TG的危险因素,体力强度是其保护因素;年龄、SBP、DBP、HC、BMI、经常食用坚果类是高CHO的危险因素,文化程度、体力强度是其保护因素;年龄、SBP、DBP、WC、BMI、经常饮用牛奶、绿茶和经常食用坚果类是低HDL-c的保护因素。结论玉林市社区中老年居民血脂异常状况严重,血脂异常应综合控制。     

母婴依恋的代际传递性和跨时间的稳定性

目的 探讨母婴依恋的代际传递性和从婴儿期到幼儿期跨时间的一致性和稳定性。 方法 对160对已经采用“陌生情境法”进行了母-婴依恋类型测评的健康母婴对,在儿童的幼儿期:1)采用成人依恋访谈问卷(Adult Attachment Interview Questionnaire,AAIQ)测查母亲自身幼年时期的依恋模式;2)采用儿童行为Q分类法(Waters & Deane's Attachment Q-set,AQS)测评幼儿与其母亲之间的依恋关系。 结果 最终完成随访的母婴对有118对,随访率为73.8%。母亲与婴儿两者依恋类型之间一一对应的总对应率为:63.6%,其中安全型母亲与其婴儿的安全性之间的对应性最高,为86.2%;幼儿期安全型依恋占64.4%,不安全型依恋占35.6%,与婴儿期依恋安全性的分布基本一致。其中,安全型的婴儿中有89.7%在幼儿期仍为安全型;而不安全型的婴儿中有85.0%在幼儿期仍为不安全型,差异无统计学意义(χ²=0.569,P>0.05)。 结论 母婴依恋存在代际传递性,母亲自身的依恋模式是影响母婴依恋关系的重要因素之一。儿童依恋存在跨时间跨情境的一致性和稳定性,婴儿依恋类型对幼儿期的依恋安全性有较高的预测效度。     

Pertussis vaccination during pregnancy in Belgium: Follow-up of infants until 1 month after the fourth infant pertussis vaccination at 15 months of age

Vaccination of pregnant women with a pertussis containing vaccine is a recommended strategy in some industrialized countries, to protect young infants from severe disease. One of the effects of the presence of high titers of passively acquired maternal antibodies in young infants is blunting of immune responses to infant vaccination. We present infant immune responses to a fourth pertussis containing vaccine dose at 15 months of age, as a follow-up of previously presented data.In a prospective cohort study, women were either vaccinated with an acellular pertussis vaccine (Boostrix^®) during pregnancy (vaccine group) or received no vaccine (control group).All infants were vaccinated with Infanrix Hexa^® according to the standard Belgian vaccination schedule (8/12/16 weeks, 15 months). We report results from blood samples collected before and 1 month after the fourth vaccine dose. Immunoglobulin G (IgG) antibodies against pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin (Prn), tetanus toxoid (TT) and diphtheria toxoid (DT) were measured using commercially available ELISA tests. Antibody levels were expressed in International Units per milliliter.Demographic characteristics were similar in the vaccine and control group. Before the fourth vaccine dose, significantly lower antibody titers were measured in the vaccine group compared to the control group for anti-Prn IgG (p = 0.003) and anti-DT IgG (p = 0.023), with a steep decay of antibody titers since post-primary vaccination. One month after the fourth dose, antibody titers were only significantly lower in the vaccine group for anti-PT IgG (p = 0.006). For all antigens, there was a rise in antibody titer after the fourth vaccine dose.The present results indicate still a minor blunting effect 1 month after a fourth vaccine dose for anti-PT antibodies. However, a good humoral immune response on all measured antigens was elicited in both groups of children. The clinical significance of such blunting effect is yet unknown.Clinicaltrials.gov identifier: NCT01698346.     

Pertussis vaccination in infancy lowers the incidence of pertussis disease and the rate of hospitalisation after one and two doses: analyses of 10 years of pertussis surveillance

Objectives

Shortly after pertussis vaccination was reintroduced in Sweden in 1996, an intensified pertussis disease surveillance programme was set up. In this study, we report on in-depth analyses of age–dose–number-specific incidences and the rate of pertussis hospitalisation for children with no, 1 or 2 doses of an acellular pertussis vaccine before pertussis disease. Vaccine coverage, the timeliness of childhood vaccination and the effect of later than scheduled pertussis vaccination(s) are also examined.

