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Resume L'isolement des Bordetella doit etre pratique a une phase precoce de l'infection, car ces bacteries sont expulsees de l'epithelium respiratoire des la survenue des signes cliniques de la phase d'etat, notamment les acces de toux paroxystique dans le cas de la coqueluche. L'identification de B. pertussis repose sur un examen microscopique attentif, la capacite de croitre sur milieu de Bordet Gengou au sang mais non pas, a l'isolement, sur gelose ordinaire, l'aspect des colonies en «gouttelettes de mercure et entourees d'une zone d'hemolyse, n'apparaissant qu'apres 72 h. B. parapertussis est hemolytique et urease +. B. bronchiseptica pousse sur gelose ordinaire et est mobile, possede une urease, une nitrate reductase et utilise le citrate comme source unique de carbone. B. avium se distingue essentiellement de B. bronchiseptica par l'absence d'urease et de nitrate reductase.

The long term respiratory consequences of whooping cough in childhood were sought among members of the National Survey of Health and Development. Peak expiratory flow rate was measured when the survey members were 36 years old and seven respiratory symptoms were reported at the same time. Peak expiratory flow rate was slightly reduced in those who had had whooping cough as a child, and this difference became non-significant when other factors were taken into account. Unexpectedly, chronic cough was significantly less likely to be reported by those who had had whooping cough, and this difference remained significant only among men after other factors had been taken into account. This study failed to show a long term detrimental effect of whooping cough on the respiratory system.

We evaluated the diagnostic performance of 15 clinical case definitions for pertussis in 233 patients who developed acute respiratory illness during community outbreaks in Wisconsin and Delaware. Using results from culture (Regan-Lowe media) and serology (Ig-class-specific ELISA) as diagnostic standards, cough for greater than or equal to 14 days was both sensitive (84 per cent-92 per cent) and specific (63 percent-90 per cent) in identifying patients with pertussis. This definition may be useful in monitoring pertussis outbreaks and for investigating contacts of culture-positive cases.

Una sinopsis de los hechos más notables presentados a la Asociación Médica Americana como fruto del trabajo de investigadores de diversas partes del Hemisferio Occidental, reviste la mayor importancia para la información de los profesionales colombianos. Datos generales, y en lo posible lo más concisos, se dan en este resumen sobre trabajos personalmente seleccionados de Medicina General, Patología, Fisiología, Medicina Tropical e Higiene Pública, los cuales fueron presentados o exhibidos ante los 8.103 médicos que asistieron a la Convención médica más importante de los tiempos actuales.

Objetivo: Obtener la concordancia de técnicas diagnósticas y confirmar el diagnóstico de los casos probables de tos ferina captados por inmunofluorescencia directa (IFD) durante un brote en 2013 en el departamento de Antioquia. Materiales y métodos: Se analizaron los datos demográficos, clínicos, epidemiológicos y de resultados de laboratorio de casos probables de tos ferina confirmados por IFD en un pico de tos ferina en 2013 en el departamento de Antioquia. Las muestras de aspirado nasofaríngeo y suero fueron recolectadas y recibidas entre los periodos epidemiológicos IV - VII de 2013. Todos los pacientes confirmados por IFD fueron confirmados por PCR o ELISA. El análisis de concordancia se realizó por índice kappa. Resultados: De las 180 muestras procesadas en el LSP de Antioquia, 134 (74%) fueron positivas por la técnica de IFD, de las cuales se confirmaron por PCR 109 muestras con 24 (22%) positivas para B. parapertussis , 3 (2,8%) para B. pertussis , 17 (15,6%) para Bordetella spp. y 18 (16,5%) con infección mixta por B. pertussis y B. parapertussis . De 81 casos que se confirmaron por ELISA, 31 (38,3%) fueron positivos. En el municipio de La Estrella la edad media de los casos confirmados fue de 6,6 años y la mediana de 3 años (rango: 2-4 años). Con respecto a los casos del municipio de Medellín, la edad media fue de 28,7 años y la mediana de 25 años (rango: 12-42 años). En su mayoría, en los síntomas no hubo diferencias significativas, excepto para la tos paroxística entre los casos confirmados de B. parapertussis y B. pertussis (p =

