Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil.
Escola Bahiana de Medicina e Saúde, Salvador, Bahia, Brazil.
PLoS One. 2020 Sep 11;15(9):e0238932. doi: 10.1371/journal.pone.0238932. eCollection 2020.
Pertussis, a severe respiratory infection caused by Bordetella pertussis, is distributed globally. Vaccination has been crucial to annual reductions in the number of cases. However, disease reemergence has occurred over the last decade in several countries, including Brazil. Here we describe the clinical and epidemiological aspects of suspected pertussis cases in Salvador, Brazil, and evaluate factors associated with case confirmation. This descriptive and retrospective study was conducted in the five hospitals in Salvador that reported the highest number of pertussis cases between 2011-2016. Demographic and clinical data were recorded for each patient. Bivariate analysis was performed to evaluate differences between groups (confirmed vs. unconfirmed cases) using Pearson's Chi-square test or Fisher's exact test. Results: Of 529 suspected pertussis cases, 29.7% (157/529) were confirmed by clinical, clinical-epidemiological or laboratory criteria, with clinical criteria most frequently applied (63.7%; 100/157). Unvaccinated individuals (43.3%; 68/157) were the most affected, followed by age groups 2-3 months (37.6%; 59/157) and <2 months (31.2%; 49/157). Overall, ≤50% of the confirmed cases presented a complete vaccination schedule. All investigated cases presented cough in association with one or more symptoms, especially paroxysmal cough (66.9%; 105/529) (p = 0.001) or cyanosis (66.2%; 104/529) (p<0.001). Our results indicate that pertussis occurred mainly in infants and unvaccinated individuals in Salvador, Brazil. The predominance of clinical criteria used to confirm suspected cases highlights the need for improvement in the laboratory tools used to perform rapid diagnosis. Fluctuations in infection prevalence demonstrate the importance of vaccination strategies in improving the control and prevention of pertussis.
百日咳是由百日咳博德特氏菌引起的一种严重呼吸道感染，在全球范围内均有分布。疫苗接种对于每年减少病例数量至关重要。然而，在过去十年中，包括巴西在内的几个国家都出现了疾病再次爆发的情况。在这里，我们描述了巴西萨尔瓦多疑似百日咳病例的临床和流行病学特征，并评估了与病例确诊相关的因素。这项描述性和回顾性研究在 2011 年至 2016 年间报告百日咳病例数最高的萨尔瓦多的五家医院进行。记录了每位患者的人口统计学和临床数据。使用 Pearson 卡方检验或 Fisher 确切检验对组间差异（确诊病例与未确诊病例）进行了双变量分析。结果：在 529 例疑似百日咳病例中，29.7%（157/529）通过临床、临床-流行病学或实验室标准确诊，其中最常应用临床标准（63.7%；100/157）。未接种疫苗的个体（43.3%；68/157）受影响最严重，其次是 2-3 个月龄（37.6%；59/157）和<2 个月龄（31.2%；49/157）的个体。总体而言，确诊病例中仅有≤50%的个体完成了完整的疫苗接种计划。所有调查病例均表现出咳嗽，并伴有一种或多种症状，特别是阵发性咳嗽（66.9%；105/529）（p=0.001）或发绀（66.2%；104/529）（p<0.001）。我们的结果表明，在巴西萨尔瓦多，百日咳主要发生在婴儿和未接种疫苗的个体中。用于确诊疑似病例的临床标准占主导地位，这突出表明需要改进用于进行快速诊断的实验室工具。感染流行率的波动表明，疫苗接种策略对于改善百日咳的控制和预防至关重要。
