Family physician at the Queen Charlotte Medical Clinic in British Columbia and Clinical Assistant Professor in the Faculty of Medicine at the University of British Columbia.
Public health nurse in Queen Charlotte.
Can Fam Physician. 2018 Jul;64(7):e317-e324.
To present characteristics of and response to a large outbreak of pertussis on Haida Gwaii, BC, in 2014.
Quantitative descriptive review.
Haida Gwaii, a remote island archipelago located 100 km off of British Columbia's west coast.
All patients presenting with symptoms evaluated for pertussis on Haida Gwaii between February and August 2014.
The primary outcome measures included the demographic characteristics, time course, and morbidity of the outbreak. The secondary outcome measures included the laboratory result reports, the effects on clinician workload, and the treatment and prophylaxis practices. Statistical analysis for significance of pertussis severity and immunization status was performed with a maximum-likelihood framework.
Between February and August 2014, out of 873 clinical encounters, 579 patients were seen for pertussis-related care. Of these, 260 patients were reported to public health for case identification, contact tracing, and follow-up. There were 123 cases of probable and confirmed pertussis, a case rate of 2795 cases per 100 000 population. Of these 123 cases, 91 had a cough of more than 2 weeks' duration. A subset of patients presented with mild symptoms, atypical of pertussis. Nasopharyngeal swabs were collected on 221 occasions, 378 antibiotic prescriptions were written, and 248 prophylactic immunizations were given. The odds ratio that previous immunization protected against the development of classic pertussis was 0.23; however, statistical significance was not reached ( = .112).
Pertussis is resurging. Physicians need to remain vigilant for its characteristic symptoms. Clear and standardized criteria for the declaration of an outbreak should be developed. To contain an outbreak, it is crucial to deploy resources commensurate with disease activity while coordinating public health and primary care. More research into why large outbreaks continue to occur, why endemic rates continue to rise, and how these can be most effectively prevented is essential.
介绍 2014 年不列颠哥伦比亚省海达瓜伊岛（Haida Gwaii）百日咳大暴发的特征和应对措施。
定量描述性综述。
海达瓜伊，位于不列颠哥伦比亚省西海岸外 100 公里处的一个偏远岛屿群岛。
2014 年 2 月至 8 月期间在海达瓜伊岛出现百日咳症状并接受评估的所有患者。
主要观察指标包括暴发的人口统计学特征、时间进程和发病率。次要观察指标包括实验室结果报告、对临床医生工作量的影响以及治疗和预防措施。使用最大似然框架对百日咳严重程度和免疫接种状况的统计学意义进行分析。
2014 年 2 月至 8 月期间，在 873 例临床就诊中，有 579 例因百日咳相关护理就诊。其中，260 例患者向公共卫生部门报告以进行病例识别、接触者追踪和随访。有 123 例确诊和可能的百日咳病例，发病率为每 100 000 人口 2795 例。在这 123 例病例中，91 例咳嗽持续时间超过 2 周。有一部分患者表现出轻微症状，不典型。共采集了 221 份鼻咽拭子样本，开了 378 份抗生素处方，提供了 248 次预防免疫接种。先前免疫接种对发展为典型百日咳的保护作用的优势比为 0.23；然而，未达到统计学意义（ =.112）。
百日咳正在死灰复燃。医生需要对其特征性症状保持警惕。应制定明确和标准化的暴发宣言标准。为了控制暴发，必须根据疾病活动情况调配资源，同时协调公共卫生和初级保健。开展更多研究，了解为何大型暴发仍在继续、为何流行率持续上升，以及如何最有效地预防这些问题至关重要。
