Singh Meenu, Lingappan Krithika
Post Graduate Institute of Medical Education and Research, Chandigarh, India 160012.
Chest. 2006 Nov;130(5):1547-53. doi: 10.1378/chest.130.5.1547.
Pertussis, a highly contagious disease caused by Bordetella pertussis, is making a comeback globally despite good immunization coverage. The developed countries have also shown a shift in the epidemiology of the disease to the adolescent and the adult age group, leading to a revision of their vaccination policies. The disease epidemiology in the South East Asian region seems poised for a similar change. Outbreaks have been reported among children and adults in countries such as Afghanistan, Israel, and Taipei. The anticipation and early recognition of this change in the epidemiology is important because the affected adolescents and adults act as reservoirs of the disease to the vulnerable population of infants, for whom the disease can be life threatening. The clinical presentation can be atypical in the adolescent age group, and the disease is often misdiagnosed. With the availability of polymerase chain reaction and serology, the disease can be diagnosed even later in the course of the disease when culture results are often negative. The whole-cell pertussis vaccine dramatically reduced the incidence of the disease but fell into disrepute due to the rare serious neurologic side effects that led to the introduction of the acellular pertussis vaccine, which led to fewer adverse reactions and also proved to be safe and effective in the adolescent age group when used as a booster. However, the cost of the acellular vaccine is may be prohibitive for widespread use in the developing nations of the South East Asian region.
百日咳是一种由百日咳博德特氏菌引起的高度传染性疾病，尽管免疫接种覆盖率良好，但它正在全球范围内卷土重来。发达国家的疾病流行病学也已转向青少年和成年年龄组，导致其疫苗接种政策有所修订。东南亚地区的疾病流行病学似乎也将发生类似变化。在阿富汗、以色列和台北等国家，儿童和成人中均有疫情报告。预期并尽早认识到这种流行病学变化很重要，因为受影响的青少年和成年人是该疾病对婴儿脆弱人群的传染源，而该疾病对婴儿可能会危及生命。青少年年龄组的临床表现可能不典型，该疾病常常被误诊。随着聚合酶链反应和血清学检测方法的出现，即使在疾病后期培养结果往往为阴性时也能诊断出该疾病。全细胞百日咳疫苗曾大幅降低了该疾病的发病率，但因罕见的严重神经副作用而声名狼藉，这导致了无细胞百日咳疫苗的引入，后者不良反应较少，并且在用作加强针时在青少年年龄组中也被证明是安全有效的。然而，无细胞疫苗的成本对于东南亚地区的发展中国家广泛使用来说可能过高。
