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Despite high levels of vaccination coverage in Spain and Catalonia (98% in 2002), pertussis is a significant cause of morbidity among infants. The study aim was to estimate the incidence of hospitalizations for pertussis among infants from 1997 through 2001 in Catalonia.A retrospective review of records for patients12 months of age with a diagnosis of pertussis (International Classification of Diseases, 9th revision, code 033) at discharge from 11 Catalonian hospitals was performed.Three hundred forty-six patients were identified, 62 (1997), 28 (1998), 59 (1999), 150 (2000) and 47 (2001), of whom 284 (82%) were4 months of age. The incidence of hospitalizations because of whooping cough from 1997 through 2001 in Catalonia was estimated at 118 cases per 100,000 inhabitants12 months of age. Symptoms included paroxysmal cough (95%), cyanosis (67.9%), vomiting (36.7%) and apneic episodes (27.7%). Three infants (0.8%) died, all2 months of age. Two hundred thirty-four patients (67.6%) were unvaccinated (222 patients were3 months of age). Six patients (1.7%) were fully vaccinated (3 doses). Considering that only 220 patients12 months of age were reported through the Catalonian Notification System in 1997-2001, at least 126 hospitalizations (36.4%) for pertussis were not reported to this system (mean difference per year, 32.6%; range, 8.4-56%).In this study, hospitalizations exceeded the number of notifications by at least 32.6%; therefore, the real incidence is likely to be greatly underestimated. Pertussis incidence remains high among infants, most of whom are4 months of age and have had no or 1 dose of vaccine.

The epidemiology of pertussis in Italy is described by using data from the statutory notification system and from seroepidemiology studies. Starting from the 1990s, the incidence of pertussis in Italy has shown a sharp decline and is now at the lowest level ever reached. During this time period vaccination coverage has increased from 88% in 1998 to 95% in 2003. In 1996–97, the prevalence of subjects with levels of IgG antibodies against PT greater than 2 EU/ml was 77.6%. The increase in vaccination coverage will probably change the pattern of disease transmission and increase the number of susceptible adults, unless administration of booster doses to adolescents and adults is considered.

In the United States in the 1990s, the incidence of reported pertussis in adults, adolescents and infants increased; infants younger than 1 year of age had the highest reported incidence.In 4 states with Enhanced Pertussis Surveillance, we examined the epidemiology of reported pertussis cases to determine the source of pertussis among infants. A source was defined as a person with an acute cough illness who had contact with the case-infant 7-20 days before the infant's onset of cough.The average annual pertussis incidence per 100,000 infants younger than 1 year of age varied by state: 22.9 in Georgia; 42.1 in Illinois; 93.0 in Minnesota; and 35.8 in Massachusetts. Family members of 616 (80%) of 774 reported case-infants were interviewed; a source was identified for 264 (43%) of the 616 case-infants. Among the 264 case-infants, mothers were the source for 84 (32%) and another family member was the source for 113 (43%). Of the 219 source-persons with known age, 38 (17%) were age 0-4 years, 16 (7%) were age 5-9 years, 43 (20%) were age 10-19 years, 45 (21%) were age 20-29 years and 77 (35%) were ageor =30 years.The variation in reported pertussis incidence in the 4 states might have resulted from differences in awareness of pertussis among health care providers, diagnostic capacity and case classification. Among case-infants with an identifiable source, family members (at any age) were the main source of pertussis. Understanding the source of pertussis transmission to infants may provide new approaches to prevent pertussis in the most vulnerable infants.

Presenta datos estadísticos de Enfermedades inmunoprevenibles como: Rubéola y sarampión, Tos ferina; Enfermedades transmitidas por vectores como: Dengue, Fiebre amarilla; Enfermedades zoonóticas como: Rabia, pestepor último enfermedades de Transmisión sexual como: VIH - SIDA

To assess whether pertussis-containing vaccines cause encephalitis or encephalopathy, the IMPACT network of Canadian pediatric centers screened more than 12,000 admissions for neurologic disorders between 1993 and 2002. Seven cases of encephalopathy began within 7 days after pertussis vaccination, but a more likely cause was found in each instance. No attributable case followed administration of >6.5 million doses of vaccine.

