Zumstein Jana, Heininger Ulrich
University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology Unit, Basel, Switzerland.
University of Basel, Faculty of Medicine, Basel, Switzerland.
Swiss Med Wkly. 2021 Dec 13;151:w30064. doi: 10.4414/smw.2021.w30064. eCollection 2021 Dec 6.
Surveillance of pertussis at a national level is important to collect information on the epidemiology of the disease and to design optimal immunisation strategies. After an initial surveillance period for pertussis in hospitalised children in Switzerland from 2006 to 2010, new recommendations (including immunisation in pregnancy) were implemented in the national pertussis immunisation schedule in 2013. To monitor its effects, surveillance was resumed in 2013 and concluded in 2020.
From 1 January 2013 to 31 December 2020, hospitalised children under the age of 16 years with suspected or proven Bordetella pertussis infection were reported to the Swiss Paediatric Surveillance Unit. We analysed epidemiological and clinical characteristics for all patients who fulfilled the clinical case definition of pertussis (physician diagnosis, cough lasting ≥14 days in combination with at least one of the following symptoms: paroxysmal cough, whooping or post-tussive vomiting, or apnoea not otherwise explained in patients under the age of 12 months) with and without laboratory confirmation (polymerase chain reaction, culture or serology).
220 of the 306 reported cases met the inclusion criteria. Of these, 214 (97%) were laboratory-confirmed B. pertussis infections: 209 by polymerase chain reaction and 5 by culture from nasopharyngeal specimens. 172/220 (78%) patients were infants under six months of age at the day of hospitalisation. The mean annual hospitalisation rate for pertussis was 27.9 per 100,000 children for infants and 2.1 per 100,000 in all children <16 years of age. Of the 115 cases with precise records of immunisation, 50 (43%) were unimmunised, 3 (3%) were incompletely immunised and 62 (54%) were up to date with their immunisation status according to their age, including 10 (9%) whose next doses were due. However, most patients with an up-to-date immunisation status (85%) were still too young to have completed their primary series, leaving only eight cases of vaccine failure. Only 5 of the 172 infants <6 months of age had mothers who had been vaccinated during pregnancy.
After the introduction of immunisation in pregnancy in Switzerland, hospitalisation rates in infants declined. However, the remaining cases call for increased efforts towards more complete and timely immunisation of children, those in close contact with children, and pregnant women.
在国家层面监测百日咳对于收集该疾病的流行病学信息以及制定最佳免疫策略至关重要。在2006年至2010年对瑞士住院儿童进行百日咳初步监测之后，2013年在国家百日咳免疫计划中实施了新的建议（包括孕期免疫）。为监测其效果，2013年恢复监测并于2020年结束。
2013年1月1日至2020年12月31日，疑似或确诊为百日咳博德特氏菌感染的16岁以下住院儿童被报告给瑞士儿科监测单位。我们分析了所有符合百日咳临床病例定义（医生诊断，咳嗽持续≥14天并伴有以下至少一种症状：阵发性咳嗽、鸡鸣样吼声或咳嗽后呕吐，或12个月以下儿童出现无法用其他原因解释的呼吸暂停）且有或无实验室确诊（聚合酶链反应、培养或血清学检测）的患者的流行病学和临床特征。
306例报告病例中有220例符合纳入标准。其中，214例（97%）为实验室确诊的百日咳博德特氏菌感染：209例通过聚合酶链反应确诊，5例通过鼻咽标本培养确诊。172/220例（78%）患者在住院当天为6个月以下婴儿。百日咳的年平均住院率在婴儿中为每10万名儿童27.9例，在所有16岁以下儿童中为每10万名儿童2.1例。在115例有精确免疫记录的病例中，50例（43%）未接种疫苗，3例（3 %）接种不完全，62例（54%）根据年龄免疫状态正常，其中10例（9%）下次接种时间已到。然而，大多数免疫状态正常的患者（85%）年龄仍太小，尚未完成基础免疫系列接种，仅有8例疫苗接种失败。172例6个月以下婴儿中只有5例的母亲在孕期接种过疫苗。
瑞士实施孕期免疫后，婴儿住院率下降。然而，其余病例表明需要加大力度，使儿童、与儿童密切接触者以及孕妇更全面、及时地接种疫苗。