ResumenLa tos ferina es una enfermedad del tracto respiratorio superior que ha incrementado últimamente su incidencia. Se ha demostrado que los adultos son la principal fuente de transmisión para los niños susceptibles. En la actualidad, la enfermedad afecta con más frecuencia a los niños menores de 3 meses, entre los cuales, los menores de 1 mes tienen mayor riesgo de complicaciones y letalidad.Se presenta un caso autóctono de una recién nacida de 16 días con episodios de tos quintosa, cianosante y emetizante, cuadro hemático que evidencia leucocitosis y linfocitosis, que se originó en un área donde está implementada, como política de salud pública, la vacunación para tos ferina en niños. La paciente tuvo una evolución tórpida complicada con convulsiones y necesidad de ventilación mecánica. Se identificó en la paciente Bordetella pertussis por inmunofluorescencia, reacción en cadena de la polimerasa y cultivo. Se hace una breve revisión de la literatura, haciendo énfasis en el panorama actual de la vacunación en neonatos.AbstractNeonatal pertussis is an upper respiratory tract infection whose incidence has recently increased. Adults have been demonstrated to be the main source for neonatal infection, accounting for the rising rates of disease in this later population group. Currently, the disease affects chiefly infants under three months of age, among which, those younger than one moth have the highest rates of complication and death.Here we present an indigenous case of a 16 days old newborn that arose in an area where pertussis vaccination during the first months of life is the rule and very few cases had been documented throughout the last years. The patient presented whooping cough with cyanosis and emesis episodes, whose complete blood count showed markedly and increasingly high leukocytosis and lymphocytosis. Her clinical course complicated with seizures and required mechanical ventilation. B. pertussis was demonstrated by means of immunofluorescence, polymerase chain reaction and culture. A brief literature review is made with emphasis on current landmarks on pertussis vaccination.

SUMMARYAlthough an effective whooping cough vaccine has been available in the UK since the 1950s, its current association with neurotoxicity has resulted in poor uptake: as a consequence major epidemics (with significant morbidity and mortality) arc still being experienced.Component (sub-unit) vaccines, which incorporate those antigens thought to be concerned with generating a protective effect, have been developed and are now available for field testing. This paper addresses how such a vaccine might be evaluated, the organization of a trial and the difficulties to be expected.

Steinman et al. (...) described a reaction in mice receiving bovine serum albumin (BSA) and killed Bordetella pertussis organisms which appeared to involve the central nervous system. The response was interpreted as representing an encephalopathy and was proposed as a model for vaccine-associated events in DTP recipients. It is not appropriate at present, however, for this phenomenon to be considered a «model for pertussis vaccine encephalopathy» or for this protocol to be used to test the «encephalopathic potential» of pertussis vaccines

Both the absolute levels and the seasonal pattern of pertussis have changed over the past four decades in England and Wales. Three-to-four-year period epidemics tended to peak in the early or middle part of the year prior to 1957, during the last quarter between 1958 and 1975, and have been bimodal, with peaks in February and September, in both epidemics since 1976. Analysis of reported incidence data reveals similarities in the underlying seasonal pattern of transmission throughout this period. Seasonal effects include an increase in transmission coincident with the opening of schools in September. Other features of the pattern, such as a sharp fall in transmission in late November and a protracted low during February and March, are more difficult to explain, but may indicate important factors in the natural history of pertussis. The bimodality of recent epidemics appears to be a consequence of a seasonal low in transmission during February and March followed by a high level of transmission during the summer months. These seasonal trends may in turn reflect the increasing proportion of cases among pre-school children as a consequence of the fall in vaccine uptake during the mid 1970's.