Presenta estadísticas de enfermedades sujetas a notificación obligatoria enfermedades inmunoprevenibles como: Sarampión y Tos Ferina; Enfermedades transmitidas por vectores como: Dengue, Fiebre amarilla; Enfermedades de Chagas, Bartonelosis - Enfermedad de Carrión; Enfermedades de transmisión sexual como : VIH - SIDA y por último Enfermedades zoonóticas como: Rabia, Peste, Leptospirosis

Aim: To observe reactogenicity of a three-component acellular pertussis (aP) vaccine simultaneously given with dT-IPV vaccine at the age of 4 years. Results: Of 813 subjects 36% had no adverse events. At the first day the score for pain was 47-55% (aP versus dT-IPV), for redness 3-4% and for swelling 5-6%. Irritability and loss of appetite had a score of 20%. In 3% of the children fever was present. Most symptoms disappeared within 3 days. Conclusion: Boostervaccination with an aP vaccine simultaneously given with dT-IPV vaccine at the age of 4 years is well tolerated.

A study was designed to assess the performance of various swabs and transport media routinely used to collect specimens submitted for Bordetella culture and PCR. Calcium-alginate swabs inhibited the PCR. No inhibition was detected in any PCRs with dacron or rayon swabs. All swab materials performed similarly for recovery of Bordetella pertussis in culture. The Amies with charcoal transport system performed poorly for culture. Calcium-alginate swabs are not recommended for PCR-based detection of B. pertussis . Dacron and rayon swabs are an excellent choice for both PCR and culture.

Fundamentos: Para un buen desarrollo de los programas de vacunación es primordial conocer la cobertura de vacunación. En las Islas Baleares la cobertura notificada era muy inferior a la del resto de España. El objetivo de este trabajo es la estimación de la cobertura de las vacunas incluidas en el calendario recomendado hasta los 18 meses de edad (4 dosis de polio oral, tétanos y difteria; 3 de tosferina; 1 de sarampión, rubeola y parotiditis). Métodos: Estudio descriptivo, transversal, de base poblacional. Se calcularon los estimadores puntuales de distribución de frecuencias y los intervalos de confianza al 95% (IC95%) correspondientes, sobre una muestra de la población residente en Baleares de dos años de edad (nacida en 1995), seleccionada por muestreo aleatorio por conglomerados en una sola etapa a partir de las secciones censales. Se consultan los registros de vacunas de Sanidad y de los centros de salud del Insalud, se pide telefónicamente a las familias los datos del documento de vacunación y a los pediatras privados los de la historia clínica. Resultados: La muestra incluía 606 niños. Pudo obtenerse la información completa de 532. Se consiguió la información completa de 377 casos (62%) a partir de los registros del sector público. La cobertura más baja fue la de la vacuna antidiftérica, 518 niños complentamente vacunados, el 96,8% (IC95% = 94,8 - 98,1) y la más alta la de la vacuna antipertussis, 537 niños, el 98,9% (IC95% = 97,5 - 99,5). Conclusiones: En las Islas Baleares existe una buena cobertura de la vacunación, similar a lo que se viene estimando en España en su totalidad. Se cumple el objetivo incluido en el Plan de Erradicación de la Polio. La información recogida desde el sector público es escasa. Background: In order for vaccination programs to be carried out properly, it is essential for the vaccination coverage to be known. On the Balearic Islands, the reported coverage was much less than for the rest of Spain. The objective of this study is that of estimating the coverage of the vaccinations included on the recommended schedule up to 18 months of age (4 doses of oral polio, tetanus and diphtheria; 3 doses of whooping cough; 1 dose of measles, rubella and mumps). Methods: A descriptive, cross-sectional study of the population base. The ideal-time frequency distribution estimators and the corresponding confidence intervals were calculated at 95% (CI95%) for a sample of the resident two-year-old (born in 1995) Balearic Island population selected by means of a single-stage conglomerate random sampling based on census sections. The National Public Health System and National Health Institute vaccination records were reviewed, the data from the vaccination document having been requested from the families and the clinical record from the private pediatricians by telephone. Results: The sample included 606 children, it having been possible to obtain full information on 532 children. Full information was obtained on 377 cases (62%) from the public health sector records. The least degree of coverage was found for the diphtheria vaccine, 518 children having been fully vaccinated, 96.8% (CI95% = 94.8 - 98.1), the highest degree of coverage having been found for the whooping cough vaccine, 537 children, 98.9% (CI95% = 97.5 - 99.5). Conclusions: Good vaccination coverage was found to exist on the Balearic Islands, being similar to what has been being estimated for Spain as a whole. The objective included within the Polio Eradication Plan is accomplished, very little information being gathered from the public sector.