Study design

Children with notified laboratory-confirmed (culture or PCR) pertussis disease were evaluated among the surveillance population of about 1 million infants, born between 1996 and 2007 and followed for pertussis disease from October 1997 to December 2007, for nearly 6 million person-years. Birth and vaccination dates of the diseased children are known from the surveillance programme. To estimate denominators of the age–dose–number-specific pertussis incidences, we used birth and vaccination dates from a vaccine trial with more than 72,000 infants combined with national pertussis vaccine coverage data for children in the surveillance population.

Results

For infants from 3 to <5 months of age, the incidence of pertussis disease with at least 14 days of cough decreased from 264/100,000 for unvaccinated infants to 155/100,000 for infants with one dose of a pertussis vaccine prior to onset of the disease. In the age range 5 to <12 months, the age–dose specific incidences were 526, 95, and 24/100,000 for infants with no, 1 and 2 doses, respectively. The rate of hospitalisation for infants with 1 dose of a pertussis vaccine prior to onset of the disease was significantly lower than for unvaccinated infants of the same age.For many infants, there is a delay in administration of the vaccine doses according to the regular 3–5–12 month schedule (which has been the case for many years). Hypothetically, if all infants had been vaccinated exactly on schedule, we would expect about 28% fewer pertussis cases with at least 14 days of cough and 38% fewer hospitalisations due to pertussis, of cases possible to influence by vaccinations on schedule.

Conclusion

Pertussis vaccination had a significant effect among infants already after the first dose. This is particularly important for premature infants and infants with severe respiratory and cardiac diseases. A moderate decrease in the incidence of pertussis disease in infants and rate of hospitalisation could be expected if primary vaccinations were carried out closer to the scheduled time than is currently the practice in Sweden.     

广东省1951～1996年百日咳流行动态及免疫效果分析

广东省１９５１～１９９６年百日咳经历了８次大小流行，１９６１年报告发病率达２５４３５／１０万，１９８７年实施计划免疫后，发病率明显下降，１９９１年达历史最低水平，但仍未控制百日咳的流行，主要原因是接种疫苗后群体保护率还不够高。１９９０年使用含百日咳菌４５亿／ｍｌ百日破混合制剂（ＤＰＴ），对２０６人检测抗体水平，保护率为３４４７％；１９９４～１９９５年使用含百白咳菌９０亿／ｍｌＤＰＴ后，１９９５年对０～６０岁各地人群检测抗体，保护率为５４７８％。１９９６年广州市试用无细胞吸附精制百白破制剂（ＡＰＤＴ），免疫成功率与ＤＰＴ基本一致，但抗体阳性率高。结果证明：百日咳发病与免疫接种和接种的疫苗含量有很大关系，应加强免疫接种工作和疾病监测，减少疾病的发生。     

Effectiveness of acellular pertussis vaccine and evolution of pertussis incidence in the community of Madrid from 1998 to 2015

IntroductionPertussis is a communicable disease that primarily affects infants. Vaccination has led to an important reduction in the incidence of the disease, however, resurgence of the disease has been observed. This study aimed to analyze the incidence of pertussis and assess the vaccination effectiveness (VE) of different schedules of acellular pertussis vaccination in the community of Madrid.MethodsPertussis cases notified to the Mandatory Disease Reporting System from 1998 to 2015 were analyzed. Five comparison periods were created: 1998–2001 (reference), 2002–2005, 2006–2009, 2010–2012 and 2013–2015. The incidence ratio (IR) between inter-epidemic periods was analyzed using a Poisson regression. VE was calculated using the screening method. Vaccine status data were collected from the vaccine registry.ResultsIn total, 3855 cases were notified. Inter-epidemic periods were observed every 3–4 years. The incidence increased (IR: 5.99, p < 0.05) in the 2013–2015 period, particularly among infants younger than 1 month (IR: 32.41, p < 0.05). Vaccination data were available in 89% of cases. For those receiving the last dose at ≤6-month VE was 89.9% (95% confidence interval (CI): 87.3–92.0) after one year of follow-up, and 85.5% (95% CI: 82.4–88.1) after 11 years of follow-up. For those receiving the last dose at 18-months VE decreased from 98.8% (95% CI: 98.3–99.1) to 85.1% (95% CI: 81.9–87.7) in the same period, and for those receiving the last dose at 4-year VE decreased from 99.6% (95% CI: 99.3–99.7) to 79.3% (95% CI: 74.6–83.1).ConclusionsB. pertussis is circulating in our population, as shown by the epidemic peaks and increased incidence of pertussis in recent years. VE increased with the number of doses and decreased with the follow-up period. The effect of this and other vaccination strategies must be monitored to control the disease.     

