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New trends in the pertussis disease epidemiology : the need to be aware for taking decisions

Epidemiology Talk @ Sydney October 2010
by

Alberto Tozzi

on 4 June 2015

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Transcript of New trends in the pertussis disease epidemiology : the need to be aware for taking decisions

Infants Adolescents Young adults Adults Elderly Vaccinated persons Children 1998 1999 2000 2001 2002 2003-2007 < 1 year 1-4 years 5-9 years 10-14 years > 14 years 20% 40% 60% 80% 100% 0% Infant Transmission Vaccine-induced protection Waning immunity Limited natural immunity 0 3 months Children Adolescents Adults Complications Death long lasting aspecific mostly cough the need to be aware for taking decisions Dr Alberto E Tozzi EUVAC-NET Cases over 14 are increasingly Adult misdiagnosed in Sotir 2008 Adolescent 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-29 30-39 40-49 50-59 60-69 258 212 208 313 385 989 2239 1265 1160 547 333 45 56 97 28 28 1000 500 2500 1500 2000 0 Sin 2009 Child Attack rate according to time since last vaccine dose in years after pertussis vaccinations Time since last vaccine dose in years Attack rate % 6 7 8 9 10 <10 1.9 6.3 14.7 19.0 32.0 17.6 23.1 ≤5 4 EUVAC-NET mothers
13 fathers
7 brothers
18 sisters
10 Aunts
15 Cousins (male)
11 Cousins (female)
16 Uncles
9 Grandmothers
6 Grandfathers
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
Mothers 9/25
Fathers 11/27
Siblings 1/4
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



Post-tussive vomiting



Inspiratory whoop



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

Apnea

Pneumonia

Seizure

Death 12458 (60.5%)

11362 (55.0%)

2102 (19.3%)

222 (1.1%)

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
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