Nota técnica N. 13/2024 - SES/GVEDT: aumento de casos de coqueluche / Technical note N. 13/2024 - SES/GVEDT: increase in pertussis cases

Nota técnica com o objetivo de alertar os gestores e profissionais de saúde quanto ao aumento de casos confirmados por coqueluche em 17 países em 2024, bem como em alguns estados brasileiros, conforme Nota técnica nº 70/2024 - DPNI/SVSA/MS e também reforçar para a necessidade de alcançar as coberturas vacinais conforme preconizado pelo Ministério da Saúde, além de adoção de medidas para fortalecimento da vigilância epidemiológica e laboratorial do agravo diante da suspeita clínica, diagnóstico e tratamento oportuno da doença a fim de evitar a morbimortalidade pela doença no Estado de Goiás

Technical note with the aim of alerting managers and health professionals regarding the increase in confirmed cases of pertussis in 17 countries in 2024, as well as in some Brazilian states, according to Technical Note nº 70/2024 - DPNI/SVSA/MS and also to reinforce to the need to achieve vaccination coverage as recommended by the Ministry of Health, in addition to adopting measures to strengthen epidemiological and laboratory surveillance of the disease in the face of clinical suspicion, diagnosis and timely treatment of the disease in order to avoid morbidity and mortality due to the disease in the State from Goiás

Casos de coqueluche em Goiás: alerta aos serviços de saúde de Goiás quanto à prevenção e controle da coqueluche / Cases of pertussis in Goiás: alert to health services in Goiás regarding the prevention and control of pertussis

A coqueluche é uma doença infecciosa aguda, de elevada transmissibilidade e distribuição universal, imunoprevinível e de notificação obrigatória. Considerando a atual situação epidemiológica dos casos de coqueluche no Brasil e no Estado de Goiás, o Centro de Informações Estratégicas e Resposta em Vigilância em Saúde do Estado de Goiás - CIEVS/GO elaborou esse alerta aos serviços de saúde para a prevenção e controle da coqueluche, visto o risco de ocorrência de aumento de casos isolados ou surtos

Pertussis is an acute infectious disease, highly transmissible and universally distributed, vaccine-preventable and mandatory notification. Considering the current epidemiological situation of pertussis cases in Brazil and the State of Goiás, the Center for Strategic Information and Response in Health Surveillance of the State of Goiás - CIEVS/GO prepared this alert to health services for the prevention and control of pertussis , given the risk of an increase in isolated cases or outbreaks

Epidemiological characteristics and clinical features of pertussis in Shandong Province from 2007 to 2022 / 中华预防医学杂志

Objective: To analyze the epidemiological characteristics and clinical features of pertussis cases reported in Shandong Province of China. Methods: Data on pertussis cases in Shandong Province from 2007 to 2022 were collected from China Information System for Disease Control and Prevention. At the same time, some case information was collected from the database of notifiable pertussis in Shandong Province from 2007 to 2022. The distribution characteristics and clinical features of pertussis were analyzed. A spatial distribution map of pertussis cases in Shandong Province was drawn. Results: A total of 26 122 pertussis cases were reported in Shandong Province during 2007-2022, with an annual incidence rate ranging from 0.11 to 5.77 cases per 100 000 people. Cases occurred throughout the whole year, with a seasonal peak occurring in spring and summer, especially in July and August. In recent years, reported cases were mainly distributed in the central and western regions of Shandong Province, with fewer cases in the eastern region. The hot spots of the disease shifted from Heze and Dezhou City in 2007-2013 to Jinan and Tai'an city in 2014-2022. The age range of onset was from 1 day to 93 years old. The proportion of cases with age≤1 year was the largest (41.81%, 10 922/26 122), and the proportion of cases aged 0-6 months decreased from 32.21% (67/208)-55.67% (157/282) within the period of 2007 to 2013 to 16.78% (883/5 263)-41.97% (444/1 058) within the period of 2014 to 2022, with a statistically significant trend (χ² trend=670.01, P<0.001). There were 13 682 male cases and 12 440 female cases, with a male-female ratio of 1.10∶1. The male-female ratio was 1.45∶1 (806∶556) from 2007 to 2013 and 1.08∶1 (12 876∶11 884) from 2014 to 2022. The proportion of women increased from 42.31% (88/208) in 2007 to 47.84% (2 518/5 263) in 2022, and with a significant trend (χ² trend=22.25, P<0.001). In pertussis cases, the proportions of scattered children, kindergarten children and students were 71.38% (18 645/26 122), 15.13% (3 951/26 122), and 11.60% (3 031/26 122), respectively. The top five clinical symptoms of pertussis cases were paroxysmal spasmodic cough (86.33%, 21 411 cases), flushing (39.61%, 9 824 cases), restless sleep (34.51%, 8 558 cases), fever (30.80%, 7 638 cases), and crowing (27.53%, 6 829 cases). Among 24 802 cases, there were 15 542 cases (62.66%) with a history of immunization against pertussis vaccine. Conclusion: From 2007 to 2022, the incidence rate of pertussis cases in Shandong Province shows an upward trend, with the majority being young children, and the clinical symptoms are relatively typical.

