Heil Jeanne, Ter Waarbeek Henriëtte L G, Hoebe Christian J P A, Jacobs Peter H A, van Dam Dirk W, Trienekens Thera A M, Cals Jochen W L, van Loo Inge H M, Dukers-Muijrers Nicole H T M
Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.
Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
Euro Surveill. 2017 Jul 13;22(28). doi: 10.2807/1560-7917.ES.2017.22.28.30571.
Pertussis is most severe among unvaccinated infants (< 1 year of age), and still leads to several reported deaths in the Netherlands every year. In order to avoid pertussis-related infant morbidity and mortality, pertussis surveillance data are used to guide pertussis control measures. However, more insight into the accuracy of pertussis surveillance and control, and into the range of healthcare and public health-related factors that impede this are needed. We analysed a unique combination of data sources from one Dutch region of 1.1 million residents, including data from laboratory databases and local public health notifications between 2010 and 2013. This large study (n = 12,090 pertussis tests) reveals possible misdiagnoses, substantial under-notification (18%, 412/2,301 laboratory positive episodes) and a delay between patient symptoms and notification to the local public health services (median 34 days, interquartile range (IQR): 27-54). It is likely that the misdiagnoses, under-notification and overall delay in surveillance data are not unique to this area of the Netherlands, and are generalisable to other countries in Europe. In addition to preventive measures such as maternal immunisation, based on current findings, we further recommend greater adherence to testing guidelines, standardisation of test interpretation guidelines, use of automatic notification systems and earlier preventive measures.
百日咳在未接种疫苗的婴儿（<1岁）中最为严重，并且在荷兰每年仍有几例死亡报告。为了避免与百日咳相关的婴儿发病和死亡，百日咳监测数据被用于指导百日咳控制措施。然而，需要更深入了解百日咳监测和控制的准确性，以及阻碍这一过程的一系列医疗保健和公共卫生相关因素。我们分析了来自荷兰一个拥有110万居民的地区的独特数据源组合，包括2010年至2013年期间实验室数据库和当地公共卫生通知的数据。这项大型研究（n = 12,090次百日咳检测）揭示了可能的误诊、大量漏报（18%，412/2,301次实验室确诊病例）以及患者出现症状到通知当地公共卫生服务机构之间的延迟（中位数34天，四分位间距（IQR）：27 - 54天）。监测数据中的误诊、漏报和总体延迟可能并非荷兰这一地区所独有，而是欧洲其他国家也普遍存在的情况。除了诸如孕产妇免疫等预防措施外，基于当前研究结果，我们进一步建议更严格遵守检测指南、统一检测结果解读指南、使用自动通知系统以及更早采取预防措施。