The efficacy of 10 pertussis vaccines prepared from various concentrations of pertussis toxin (PT) and filamentous hemagglutinin (FHA) was investigated in a murine model of respiratory infection (aerosol challenge model) and a murine intracerebral (ic) challenge model. PT was necessary as a vaccine component for protection against an ic challenge with Bordetella pertussis. FHA appeared to play an important role as a vaccine component in protection against an aerosol challenge with B. pertussis. Vaccines containing a small amount of FHA with a large amount of PT (FHA:PT=1:11 or 2:10, w/w) were strongly protective in both the aerosol challenge and the ic challenge models. Ratios of FHA:PT of 1:11 or 2:10 (w/w) might be suitable for future formulations.

This epidemiological survey was undertaken to estimate the annual burden of hospitalizations for pertussis in Spain during a four-year period 1995–1998. Data were obtained from the national surveillance system for hospital data. All hospital discharges for pertussis (ICD-9- CM 033) were analyzed. The annual incidence of hospitalization for pertussis was 1.7 per 100,000 population. Eighty-nine percent of the cases were

A real-time PCR assay based on the TaqMan technology was developed for the detection of Bordetella pertussis and B. parapertussis in clinical samples. The assay was evaluated with 182 specimens from 153 patients with and without symptoms of pertussis. The analytical sensitivity ranged from 0.1 to 10 cfu for B. pertussis and B. parapertussis, respectively, and diagnostic sensitivity was 94.1% when culture was used as a reference. No sample from a patient without symptoms of pertussis was positive in PCR. Twenty-four of 28 patients who were negative by culture and positive by PCR assay met the CDC clinical case definition for pertussis; the remaining four patients had paroxysms of shorter duration. Intra- and inter-assay variation were

El INS es el Laboratorio de Referencia para la confirmación de varias enfermedades de interés en salud pública. En el siguiente cuadro se presentan los resultados de laboratorio confirmatorios indicando la técnica, a partir de las muestras que han sido enviadas por las Direcciones de Salud. Es importante mencionar que es necesario correlacionar esta información con el reporte epidemiológico de casos, puesto que no necesariamente se han obtenido muestras de laboratorio para llegar a un diagnóstico de los pacientes reportados como sospechosos de alguna de las enfermedades bajo vigilancia.

To improve the cultivation of Bordetella pertussis and take advantage of the newest techniques in monitoring and control, a quantitative description of substrate utilisation is necessary. Growth of the organism is limited by two main substrates. However neither interactive nor non-interactive modelling seem appropriate. A model that combines essential and enhanced kinetics was developed based on experimental observation. Instead of fitting all model parameters at once, a step-wise experimentation procedure was used. Finally two cultivations showed the accuracy of the model.

Older children still contribute to the transmission of pertussis to infants in French regions with low booster coverage at 2 years of age. Booster vaccination seems crucial for protection against symptomatic pertussis in childhood.

Pertussis was first recognized as an epidemic disease in the 16th century. The classic illness is a three-stage illness (catarrhal, spasmodic, and convalescent), with a distinctive cough, and its characteristics today are similar to those in the prevaccine era. In the prevaccine era, the calculated attack rate was 872/100,000 population, and the majority of cases occurred in children

A rapid and sensitive method has been devised for the detection of Bordetella pertussis in clinical samples. The feasibility of the technique, which is based upon enzymatic assay of adenylate cyclase associated with the intact B. pertussis organisms, has been demonstrated in laboratory simulations. In the present study, we evaluated this novel diagnostic method using clinical specimens obtained from 120 children with suspected pertussis. Levels of adenylate cyclase activity in these specimens were highly correlated with culture results; intermediate and high levels in 28 samples predicted positive cultures in 23 (82%). Further, the adenylate cyclase assay results were obtained 2-7 days earlier than the results of cultures. Among 92 specimens with low levels of adenylate cyclase activity, only 11 were positive in culture. We conclude that adenylate cyclase assays may be suitable for rapid diagnosis of pertussis in children and might facilitate early and effective intervention.

The inclusion of an appropriate internal control DNA in polymerase chain reaction (PCR) is a rapid and simple method for the detection of PCR failure. Two PCR coamplification internal control DNAs (ICD I and ICD II) with the same primer-binding sequences as the target DNA for the detection of Bordetella pertussis and Bordetella parapertussis were produced using an overlap extension technique and a PCR MIMIC construction kit, respectively. The ICD II was further evaluated in a prospective clinical study in 360 patients with a clinical diagnosis of pertussis. From 360 nasopharyngeal swabs the internal control was positive in 318 (88%) samples, but was negative in 42 (12%). After phenol-chloroform extraction an additional 10 internal controls became positive. For the detection of PCR failure, the use of internal control DNA is highly recommended for PCR-based identification of B. pertussis and B. parapertussis organisms from nasopharyngeal swabs and aspirates.

