Wensley A, Hughes G J, Campbell H, Amirthalingam G, Andrews N, Young N, Coole L
Field Epidemiology Service,National Infections Service,Public Health England,Leeds,UK.
Immunisation, Hepatitis and Blood Safety,Public Health England,London,UK.
Epidemiol Infect. 2017 Apr;145(5):1025-1036. doi: 10.1017/S0950268816002983. Epub 2017 Jan 9.
Pertussis is a vaccine-preventable respiratory infection caused by Bordetella pertussis which can be fatal in infants. Although high vaccine coverage led to prolonged disease control in England, a national outbreak of pertussis in 2011 led to the largest increase in over two decades, including a marked increase in cases aged ⩾15 years. A case-control study in four regions of England was undertaken to investigate risk factors for pertussis in adolescents and adults, specifically employment type and professional and household contact with children. Pertussis cases were laboratory-confirmed and aged ⩾15 years. Controls were recruited through general practitioner nomination. Demographic and risk factor information were collected using an online survey. Multivariable logistic regression was used to estimate independent associations with outcome. Two hundred and thirty-one cases and 190 controls were recruited. None of the four employment variables (social care, education, health sector, patient contact) were significantly associated with pertussis. Professional contact with children aged < 1 year was associated with a significantly reduced odds of pertussis [odds ratio (OR) 0·25, 95% confidence interval (CI) 0·08-0·78, P = 0·017]. Household contact with ⩾1 child aged 10-14 years was associated with significantly increased odds of pertussis (OR 2·61, 95% CI 1·47-4·64, P = 0·001). Occupational contact with very young children was associated with reduced odds of pertussis, probably due to immune boosting by low-level exposures to B. pertussis. Sharing a household with a young adolescent was a significant risk factor for pertussis in adults and older teenagers. The primary focus of the childhood pertussis vaccination programmes is to prevent infant disease. Although evidence is emerging that adolescent vaccination does not provide indirect protection to infants, our results highlight the importance of children aged 10-14 years in pertussis transmission to older adolescents and adults.
百日咳是一种由百日咳博德特氏菌引起的可通过疫苗预防的呼吸道感染，在婴儿中可能致命。尽管高疫苗接种率使英国的疾病控制得以长期维持，但2011年的全国百日咳疫情导致病例数在二十多年来出现最大幅度增长，其中15岁及以上病例显著增加。在英格兰的四个地区开展了一项病例对照研究，以调查青少年和成人患百日咳的风险因素，特别是就业类型以及与儿童的职业和家庭接触情况。百日咳病例经实验室确诊且年龄在15岁及以上。对照通过全科医生提名招募。使用在线调查收集人口统计学和风险因素信息。采用多变量逻辑回归来估计与结局的独立关联。共招募了231例病例和190名对照。四个就业变量（社会护理、教育、卫生部门、与患者接触）均与百日咳无显著关联。与1岁以下儿童有职业接触与百日咳发病几率显著降低相关[比值比（OR）0.25，95%置信区间（CI）0.08 - 0.78，P = 0.017]。与一名或多名10 - 14岁儿童有家庭接触与百日咳发病几率显著增加相关（OR 2.61，95% CI 1.47 - 4.64，P = 0.001）。与非常年幼的儿童有职业接触与百日咳发病几率降低相关，可能是由于低水平接触百日咳博德特氏菌导致免疫增强。与青少年同住是成人和大龄青少年患百日咳的一个重要风险因素。儿童百日咳疫苗接种计划的主要重点是预防婴儿患病。尽管越来越多的证据表明青少年接种疫苗并不能为婴儿提供间接保护，但我们的结果凸显了10 - 14岁儿童在百日咳传播给大龄青少年和成人过程中的重要性。