Epidemiological characteristics and clinical features of pertussis in Shandong Province from 2007 to 2022 / 中华预防医学杂志

Objective: To analyze the epidemiological characteristics and clinical features of pertussis cases reported in Shandong Province of China. Methods: Data on pertussis cases in Shandong Province from 2007 to 2022 were collected from China Information System for Disease Control and Prevention. At the same time, some case information was collected from the database of notifiable pertussis in Shandong Province from 2007 to 2022. The distribution characteristics and clinical features of pertussis were analyzed. A spatial distribution map of pertussis cases in Shandong Province was drawn. Results: A total of 26 122 pertussis cases were reported in Shandong Province during 2007-2022, with an annual incidence rate ranging from 0.11 to 5.77 cases per 100 000 people. Cases occurred throughout the whole year, with a seasonal peak occurring in spring and summer, especially in July and August. In recent years, reported cases were mainly distributed in the central and western regions of Shandong Province, with fewer cases in the eastern region. The hot spots of the disease shifted from Heze and Dezhou City in 2007-2013 to Jinan and Tai'an city in 2014-2022. The age range of onset was from 1 day to 93 years old. The proportion of cases with age≤1 year was the largest (41.81%, 10 922/26 122), and the proportion of cases aged 0-6 months decreased from 32.21% (67/208)-55.67% (157/282) within the period of 2007 to 2013 to 16.78% (883/5 263)-41.97% (444/1 058) within the period of 2014 to 2022, with a statistically significant trend (χ² trend=670.01, P<0.001). There were 13 682 male cases and 12 440 female cases, with a male-female ratio of 1.10∶1. The male-female ratio was 1.45∶1 (806∶556) from 2007 to 2013 and 1.08∶1 (12 876∶11 884) from 2014 to 2022. The proportion of women increased from 42.31% (88/208) in 2007 to 47.84% (2 518/5 263) in 2022, and with a significant trend (χ² trend=22.25, P<0.001). In pertussis cases, the proportions of scattered children, kindergarten children and students were 71.38% (18 645/26 122), 15.13% (3 951/26 122), and 11.60% (3 031/26 122), respectively. The top five clinical symptoms of pertussis cases were paroxysmal spasmodic cough (86.33%, 21 411 cases), flushing (39.61%, 9 824 cases), restless sleep (34.51%, 8 558 cases), fever (30.80%, 7 638 cases), and crowing (27.53%, 6 829 cases). Among 24 802 cases, there were 15 542 cases (62.66%) with a history of immunization against pertussis vaccine. Conclusion: From 2007 to 2022, the incidence rate of pertussis cases in Shandong Province shows an upward trend, with the majority being young children, and the clinical symptoms are relatively typical.

Abordaje integral de infecciones respiratorias agudas virales y coqueluche / Comprehensive approach to acute viral respiratory infections and whooping cough

Informe sobre el objetivo del abordaje de estas patologías, desde el Ministerio de Salud de la Ciudad de Buenos Aires: Medidas de prevención; Priorización de diagnóstico; Estrategia integrada de vigilancia de la Infecciones Respiratorias Agudas de posible origen viral; Vigilancia Universal; Vigilancia epidemiológica de coqueluche (tos convulsa); y Recomendaciones sobre el uso de antivirales para influenza; (AU)

Challenges to global pertussis prevention and control / 中华流行病学杂志

Pertussis is an acute, highly infectious respiratory disease caused by Bordetella pertussis, and is one of the leading causes of infant disease and death worldwide. The pertussis vaccine has been used in the expanded program on immunization globally since 1974 and the vaccination coverage remains high. In recent years, the pertussis incidence rate increased, even pertussis outbreaks occurred, in more and more countries or areas after years with low incidence level. The disease burden of pertussis has been seriously underestimated, and the prevention and control of pertussis is facing many challenges. This article reviews the epidemic status of pertussis worldwide, the factors affecting the reemergence of pertussis, and the challenges in the prevention and control to provide a reference for prevention and control of pertussis.

Estandarización de un ELISA para la cuantificación de anticuerpos IgG humanos contra células enteras de Bordetella pertussis / Standardization of an ELISA for the quantification of human IgG antibodies against whole cells of Bordetella pertussis

