Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5HT, UK.
BMJ. 2014 Jun 24;348:g3668. doi: 10.1136/bmj.g3668.
To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination.
Prospective cohort study (November 2010 to December 2012).
General practices in Thames Valley, UK.
279 children aged 5 to 15 years who presented in primary care with a persistent cough of two to eight weeks' duration. Exclusion criteria were cough likely to be caused by a serious underlying medical condition, known immunodeficiency or immunocompromise, participation in another clinical research study, and preschool pertussis booster vaccination received less than one year previously.
Evidence of recent pertussis infection based on an oral fluid anti-pertussis toxin IgG titre of at least 70 arbitrary units. Cough frequency was measured in six children with laboratory confirmed pertussis.
56 (20%, 95% confidence interval 16% to 25%) children had evidence of recent pertussis infection, including 39 (18%, 13% to 24%) of 215 children who had been fully vaccinated. The risk of pertussis was more than three times higher (21/53; 40%, 26% to 54%) in children who had received the preschool pertussis booster vaccination seven years or more previously than in those who had received it less than seven years previously (20/171; 12%, 7% to 17%). The risk of pertussis was similar between children who received five and three component preschool pertussis booster vaccines (risk ratio for five component vaccine 1.14, 0.64 to 2.03). Four of six children in whom cough frequency was measured coughed more than 400 times in 24 hours.
Pertussis can still be found in a fifth of school age children who present in primary care with persistent cough and can cause clinically significant cough in fully vaccinated children. These findings will help to inform consideration of the need for an adolescent pertussis booster vaccination in the United Kingdom.
UK Clinical Research Network portfolio ID 8361.
自学龄前百日咳加强疫苗接种的引入和实施以来，估计在初级保健中出现持续咳嗽的学龄儿童中百日咳（百日咳）的患病率和临床严重程度。
前瞻性队列研究（2010 年 11 月至 2012 年 12 月）。
英国泰晤士河谷的普通诊所。
279 名年龄在 5 至 15 岁之间的儿童，他们因持续咳嗽 2 至 8 周而在初级保健中就诊。排除标准为咳嗽可能由严重的潜在疾病引起、已知免疫缺陷或免疫抑制、参加另一项临床研究以及学龄前百日咳加强疫苗接种不到一年前接种。
基于口服液体抗百日咳毒素 IgG 效价至少为 70 个任意单位的近期百日咳感染证据。在六名实验室确诊为百日咳的儿童中测量咳嗽频率。
56 名（20%，95%置信区间 16%至 25%）儿童有近期百日咳感染的证据，其中 215 名完全接种疫苗的儿童中有 39 名（18%，13%至 24%）。在接受学龄前百日咳加强疫苗接种 7 年或以上的儿童中，百日咳的风险是接受该疫苗接种不到 7 年的儿童的三倍以上（53 例中的 21 例，40%，26%至 54%）。接受五组分和三组分学龄前百日咳加强疫苗接种的儿童之间的百日咳风险相似（五组分疫苗的风险比为 1.14，0.64 至 2.03）。在六名测量咳嗽频率的儿童中，有 4 名儿童在 24 小时内咳嗽超过 400 次。
在因持续性咳嗽而在初级保健中就诊的学龄儿童中，仍有五分之一可发现百日咳，并且在完全接种疫苗的儿童中可引起临床显著咳嗽。这些发现将有助于确定英国是否需要青少年百日咳加强疫苗接种。
英国临床研究网络投资组合 ID 8361。
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