McDonald Scott A, Teunis Peter, van der Maas Nicoline, de Greeff Sabine, de Melker Hester, Kretzschmar Mirjam E
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, Netherlands.
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, Netherlands.
BMC Infect Dis. 2015 Dec 29;15:588. doi: 10.1186/s12879-015-1324-y.
Despite high vaccination coverage, infection with Bordetella pertussis is a current public health concern in the Netherlands and other European Union member states. Because surveillance data are subject to extensive under-ascertainment and under-reporting, incidence is difficult to determine. Our objective was to estimate the age-group specific incidence of symptomatic pertussis infection in the Netherlands over the period 2005-2011, using multi-parameter evidence synthesis.
Age-specific seroconversion probabilities were estimated for 2007 using Netherlands population data stratified by age-group and cross-sectional population-wide serosurvey (PIENTER-2) data, with a sero-diagnostic cut-off of 125 EU/ml as a proxy for recent infection. Symptomatic probabilities were derived from a study of household contacts and from PIENTER-2. The annual number of symptomatic infected (SI) persons was estimated using evidence synthesis methods in a Bayesian framework, by combining the estimated incidence of infection with notification data and symptomatic probabilities.
An incidence rate of 128 SI cases per 10,000 population (95 % credible interval [CrI]: 110-150) was estimated for 2005, which decreased to 107 per 10,000 (95 % CrI: 91-126) for 2011. The degree of underestimation in statutory notified cases was age-dependent, ranging from 10-fold (10-19 years) to 69-fold (60+ years). The largest annual decreases in SI incidence rate over the study period were in the 1-4 and 5-9 years age-groups (24.3 %, 15.9 % per year, respectively).
By synthesising all available data, the incidence of symptomatic pertussis and the extent to which SI is underrepresented by notification data can be estimated. Such estimates are essential for disease burden computation and for informing public health priority-setting.
尽管疫苗接种覆盖率很高，但百日咳博德特氏菌感染仍是荷兰及其他欧盟成员国当前关注的公共卫生问题。由于监测数据存在大量漏查和漏报情况，发病率难以确定。我们的目标是通过多参数证据综合法估算2005年至2011年期间荷兰有症状百日咳感染的年龄组特异性发病率。
利用按年龄组分层的荷兰人口数据和全人群横断面血清学调查（PIENTER - 2）数据，以125 EU/ml的血清诊断临界值作为近期感染的替代指标，估算2007年各年龄组的血清转化概率。有症状概率来自一项家庭接触者研究和PIENTER - 2。在贝叶斯框架下，通过将估计的感染发病率与通报数据及有症状概率相结合，采用证据综合法估算每年有症状感染（SI）人数。
2005年估计发病率为每10000人中有128例SI病例（95%可信区间[CrI]：110 - 150），2011年降至每10000人中有107例（95% CrI：91 - 126）。法定通报病例的低估程度因年龄而异，从10倍（10 - 19岁）到69倍（60岁及以上）不等。在研究期间，SI发病率年度下降幅度最大的是1 - 4岁和5 - 9岁年龄组（分别为每年24.3%、15.9%）。
通过综合所有可用数据，可以估算有症状百日咳的发病率以及通报数据对SI代表性不足的程度。此类估计对于疾病负担计算和为公共卫生优先事项设定提供信息至关重要。