Bordetella pertussis es un patógeno exclusivo de humanos que causa la tos ferina, enfermedad respiratoria aguda que afecta principalmente a la población pediátrica. Existen dos tipos de vacunas comercializadas contra este patógeno: celulares y acelulares. Las vacunas celulares han sido extensamente utilizadas y siguen teniendo gran relevancia. El presente trabajo tuvo como objetivo la estandarización de un ELISA para la cuantificación de anticuerpos IgG contra células enteras de Bordetella pertussis. Para ello se determinó la concentración de recubrimiento, el rango lineal de la curva, los parámetros de precisión intra e interensayo, la especificidad, el valor de corte y el límite de detección. Se determinó como concentración de recubrimiento 0,5 UO/mL de células enteras. La curva estándar utilizando un suero de referencia internacional presentó un buen ajuste a una función polinómica en un intervalo entre las diluciones 1/100 y 1/24.300 con un coeficiente de correlación R2≥0,98. Los coeficientes de variación en los ensayos de precisión intra e interensayo estuvieron en los intervalos establecidos para cada uno (≤10 por ciento, ≤20 por ciento respectivamente). Los resultados obtenidos avalan el empleo de este ELISA cuantitativo para la evaluación de la respuesta a células enteras de Bordetella pertussis en ensayos clínicos(AU)

Bordetella pertussis is a pathogen exclusive to humans that causes pertussis, an acute respiratory disease that mainly affects the pediatric population. There are two types of vaccines commercially available against this pathogen: cellular and acellular. Cellular vaccines have been widely used and continue to be of great relevance. The aim of the present work was to standardize an ELISA for the quantification of IgG antibodies against whole cells of Bordetella pertussis. For this purpose, the coating concentration, the linear range of the curve, the intra- and inter-assay precision parameters, the specificity, the cut-off value and the detection limit were determined. The coating concentration was determined as 0.5 UO/mL of whole cells. The standard curve using an international reference serum presented a good fit to a polynomial function in a range between dilutions 1/100 and 1/24,300 with a correlation coefficient R2≥0.98. The coefficients of variation in the intra- and inter-assay precision tests were in the intervals established for each (≤10percent, ≤20percent respectively). The results obtained support the use of this quantitative ELISA for the evaluation of whole-cell response to Bordetella pertussis in clinical trials(AU)

Amplificación directa de ADN de Bordetella pertussis purificado de hisopados nasofaríngeos por un método de bajo costo, rápido (60-segundos) y libre de equipos / Direct amplification of Bordetella pertussis DNA purified from nasopharyngeal swabs by a low-cost, fast (60-second), and equipment-free method

RESUMEN Objetivo. Desarrollar y evaluar un método de bajo costo basado en celulosa para la purificación rápida y amplificación directa de ADN de Bordetella pertussis de hisopados nasofaríngeos. Materiales y métodos. Se prepararon discos de celulosa y se evaluaron diferentes parámetros (buffers de lisis/lavado, número de discos y elución de ADN). El método se acopló a una amplificación directa por PCR en tiempo real (qPCR) y se estimó el rendimiento utilizando hisopados nasofaríngeos que fueron positivos (n=100) y negativos (n=50) para ADN B. pertussis por qPCR, comparado con el método basado en columnas de sílice. Se calculó el grado de concordancia, sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Se evaluó la factibilidad del método rápido para ser acoplado a un ensayo colorimétrico de amplificación isotérmica mediada por lazo (LAMP). Resultados. El método rápido con un disco de celulosa y buffer de lisis y lavado conteniendo PVP-40 y Tween 20, respectivamente, mostró una mayor capacidad para purificar ADN amplificable de B. pertussis. El método tuvo una sensibilidad de 89,0% (IC95%, 80,2%-94,9%) y una especificidad de 98,5% (IC95%, 92,1%-100,0%), con un buen grado de concordancia (Kappa=0,867; IC95% 0,788 - 0,946), respecto al método referencial. Los VPP y VPN fueron 98,6% (IC95%, 92,7,2%-100,0%) y 88,2% (IC95%, 78,7%-94,4%), respectivamente. Se evidenció una amplificación exitosa por LAMP, y se obtuvieron resultados comparables con el método por columnas de sílice. Conclusión. El método desarrollado es simple, de bajo costo y libre de equipos para la obtención rápida (60 segundos) de ADN en el punto de atención, y puede ser implementado en diversas técnicas moleculares orientados al diagnóstico oportuno y al estudio epidemiológico de tos ferina.

ABSTRACT Objective. To develop and evaluate a low-cost cellulose-based method for rapid purification and direct amplification of Bordetella pertussis DNA from nasopharyngeal swabs. Materials and methods. We prepared cellulose discs and evaluated different parameters (lysis/wash buffers, number of discs and DNA elution). The method was coupled to a direct real-time PCR (qPCR) amplification and the performance was estimated using nasopharyngeal swabs that were positive (n=100) and negative (n=50) for B. pertussis DNA by qPCR, compared to the silica column-based method. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and the degree of agreement. The feasibility of the rapid method to be coupled to a loop-mediated isothermal amplification colorimetric assay (LAMP) was evaluated. Results. The rapid method, with a cellulose disk and lysis and wash buffer containing PVP-40 and Tween 20, respectively, showed a greater capacity to purify amplifiable DNA from B. pertussis. The method had a sensitivity of 89.0% (95%CI: 80.2%-94.9%) and a specificity of 98.5% (95%CI: 92.1%-100.0%), with a good degree of agreement (Kappa=0.867; 95%CI: 0.788 - 0.946), compared to the reference method. The PPV and NPV were 98.6% (95%CI: 92.7.2%-100.0%) and 88.2% (95%CI: 78.7%-94.4%), respectively. Successful amplification by LAMP was evident, and comparable results were obtained with the silica column method. Conclusion. The developed method is simple, low-cost and equipment-free for rapid (60 seconds) DNA collection at the point of care, and can be implemented in various molecular techniques aimed at the timely diagnosis and epidemiological study of pertussis.