Dr A.H. Griffith's article on this subject 1 raises some important issues which require comment. We, like him, regret the controversy over the safety and efficacy of whole cell pertussis vaccines over the last 15 years. It does indeed represent a sorry saga whose principal victims are children, many of whom have not been vaccinated against this unpleasant and sometimes dangerous illness because of fears over safety of the vaccine. The National Childhood Encephalopathy Study (NCES), was set up in 1976 as an independent scientific enquiry into severe acute neurological illnesses associated with pertussis vaccine in an attempt to help resolve the matter. The report on the results 2 concluded that these suggested, but did not prove, that the vaccine may very rarely cause the development of potentially damaging severe acute neurological illnesses in children who were previously apparently neurologically normal. Unfortunately the number of cases in the NCES was too small to allow any firm conclusions on whether or not the vaccine can cause permanent damage. The NCES has since been subject to intense scrutiny and criticism both by those who consider the vaccine can cause permanent neurological damage 3 and by those, such as Dr Griffith, who consider it does not. Regrettably, the controversy continues.

In order to determine whether healthy adults can be of importance for the spread of pertussis the nasopharyngeal flora of 391 healthy individuals working in close contact with children was investigated during the height of a pertussis epidemic. Only 1 carrier of Bordetella pertussis was found, even though all individuals were exposed to the organism during the study period through their work.

The effects of whooping cough were studied in 21 children admitted to hospital with the disease and in their families. The illness caused considerable distress to both child and family. Parents suffered especially from fears for the life and health of their child and from serious loss of sleep. Two months after admission the child's behaviour was still disturbed, but in most cases the rest of the family had returned to normal. There was much misunderstanding and misinformation about whooping cough among both parents and doctors.

Pertussis causes a large number of cases and hospitalizations in Catalonia and Navarra. We made a study of household cases of pertussis during 2012 and 2013 in order to identify risk factors for hospitalization in pertussis cases. Each primary case reported triggered the study of their contacts. Close contacts at home and people who were in contact for >2 hours during the transmission period of cases were included. The adjusted OR and 95% confidence intervals (CI) was calculated using logistic regression. A total of 1124 pertussis cases were detected, of which 14.9% were hospitalized. Inspiratory whoop (aOR: 1.64; CI: 1.02–2.65), apnoea (aOR: 2.47; CI: 1.51–4.03) and cyanosis (aOR: 15.51; CI: 1.87–128.09) were more common in hospitalized than in outpatient cases. Hospitalization occurred in 8.7% of correctly-vaccinated cases, 41.1% of non-vaccinated cases and 9.4% of partially-vaccinated cases. In conclusion, inspiratory whoop, apnoea and cyanosis were associated factors to hospitalization while vaccination reduced hospitalizations due to pertussis. Ministry of Science and Innovation, Institute of Health Carlos III (Project PI11/02557) and Fondo Europeo de Desarrollo Regional (FEDER-Una manera de hacer Europa); the Catalan Agency for the Management of Grants for University Research (AGAUR Grant number 2014/ SGR 1403).

BACKGROUND: Pertussis is a re-emerging disease worldwide despite its high vaccination coverage. European and Latin-American countries have used different surveillance and vaccination policies against pertussis. We compared the epidemiology of this disease in two Ibero-American countries with different vaccination and surveillance policies. METHODS: We compared the epidemiology of pertussis in Spain and the Dominican Republic (DR). We present a 10-year observational study of reported pertussis based on suspected and/or probable cases of pertussis identified by the national mandatory reporting system in both countries between 2005 and 2014. Both countries have a similar case definition for pertussis surveillance, although Spain applies laboratory testing, and uses real time PCR and/or culture for case confirmation while in DR only probable and/or suspected cases are reported. We analyzed incidence, hospitalization, case-fatality rates, mortality and vaccination coverage. RESULTS: The average annual incidence in children aged

A PCR-based assay for Bordetella pertussis was inhibited by using a calcium alginate fiber-tipped swab with an aluminum shaft but not by using a Dacron fiber-tipped swab with a plastic shaft. The calcium alginate fiber component inhibited the assay following storage for less than 1 min in a suspension of 10(3) CFU of B. pertussis per ml, whereas the aluminum shaft component required storage for at least 48 h in order to cause inhibition. We recommend the Dacron swab over the calcium alginate swab for collecting specimens for testing in PCR-based assays.

Enquete sur 26 familles (90 personnes au total) dans lesquelles 1 enfant au moins a ete atteint de coqueluche. La contamination se fait frequemment par un des parents atteint soit de coqueluche typique, soit de coqueluche atypique, soit d'infection asymptomatique par Bordetella pertussis