This case-control study investigated the protective efficacy against pertussis of three doses of a two-component acellular pertussis vaccine (manufactured by Biken in Japan) combined with diphtheria and tetanus toxoids (manufactured by Connaught Laboratories in the US) in infants.A case-control study was performed in 63 pediatric practices in Germany. Prospective recruitment of 16,780 infants ages 6 to 17 weeks took place between February, 1993, and July, 1994. According to parental choice infants received either Biken acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTacP) (74.6%) at approximately 2, 4 and 6 months of age, or a licensed German diphtheria-tetanus toxoids-whole cell pertussis vaccine (10.9%), diphtheria-tetanus toxoids vaccine (12.5%) or no vaccine (2.0%). Prospective surveillance of pertussis cases between February, 1993, and May, 1995, was accomplished by culturing all infantsor =2 years of age presenting with coughor = 7 days. A pertussis case was defined as any cough of 21 days or longer plus a positive Bordetella pertussis culture or household contact exposure.We identified 241 pertussis cases prospectively by 11,017 B. pertussis cultures and 949 controls matched for age were selected from the same pediatric practices. Medical history and demographic and vaccine status data were collected from each case and for four controls. Data were analyzed through conditional logistic regression taking into account individual matching and adjusting for potential confounding variables. DTacP combined with diphtheria and tetanus toxoids vaccine was 82% protective (95% confidence interval, 68 to 90), diphtheria-tetanus toxoids-whole cell pertussis vaccine was 96% protective (95% confidence interval, 78 to 99). Protection against typical B. pertussis infection characterized by paroxysmal cough lastingor =21 days was 96% (95% confidence interval, 87 to 99) for DTacP and was 97% (95% confidence interval, 79 to 100) for diphtheria-tetanus toxoids-whole cell pertussis vaccine. Adjustment for potentially confounding variables did not change the results significantly.Three doses of the two-component acellular pertussis vaccine protected infants against pertussis disease during the period before the recommended booster vaccination. For typical pertussis disease as defined by the WHO efficacy was high and similar to that of a licensed German diphtheria-tetanus toxoids-whole cell pertussis vaccine.

There are number of factors that contribute to the difficulty isolating Bortadella pertussis. These factors include specimen choice, swab material, collection, transport, prior therapy and culture techniques. The aim of this study was to analyze the isolation rate of B.pertussis from various upper respiratory tract specimens in patients with paroxysmal cough, treated at University Hospital of Infectious Diseases, Zagreb, Croatia.

During the last 2 decades an increase of reported pertussis has been noted in the United States and other countries in which infants and children are universally immunized.1–3 Presently, this “resurgence” of pertussis is presented with alarm in frequent newspaper headlines from many geographic areas throughout the United States. Reported pertussis in the United States in the prevaccine and vaccine eras is presented in Fig 1, and the age distribution of pertussis cases in a prevaccine period and 2 periods in the vaccine era are presented in Table 1. As can be seen (Fig 1), the “resurgence” is modest when the big picture is observed. The data in Table 1 note that in the prevaccine era 95% of the reported cases were in children 6-fold higher than in the prevaccine era. Finally … Reprint requests to (J.D.C.) Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, 22-442 MDCC, Los Angeles, CA 90095-1752. E-mail: jcherry{at}mednet.ucla.edu

Two infants with life-threatening pertussis are presented in whom the diagnosis was delayed. A review of pertinent literature suggests that the diagnosis of pertussis in infants is frequently missed and therefore the morbidity and mortality from this disease is underestimated.

To date, the most significant use of recombinant-DNA technologies has been to hyperproduce natural molecules that are difficult to obtain in large quantities by conventional methods. However, genetic manipulation can also be an efficient way to modify the properties of natural molecules in order to make them more suitable for human use. In the development of third-generation whooping cough vaccines, recombinant-DNA methods were used to remove the enzymatic activity of pertussis toxin in order to obtain a new molecule which is devoid of toxicity, and can be used for safer vaccination against this disease.

Awareness is growing of the role of pertussis infection among adolescents and adults, and of the possibility of nosocomial transmission. However, pertussis remains difficult to diagnose. We report a case of nosocomially acquired pertussis in a healthcare worker, diagnosed by polymerase chain reaction. The high sensitivity and rapid turnaround time for this test is useful to confirm the diagnosis when advising a healthcare worker to refrain from working.