Analysis of the time series of pertussis in Brazil from 2010 to 2019 / Análise da série temporal da coqueluche no Brasil no período de 2010 a 2019

Abstract Objectives: to analyze a decade of spatio-temporal behavior of pertussis in Brazil and its epidemiological characteristics. Methods: ecological time series study of pertussis cases and deaths from the Notifable Diseases Information System in Brazil (2010-2019). The method of generalized linear analysis of Prais-Winsten and the Kernel analysis were used. Results: 32,849 cases were reported, of which 466 (1.42%) evolved to death, with a prevalence of 1.63/100,000 inhabitants and a mortality rate of 0.023/100,000 inhabitants. In the temporal analysis, the cyclical behavior of pertussis was evidenced, with trend variations in the period in 2014. Most cases occurred in children under 1 year of age (60.16%, p<0.01), sex female (55.28%, p=0.066) and white (48.42%, p=0.14). The largest share of deaths was in children aged <1 year (98.07, p<0.01), females (56.01%, p=0.066) and whites (43.78%, p=0.14). In the Kernel of prevalence, the South, Southeast and Northeast regions stood out with high density; while for mortality, the Southeast and Northeast stood out. Conclusions: the cyclical behavior of pertussis was observed, with a decreasing trend in recent years and the concentration of cases in children. This reinforces the importance of strengthening the population's immunization process.

Resumo Objetivos: analisar uma década do comportamento espaço-temporal da coqueluche no Brasil e as suas características epidemiológicas. Métodos: estudo ecológico de série temporal dos casos e óbitos por coqueluche do Sistema de Informação de Agravos de Notificação no Brasil (2010-2019). Utilizou-se o método de análise linear generalizada de Prais-Winsten e a análise de Kernel. Resultados: notificaram-se 32.849 casos, desses 466 (1,42%) evoluíram para óbito, com prevalência de 1,63/100.000 habitantes e coeficiente de mortalidade de 0,023/100.000 habitantes. Na análise temporal, evidenciou-se o comportamento cíclico da coqueluche com variações de tendência no período em 2014. A maioria dos casos ocorreu em menores de 1 ano (60,16%, p<0,01), sexo feminino (55,28%, p=0,066) e brancos (48,42%, p=0,14). A maior parcela dos óbitos foi em crianças <1 ano (98,07, p<0,01), sexo feminino (56,01%, p=0,066) e brancos (43,78%, p=0,14). No Kernel da prevalência, destacaram-se as regiões Sul, Sudeste e Nordeste com alta densidade; enquanto para mortalidade, sobressaíram-se Sudeste e Nordeste. Conclusão: observou-se o comportamento cíclico da coqueluche, com tendência de decréscimo nos últimos anos e a concentração de casos no público infantil. O que reforça a importância de fortalecer o processo de imunização da população.

Artificial intelligence-based literature data warehouse for vaccine safety / 中华流行病学杂志

Objective: To establish a sustainable updated literature data warehouse for global vaccine safety assessment, and provide data support for evidence-based vaccine safety assessment. Methods: Semi-automated construction and updating of a literature data warehouse were achieved through the continuous integration of standard operating steps of evidence-based reviews with artificial intelligence technologies. Following the standard procedure of a systematic literature review, the literatures about vaccine safety assessment published before November 29, 2020 were retrieved from 9 databases including OVID, Scopus, Web of Science, Cochrane Library, and ClinicalTrails.org in English and Wanfang, CNKI, VIP, and SinoMed in Chinese. Literatures were screened for two rounds in a semi-automatic manner (by artificial intelligence literature processing system and manual work) according to the inclusion/exclusion criteria. Furthermore, the literatures were classified according to the types of vaccines and adverse events. The updating strategy was established, and the literature data warehouse was updated regularly. Experts were organized to select specific vaccine safety topics and carry out special demonstration studies. Results: More than 0.41 million articles were retrieved. According to the inclusion/exclusion criteria, 23 304 articles were included after two rounds of screening. At present, we have selected and completed three prior topics as demonstration studies, including the systematic review of "DPT (diphtheria, pertussis and tetanus) vaccine and encephalopathy/encephalitis", and the classified management of literatures about allergic purpura and brachial plexus neuritis. Conclusions: The sustainable updated literature data warehouse of vaccine safety can provide high-quality research data for vaccine safety research, including evidence support for immunization related policy-making and adjustment and vaccine safety-related methodological research or clinical tool development; and further demonstration studies can provide references for building a new methodological framework system for timely and efficient completion of the evidence-based assessment of vaccine safety.

