Hellenbrand Wiebke, Beier Dietmar, Jensen Evelin, Littmann Martina, Meyer Christiane, Oppermann Hanna, Wirsing von König Carl-Heinz, Reiter Sabine
Immunisation Division, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
BMC Infect Dis. 2009 Feb 25;9:22. doi: 10.1186/1471-2334-9-22.
Current and past pertussis epidemiology in the two parts of Germany is compared in the context of different histories of vaccination recommendations and coverage to better understand patterns of disease transmission.
Available regional pertussis surveillance and vaccination coverage data, supplemented by a literature search for published surveys as well as official national hospital and mortality statistics, were analyzed in the context of respective vaccination recommendations from 1964 onwards.
Routine childhood pertussis vaccination was recommended in the German Democratic Republic (GDR) from 1964 and in former West German states (FWG) from 1969, but withdrawn from 1974-1991 in FWG. Pertussis incidence declined to <1 case/100,000 inhabitants in GDR prior to reunification in 1991, while in FWG, where pertussis was not notifiable after 1961, incidence was estimated at 160-180 cases/100,000 inhabitants in the 1970s-1980s. Despite recommendations for universal childhood immunization in 1991, vaccination coverage decreased in former East German States (FEG) and increased only slowly in FWG. After introduction of acellular pertussis vaccines in 1995, vaccination coverage increased markedly among younger children, but remains low in adolescents, especially in FWG, despite introduction of a booster vaccination for 9-17 year olds in 2000. Reported pertussis incidence increased in FEG to 39.3 cases/100,000 inhabitants in 2007, with the proportion of adults increasing from 20% in 1995 to 68% in 2007. From 2004-2007, incidence was highest among 5-14 year-old children, with a high proportion fully vaccinated according to official recommendations, which did not include a preschool booster until 2006. Hospital discharge statistics revealed a ~2-fold higher pertussis morbidity among infants in FWG than FEG.
The shift in pertussis morbidity to older age groups observed in FEG is similar to reports from other countries with longstanding vaccination programs and suggests that additional booster vaccination may be necessary beyond adolescence. The high proportion of fully vaccinated cases in older children in FEG suggests waning immunity 5-10 years after primary immunisation in infancy. The higher incidence of pertussis hospitalisations in infants suggests a stronger force of infection in FWG than FEG. Nationwide pertussis reporting is required for better evaluation of transmission patterns and vaccination policy in both parts of Germany.
在德国两部分地区不同的疫苗接种建议历史和覆盖率背景下，比较当前和过去的百日咳流行病学情况，以更好地了解疾病传播模式。
分析现有的地区百日咳监测和疫苗接种覆盖率数据，并通过文献检索已发表的调查以及官方国家医院和死亡率统计数据，结合1964年以来各自的疫苗接种建议进行分析。
1964年起德意志民主共和国（东德）推荐常规儿童百日咳疫苗接种，1969年起前西德各州（西德）也开始推荐，但西德在1974 - 1991年期间取消了该疫苗接种。1991年两德统一前，东德的百日咳发病率降至每10万居民<1例，而在西德，1961年后百日咳不再作为法定报告疾病，据估计20世纪70年代至80年代的发病率为每10万居民160 - 180例。尽管1991年建议对儿童进行普遍免疫接种，但前东德各州（前东德）的疫苗接种覆盖率下降，而西德仅缓慢上升。1995年引入无细胞百日咳疫苗后，年幼儿童的疫苗接种覆盖率显著提高，但青少年中的覆盖率仍然较低，尤其是在西德，尽管2000年为9 - 17岁儿童引入了加强疫苗接种。前东德的报告百日咳发病率在2007年增至每10万居民39.3例，成人所占比例从1995年的20%增至2007年的68%。2004 - 2007年期间，5 - 14岁儿童的发病率最高，根据官方建议，这一年龄组中有很高比例的儿童已完全接种疫苗，不过直到2006年才包括学龄前加强疫苗接种。医院出院统计数据显示，西德婴儿的百日咳发病率比前东德高约2倍。
在前东德观察到的百日咳发病向年龄较大人群转移的情况与其他长期开展疫苗接种计划的国家的报告相似，这表明青春期后可能需要额外的加强疫苗接种。前东德年龄较大儿童中完全接种疫苗的病例比例较高，这表明婴儿期初次免疫接种5 - 10年后免疫力逐渐下降。婴儿百日咳住院率较高表明西德的感染力比前东德更强。为了更好地评估德国两部分地区的传播模式和疫苗接种政策，需要在全国范围内报告百日咳情况。