自制中医穴位敷贴治疗儿童百日咳的临床效果评价

目的 探讨自制中医穴位敷贴治疗儿童百日咳的临床效果.方法 选取0019年1月至0000年6月我院收治的百日咳患儿84例,随机分为两组各40例.对照组给予乳糖红霉素治疗,观察组给予乳糖红霉素+自制中医穴位敷贴治疗.比较两组的临床疗效、血清学指标及不良反应.结果 观察组的总有效率高于对照组,治疗后WBC、CRP低于对照组,...     

Pertussis before and after the introduction of acellular pertussis vaccines in Finland

In Finland, the whole-cell pertussis vaccine was replaced with acellular pertussis vaccine in the national immunisation schedule in 2005. Adolescent booster vaccinations were also included in the programme. The aim of this study was to evaluate the effects of these changes on the epidemiology and strain characteristics of Bordetella pertussis. From the national register, we first analysed all the laboratory diagnosed cases during the study years in 1999–2006. The major pool of the 6876 cases was among adolescents and adults. After the change of the programme and the introduction of the adolescent boosters, a general reduction of the incidence was noticed but this might be related to the natural epidemic cycles of pertussis. Secondly, a questionnaire was sent to the families of the 517 young children (<2 years of age) with registered, laboratory confirmed pertussis diagnosed during the study years. Of these, 319 (62%) participated the study. Forty-five percents of the cases in this cohort were younger than 3 months, the age of the first pertussis immunisation in schedule. Only 4% of the children in vaccination age were totally unimmunised. Thirdly, isolates of B. pertussis were analysed and found to differ from the used whole-cell pertussis vaccine strains by their prn, ptxA and PFGE profiles. However, no significant differences were found between the strains from patients with different immunisation status or age. Despite marked changes in the virulence genes and the genomes of the circulating B. pertussis strains have occurred, the epidemiological data from the national reporting system indicates that the whole-cell and acellular vaccines still protect against pertussis, but the results stress the importance of early primary immunisations and the need for booster immunisations.     

徐州市人偏肺病毒感染临床症状与流行病学研究

目前我国对儿童以外人群感染人偏肺病毒（hMPV）少见报道，其感染的临床症状、流行病学特征等均未完全阐明。本研究试图厂解徐州市因急性呼吸道感染而就诊的一般人群中的hMPV感染情况，初步描述其引起的临床症状及流行病学特征。     

Making a difference: the construction of ethnicity in HIV and STI epidemiological research by the Dutch National Institute for Public Health and the Environment

Biomedical and public health researchers and practitioners routinely record and comment on ethnicity: however, the use of this category is often vague and without explicit statement on what ethnicity is or how it correlates to health disparities. Presented here is an inquiry into the case of ethnicity in HIV/STI research in the Netherlands. This paper considers the construction and operationalization of the concept ethnicity in HIV/STI epidemiological research in the Netherlands. The concept ethnicity is followed as it is defined, measured, categorized, communicated and constructed in the annual national HIV/STI surveillance report of the Dutch National Institute for Public Health and the Environment (RIVM) and as this construction co-evolves in society through the Dutch media, politics and prevention practice. The epidemiological work of the RIVM on HIV/STI in The Netherlands has resulted in the materialization of a distinct ethnic construction, the high risk sexual ethnic other, presumed, not only to be at heightened risk for HIV, but also to spread HIV in the Netherlands through promiscuity and absent safe sex practices. This construct is shown to be perpetually self-validating as it informs methodological choices, such that, behavioural studies almost always establish ethnic behavioural differences. The construct and related ethnic rhetoric also allow for the extrapolation of "findings" within a specific ethnic group regarding a specific STI to all groups considered ethnic minorities and so a categorical ethnic minority problem group is constructed within Dutch society. This imagery is disseminated through newspaper articles and dialogue in the Dutch House of Representative and HIV/STI prevention practice, through which the construct is reaffirmed and ascribed scientific and social validity. Knowledge of ethnic minorities' high-risk status and their sexual practices that lead to this become common, and so the construct is further operationalized in government budget planning and subsequent research programmes.     