Regression analysis of satellite-derived fire spots and PM2.5 levels with respiratory cases in the Philippines

Background and Objectives@#Fire events emit pollutants that affect both air quality and respiratory health. This paper analyzed the interrelationship of satellite-derived fire spot density and annual average particulate matter (PM₂.₅) concentrations with the incidence of respiratory diseases. @*Methodology@#Monthly cases of influenza-like illness (ILI) and pertussis for 2017-2018 in all 17 regions of the Philippines were accessed from the Department of Health (DOH) Epidemiology Bureau. Reported cases per 100,000 population in the Philippines were linked with regional fire spot density and annual mean PM₂.₅ estimates from satellite data, Visible Infrared Imaging Radiometer Suite (VIIRS) active fire data, and Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2), respectively. Linear, logistic, and Poisson models were used to analyze the association between the exposure and outcome variables. @*Results and Discussion@#The highest PM₂.₅ concentrations were observed in Regions IV-A and NCR but fire spot density was relatively lower. High PM₂.₅ levels can be due to other sources in these largely urbanized regions, such as vehicular emission, among others. Similarly, results showed inconclusive association between atmospheric parameters and incidence of ILI and pertussis. Among the variables, pertussis and PM₂.₅ may have the strongest association, albeit p>0.05. Other factors contributing to the increase of disease counts may be explored including vaccine rates and case reporting. @*Conclusion@#There is insufficient evidence to show that fire events and higher PM₂.₅ levels at a regional scale increased the risk for ILI and pertussis in 2017-2018. Further studies may be explored on how satellite-derived atmospheric data can be utilized in respiratory health studies.

Incidência de coqueluche em crianças menores de 1 ano e relação com a vacinação materna no Brasil, 2008 a 2018 / Incidencia de tos ferina en niños menores de 1 año y relación con la vacunación materna en Brasil, 2008 a 2018 / Pertussis incidence in children under 1 year old and relation with maternal vaccination in Brazil, 2008-2018

Objetivo: Analisar o impacto da vacina adsorvida difteria, tétano e coqueluche (pertússis acelular), tipo adulto (dTpa), materna, na incidência de coqueluche em crianças menores de 1 ano no Brasil, de 2008 a 2018. Métodos: Estudo de tipo ecológico, descritivo de tendência temporal, utilizando-se de dados dos sistemas de vigilância do Departamento de Informática do Sistema Único de Saúde (Datasus). Foram calculadas taxas de incidência e razão das taxas de incidência (IRR), com respectivos intervalos de confiança de 95% (IC95%). Resultados: O número de casos de coqueluche foi de 20.650. Houve redução na incidência de coqueluche no período pós-vacinal, de 26,6% (IRR = 0,73; IC95% 0,66;0,82) nas crianças de 3 meses a 1 ano incompleto, e de 63,6% (IRR = 0,36; IC95% 0,15;0,58) nas crianças de zero a 2 meses. Conclusão: O aumento da cobertura da vacinação com dTpa materna correspondeu à redução na incidência de coqueluche, principalmente na faixa etária de zero a 2 meses.

Objetivo: Analizar la incidencia de tos ferina en menores de 1 año y su relación con la cobertura de vacunación materna por la vacuna adsorbida contra la difteria, el tétanos y la tos ferina (tos ferina acelular) tipo adulto (dTpa), de 2008 a 2018, en Brasil. Métodos: Estudio ecológico descriptivo de tendencia temporal utilizando datos de los sistemas de vigilancia del Departamento de Informática do Sistema Único de Saúde (Datasus). Se calcularon los tasas de incidencia y las razones de tasas de incidencia (RTI) con los respectivos intervalos de confianza del 95% (IC95%). Resultados: El número de casos de tos ferina en el período de estudio fue de 20,650. Hubo una reducción en la incidencia de tos ferina en el período post-vacunación. En los niños de 3 meses a 1 año incompleto, la reducción fue del 26,6% (RTI = 0,73; IC95% 0,66;0,82), mientras que en el otro grupo la diferencia relativa fue del 63,6% (RTI = 0,36; IC95% 0,15;0,58)]. Conclusión: La vacunación materna con dTpa coincide con una reducción en la incidencia de tos ferina, especialmente en el grupo de edad de cero a 2 meses.

Objetive: To analyze the impact of maternal vaccination coverage with diphtheria-tetanus-acellular pertussis (Tdap) adsorbed vaccine for adults on pertussis incidence in children under 1 year old in Brazil from 2008 to 2018. Methods: This was a descriptive ecological temporal trend study using data from surveillance systems managed by the Brazilian National Health System Information Technology Department (DATASUS). Incidence rates and incidence rate ratios (IRR) were calculated with respective 95% confidence intervals (95%CI). Results: There were 20,650 pertussis cases in the study period. In the post-vaccination period there was a 26.6% reduction (IRR = 0.73; 95%CI 0.66;0.82) in pertussis incidence among children aged from 3 months up to but not including 1 year old, and a 63.6% reduction (IRR = 0.36; 95%CI 0.15;0.58) among children from birth to 2 months old. Conclusion: The increase in maternal Tdap vaccination coverage coincided with a reduction in pertussis incidence, especially in the birth to two-month-old age group.

