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New trends in the pertussis disease epidemiology : the need to be aware for taking decisions
Transcript of New trends in the pertussis disease epidemiology : the need to be aware for taking decisions
15 Cousins (male)
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2 51 cases in infants <1 1-4 5-9 10-14 15-19 20+ 0 5 10 15 20 25 30 35 40 Incidence per 100,000 inhabitants Cases per 100,000 population Age group Wisconsin outbreak pertussis 2003: highest incidence in adolescents Incidence increases after 4 years of age Infants are often exposed to infection when they are too young to be vaccinated EUVAC-NET up to 17 new cases Wearing PLoS Pathog 2009 14/30
Grandparents 30 cases in infants 7/14 4/9 5/11 1/1 PCR + cough Mothers and siblings are frequent sources of infection... Bosdure E, Med Mal Infect. 2008 Pertussis is highly transmissible School B Family C Hotel staff Housing project Jail Methamphetamine users Yaari, 2006 contacts may happen outside the family Bosdure E, Med Mal Infect. 2008 ...so are other relatives... ...and Contacts often occur in the first month of life Lai-man R Chuk, Commun Dis Intell 2008 more represented in Europe Derived from Hewlett, 2005; Wendelboe, 2005 New trends in the pertussis disease epidemiology: pertussis immunization starts here pertussis hits the vulnerables protection starts waning spread adolescents the infection to other age groups pertussis Galani 2006 Canada 1988-2002 Barret, 2010 Pertussis Hellebrand 2009 notified pertussis cases California pertussis report Pertussis incidence by age and race Apnoea
Paroxysmal cough Proportion of cases (%) Barret 2010 Distribution of reported symptoms by age group >10-20/100000 >20/100000 0-10/100000 82.2/100000 0.2/100000 50.3/100000 0.2/100000 100-300/100.000 in infants < 3 months primary cause of mortality in infants < 2 months proportion of recognised cases in adolescents and adults 508/100.000 Bonmarin, 2007 Floret, 2001 Gilberg, 2002 221/1000 6.7/1000 0/1000 0.6/100000 538/1000 0/1000 13/1000 0/1000 1000/1000 18/1000 0/1000 Pertussis cumulative crude incidence Hospitalized
Death 12458 (60.5%)
179 (0.87%) 2000-2009 Hospitalizations and complications <1yr (N=25,856) Liang 2010 may go unrecognised First cases and source cases de Greeff 2010 Laboratory confirmation or epidemiological link Clinical symptoms Laboratory confirmation Kretschmar 2010 Incidence estimates adults may transmit the infection to other susceptible individuals 2004, Texas: were diagnosed of pertussis after direct care of same HCW 11 infants 5 required PICU MMWR June 6, 2008 from seroepidemiology January-June 2010 in Ireland Former East Germany 2004-2007: Northern Ireland 2010 California 2010