0～15岁健康人群及产妇血清百日咳抗体水平的检测

为了解 0～ 15岁健康人群及产妇血清特异性百日咳IgG抗体水平 ,随机选取山西省太原市 45 8人作为检测对象 ,根据年龄分为 9个组 :脐血组 (5 8例 )、0～ 5月龄 (33例 )、6～ 11月龄 (6 2例 )、1～ 2岁 (5 0例 )、3～ 5岁 (5 0例 )、6～ 8岁 (5 0例 )、9～ 12岁 (4 9例 )、13～ 15岁 (4 8例 )、产妇 (5 8例 )。其中有 5 4例为配对脐血组及产妇组。取血清应用酶联免疫吸附试验 (ELISA)测定百日咳特异性IgG抗体。结果表明 ,百日咳IgG抗体水平 1～ 2岁最高 ,13～ 15岁最低 ,0～ 5月龄处于较低水平。配对脐血组及产妇组的百日咳IgG抗体水平具有良好的相关性 (r =0 741,P <0 0 1)。百日咳抗体水平在 13～ 15岁最低 ,<6月龄次之 ,1～ 2岁最高。为根除婴儿百日咳的主要传染源 ,对年长儿及成人进行百日咳加强免疫是必要的。     

1956～2012年临沂市人群百日咳抗体水平及流行动态分析

目的了解临沂市人群百日咳抗体水平及流行特征,为预测疫情趋势和制定免疫策略提供依据。方法对临沂市1956～2012年不同免疫阶段百日咳发病资料进行描述性分析;在不同年份随机抽取健康人群,分0～、2～、5～、8～、11～、15～、20～40岁7个年龄组进行百日咳抗体检测。结果 1956～2012年临沂市共报告百日咳578 487例,死亡426例。大致分为4个阶段：1956～1960年年均发病率为86.60/10万,死亡127例;1961～1981年年均发病率为283.82/10万,死亡296例;1982～2002年年均发病率为9.75/10万,死亡3例;2003～2012年年均发病率为0.16/10万,无死亡病例。1986～2012年共检测4 556人,达到抗体保护水平的3 587人,保护率为78.73%,几何平均滴度（GMT）为1∶197.24。结论已实施的免疫策略对控制百日咳发病效果显著,发病率大幅度降低;人群保护率和抗体水平有逐年增高趋势,说明疫苗接种工作质量较高;应警惕大年龄组儿童和成人百日咳的出现和传播。     

Impact of infant and preschool pertussis vaccinations on memory B-cell responses in children at 4 years of age

Whooping cough, caused by Bordetella pertussis, is reemerging in the vaccinated population. Antibody levels to pertussis antigens wane rapidly after both whole-cell (wP) and acellular pertussis (aP) vaccination and protection may largely depend on long-term B- and T-cell immunity. We studied the effect of wP and aP infant priming at 2, 3, 4 and 11 months according to the Dutch immunization program on pertussis-specific memory B-cell responses before and after a booster vaccination with either a high- or low-pertussis dose vaccine at 4 years of age.Purified B-cells were characterized by FACS-analysis and after polyclonal stimulation, memory B-cells were detected by ELISPOT-assays specific for pertussis toxin, filamentous haemagglutinin and pertactin.Before and after the booster, higher memory B-cell responses were measured in aP primed children compared with wP primed children. In contrast with antibody levels, no dose-effect was observed on the numbers of memory B-cell responses. In aP primed children a fifth high-dose aP vaccination tended to induce even lower memory B-cell responses than a low-dose aP booster. In both wP and aP primed children, the number of memory B-cells increased after the booster and correlated with the pertussis-specific antibody concentrations and observed affinity maturation.This study indicates that aP vaccinations in the first year of life induce higher pertussis-specific memory B-cell responses in children 4 years of age compared with Dutch wP primary vaccinations. Since infant aP vaccinations have improved protection against whooping cough in children despite waning antibody levels, this suggests that an enhanced memory B-cell pool induction may have an important role in protection. However, the pertussis-dose of the preschool booster needs to be considered depending on the vaccine used for priming to optimize long-term protection against whooping cough.