Sistema de seguimiento y control eProtect infecciones respiratorias / eProtect respiratory infection monitoring and control system

Las infecciones del tracto respiratorio (ITR) son una de las principales causas de morbilidad y mortalidad en todo el mundo, y representan el 4,4 % de las muertes en todas las edades. A nivel mundial, se han observado disminuciones en la mortalidad causada por las ITR después de la introducción de las vacunas conjugadas contra Haemophilus influenzae tipo b, tos ferina y neumocócica. Sin embargo, las ITR siguen siendo una de las principales causas de mortalidad entre los niños pequeños y los ancianos en los países de ingresos bajos y medios. Se planteó un estudio donde se aplicó un sistema de seguimiento que sirvan para monitorear la vigilancia de las infecciones respiratorias agudas (IRA) en servicios de salud, por laboratorio y en unidades centinela en Perú. Participaron 67 médicos generales o cirujanos de 8 servicios de pediatría. 1453 casos de las IRA fueron de etiología viral, identificando al virus sincitial respiratorio (63,94%), Influenza AH1N1 (16,59%); en el caso de las neumonías bacterianas se aislaron Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae y Streptococcus beta hemolyticus. Durante la última década de reforma del sistema de salud, Perú ha hecho de la construcción de su sistema de APS una prioridad. Sin embargo, el sistema se enfrenta actualmente a desafíos para proporcionar atención de alta calidad y valor a la población debido a deficiencias en varias dimensiones. El sistema de APS ayudará a responder a la transición epidemiológica actual y futura epidemia brotes de manera más eficaz(AU)

Respiratory tract infections (RTIs) are one of the leading causes of morbidity and mortality worldwide, accounting for 4.4% of deaths in all ages. Globally, declines in mortality from RTIs have been observed after the introduction of Haemophilus influenzae type b, pertussis, and pneumococcal conjugate vaccines. However, RTIs remain a leading cause of mortality among young children and the elderly in low- and middle-income countries. A study was proposed where a monitoring system was applied to monitor the surveillance of acute respiratory infections (ARI) in health services, by laboratory and in sentinel units in Peru. A total of 67 general practitioners or surgeons from 8 pediatric services participated. 1453 cases of ARI were of viral aetiology, identifying the respiratory syncytial virus (63.94%), Influenza AH1N1 (16.59%); in the case of bacterial pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus beta hemolyticus were isolated. During the last decade of health system reform, Peru has made building its PHC system a priority. However, the system currently faces challenges in providing high quality and value care to the population due to deficiencies in several dimensions. The PHC system will help respond to current epidemiological transition and future epidemic outbreaks more effectively(AU)

Protective effect of exclusive breastfeeding and effectiveness of maternal vaccination in reducing pertussis-like illness

Abstract Objective: To assess the protective effect of exclusive breastfeeding and the effectiveness of maternal vaccination in reducing pertussis-like illness. Method: This was a case-control study conducted in sentinel hospitals for pertussis in Recife between July 2016 and July 2018. Cases included children aged under six months with symptoms compatible with pertussis (pertussis-like illness). Controls included children aged under six months, living in the metropolitan region of Recife with no diagnosis of pertussis-like illness and matched by the same hospital and birth date. Results: Seventy-three cases and 194 controls were included. The diagnosis of pertussis-like illness was predominantly clinical (97,2%). Amongst the main symptoms, paroxysmal cough was observed in 95.89% of cases and vomiting in 53.4%. There were 29 hospitalized cases and no deaths. Out of the 73 cases, 47 were born to mothers vaccinated against pertussis during pregnancy, and the mothers of 144 of the 194 controls had been vaccinated. The protective effect of breastfeeding was of 74% (95% CI;38%, 89%). Children younger than six months, who were exclusively breastfed and with mothers vaccinated against pertussis during pregnancy were 5 times less likely to develop pertussis-like illness, corresponding to a protection of 79% (95% CI;31%, 94%). The effectiveness of maternal vaccination against pertussis-like illness in children under six months was low (27%) and not statistically significant (CI 95%; −34% a 60%). Conclusions: Exclusive breastfeeding protects children under six months from pertussis-like illness and may be enhanced when associated with maternal vaccination. These strategies should be encouraged because they also protect against pertussis-like illnesses.

Factores que influyen en la adherencia a la vacuna contra la tosferina en mujeres embarazadas en Uruguay / Factors that influence the uptake of pertussis vaccine in pregnant women in Uruguay

Introducción: desde 2015 se ofrece la vacunación contra tosferina de modo universal y gratuito a mujeres embarazadas del Uruguay. Si bien es obligatoria, la cobertura vacunal, aún no es completa. Objetivos: conocer la prevalencia de mujeres embarazadas de dos hospitales públicos de Uruguay que recibieron vacuna dpaT en 2017 y determinar posibles factores que influyen en la adherencia a vacunarse. Métodos: estudio observacional, transversal, descriptivo, mediante encuestas a pacientes cursando puerperio inmediato. Resultados: se analizaron 884 encuestas (edad promedio 25,2 años; 16% adolescentes; la mayoría en pareja y educación secundaria incompleta). Se vacunaron 317 mujeres (36%). Dentro de los factores que se asociaron a la no vacunación se destacan: adolescencia (OR 1,88; IC 95% 1,24-2,85), no tener pareja (OR 1,40; IC 95% 1,04-1,85), no conocer la obligatoriedad de la vacuna (OR 9,44; IC 95% 6,63-13,45), no haber sido informada sobre los beneficios de la vacuna (OR 4; IC 95% 2,43-6,41) y no creer en el beneficio de las vacunas en el embarazo (OR 6,37; IC 95% 4,61-8,78). Discusión: la mayoría de las mujeres embarazadas no recibieron la vacuna dpaT ni tuvieron indicación médica. La falta de información sobre la obligatoriedad y su beneficio, y las creencias con respecto a la vacunación se asociaron a una disminución en la adherencia a la misma. Los profesionales de la salud que atienden mujeres gestantes deben recomendar e informar sobre el beneficio de la vacunación para ellas y el neonato y generar la percepción de riesgo necesaria, como una de las medidas para mejorar la cobertura vacunal.

Background: since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. Aim: to study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. Methods: we conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. Results: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). Discussion: most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.

Factores que influyen en la adherencia a la vacuna contra la tosferina en mujeres embarazadas en Uruguay / Factors that influence the uptake of pertussis vaccine in pregnant women in Uruguay

INTRODUCCIÓN: Desde 2015 se ofrece la vacunación contra tosferina de modo universal y gratuito a mujeres embarazadas del Uruguay. Si bien es obligatoria, la cobertura vacunal, aún no es completa. OBJETIVOS: Conocer la prevalencia de mujeres embarazadas de dos hospitales públicos de Uruguay que recibieron vacuna dpaT en 2017 y determinar posibles factores que influyen en la adherencia a vacunarse. MÉTODOS: Estudio observacional, transversal, descriptivo, mediante encuestas a pacientes cursando puerperio inmediato. RESULTADOS: Se analizaron 884 encuestas (edad promedio 25,2 años; 16% adolescentes; la mayoría en pareja y educación secundaria incompleta). Se vacunaron 317 mujeres (36%). Dentro de los factores que se asociaron a la no vacunación se destacan: adolescencia (OR 1,88; IC 95% 1,24-2,85), no tener pareja (OR 1,40; IC 95% 1,04-1,85), no conocer la obligatoriedad de la vacuna (OR 9,44; IC 95% 6,63-13,45), no haber sido informada sobre los beneficios de la vacuna (OR 4; IC 95% 2,43-6,41) y no creer en el beneficio de las vacunas en el embarazo (OR 6,37; IC 95% 4,61-8,78). DISCUSIÓN: La mayoría de las mujeres embarazadas no recibieron la vacuna dpaT ni tuvieron indicación médica. La falta de información sobre la obligatoriedad y su beneficio, y las creencias con respecto a la vacunación se asociaron a una disminución en la adherencia a la misma. Los profesionales de la salud que atienden mujeres gestantes deben recomendar e informar sobre el beneficio de la vacunación para ellas y el neonato y generar la percepción de riesgo necesaria, como una de las medidas para mejorar la cobertura vacunal.

BACKGROUND: Since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. AIM: To study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. METHODS: We conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. RESULTS: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). DISCUSSION: Most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.

Análisis económico de las vacunas del primer año de vida con componente pertussis en el contexto de la ini-ciativa mundial de erradicación de la poliomielitis en Argentina / Vaccination in children under 1 year with pertussis component in the context of the global initiative for the eradication of poliomyelitis in Argentina: economic analysis

INTRODUCCIÓN: La Iniciativa Mundial de Erradicación de la Polio promueve la introducción de vacuna de polio inactivada (IPV) en sus programas, con la posterior retirada de Sabin (bOPV). OBJETIVO: Construir un modelo de económico que compare diferentes esquemas de vacunación para la prevención de polio y tosferina en el primer año de vida. Material y MÉTODOS: Análisis de cuatro escenarios de vacunación del esquema primario para Argentina, en base a los precios de las vacunas, costos del programa y reactogenicidad de vacuna celular o acelular para Bordetella pertussis: - Escenario 1 (caso base): dos dosis de IPV, una dosis de bOPV y tres dosis de vacuna pentavalente (DTwP-HB-Hib); - Escenario 2: tres dosis IPV y de pentavalente; - Escenario 3: tres dosis de hexavalente (DTaP-HepB-IPV-Hib); - Escenario 4: dos dosis de hexavalente más una dosis de pentavalente más IPV. RESULTADOS: El costo incremental en base al escenario 1 fue de USD 3.716.671; 19.696.668 y 14.383.341 para los escenarios 2, 3 y 4, respectivamente. Para la reactogenicidad, la diferencia fue de USD -14.178.240 comparado el caso base con el escenario 3. DISCUSIÓN: La inversión de incorporación de full IPV y costos asociados se modifica según tipo de vacuna y reactogenicidad asociada al componente B. pertussis.

BACKGROUND: Global Polio Eradication Initiative promotes the introduction of inactivated polio vaccine (IPV) in its programs, with withdrawal of Sabin (bOPV). There is no an economic analysis of the investment related to the incorporation of IPV vaccines together with a whole cell Bordetella pertussis vaccine or combined with acellular hexavalent. AIM: An economic model that compares different vaccination schemes for the prevention of polio and pertussis in the first year of life was carried out. METHODS: Four vaccination scenarios for the primary scheme based on Argentina demographic and costs data were developed: - Scenario 1 (base case): two doses of IPV, one dose of bOPV and three doses of pentavalent (DTwP-HepB-Hib) vaccine; - Scenario 2: three doses of IPV plus three doses of pentavalent; - Scenario 3: three doses of hexavalent; - Scenario 4: two doses of hexavalent plus one dose of pentavalent plus IPV. RESULTS: The incremental cost based on scenario 1 was USD 3.716.671; 19.696.668 and 14.383.341 for scenarios 2, 3 and 4 respectively. In terms of reactogenicity savings was -14.178.240 compared base case with scenario 3. DISCUSSION: Full IPV introduction investment and costs associated were modified according to the type of vaccine and reactogenicity related with the B. pertussis component.

Cambios epidemiológicos y actualidades sobre vacunación contra Bordetella pertussis en Latinoamérica / Epidemiologic changes and novelties on vaccination against Bordetella pertussis in Latin America

Resumen A pesar de que la tosferina (coqueluche) es una enfermedad prevenible por vacunas (EPV), la epidemiología latinoamericana muestra que hay persistencia de brotes en la región. Esta persistencia se debe, al menos en parte, a factores tales como la cobertura vacunal, la presencia de movimientos anti vacunas, la diversidad de los sistemas locales de vigilancia y la falta de una definición de caso unificada para la región. Dada la importancia de la tosferina en Latinoamérica y los cambios ocurridos en las recomendaciones para la vacunación, este manuscrito tiene como objetivo revisar los datos epidemiológicos y los cambios recientes en los calendarios de vacunación y su impacto sobre la enfermedad pediátrica por Bordetella pertussis en Latinoamérica. Los datos epidemiológicos más recientes muestran que entre regiones, países, y segmentos dentro de cada país hay heterogeneidad en la cobertura vacunal, con distintos rebrotes. Esfuerzos en la región han tratado de mejorar esta situación al introducir vacunas acelulares (aP), menos reactogénicas que las vacunas de células enteras (wP) en los calendarios vacunales. Además, algunos países han mejorado la definición de caso confirmado, al introducir la reacción de polimerasa en cadena (RPC) como criterio diagnóstico. En respuesta a las heterogeneidades de cada país y a la epidemiología actual de la región, un Comité de Expertos de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE) y la Asociación Latinoamericana de Pediatría (ALAPE) propone una definición unificada de caso y recomendaciones para mejorar la cobertura vacunal y reducir los brotes de tosferina en Latinoamérica.

Abstract Although whooping cough is a vaccine-preventable disease (VPD), its epidemiologic characteristics in Latin America shows persistence of outbreaks in the region. This persistence is due, at least in part, to the presence of antivaccine movements, the diversity of the surveillance systems, and the lack of a uniform case definition for the region. Given the importance of whooping cough in Latin America and the changes in vaccine recommendations, this manuscript aims to review epidemiologic data and recent changes in the vaccination calendars and their impact on the pediatric disease by Bordetella pertussis in Latin America. Recent epidemiological data reveal that between regions, countries, and administrative units within each country there is a marked heterogeneity of vaccine coverage, with different outbreak patterns. Efforts in the region have tried to improve this situation by introducing acellular pertussis vaccines (aP) in the vaccine calendars, which are less reactogenic than whole-cell pertussis vaccines (wP). Moreover, some countries have improved the case definition. Some countries have implemented a confirmed case definition by introducing polymerase chain reaction (PCR) as a diagnostic criterion. As a response to the heterogeneities observed within and between countries and the regional epidemiologic profiles, a Steering Committee from the Latin American Society for Pediatric Infectiology (SLIPE) and the Latin American Association of Pediatrics (ALAPE) propose a unified case definition and recommendations to improve vaccine coverage and reduce the outbreaks of whooping cough in Latin America.