Pertussis Surveillance Examples from Europe - vzbb.sk · 1 Pertussis Surveillance Examples from...
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Pertussis SurveillanceExamples from Europe
Johannes G. Liese
Pediatric Infectious Diseases and ImmunologyUniversity Childrens Hospital
Julius-Maximilians-University, Würzburg, Germany
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Pertussis Surveillance
Switzerland
Austria
Sweden
Germany
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Pertussis Surveillance
Switzerland
Austria
Sweden
Germany
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SENTINELLA Network in Switzerland
Established in 1991
Approx. 200 private practice physicians (GPs, pediatricians, internists), 3% of total, representative
Weekly reporting of suspected cases to Swiss PH Office
Free PCR testing offered since 1994
Case definitions:cough lasting for at least 14 days with either an epidemiological link to another pertussis case (epidemic case) or with 1 of the following symptoms: paroxysmal cough, wheezing on inspiration, or post-tussive vomiting (sporadic case)
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SENTINELLA Network in Switzerland
From July 1991 to December 2006, a total of 4992 cases of pertussis were reported
Since 1994, 80.4% (3723 of 4629) of all reported cases have been tested with PCR
904 (24.3%) of these 3723 tested cases were positive for B. pertussis by PCR
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SENTINELLA Network in Switzerland
0
0.05
0.1
0.15
0.2
0.25
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006Year
Cas
es p
er 1
00 c
onsu
ltatio
ns
0
50
100
150
200
250
Num
ber o
f PC
R p
ositi
ve (b
lack
) and
PC
R n
egat
ive
(gre
y) c
ases
manuscript in preparation
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5664717580105
180185165
280
370
70 70
0
50
100
150
200
250
300
350
400
1992 1993 1994 1995 1996 1997 1998 2000 2001 2002 2003 2004 2005
Per 100,000
Prospective studies:Prospective studies:180180--550550
Yearly Estimated Pertussis Incidence in Switzerland (Sentinella 1992-2005)
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Pertussis Epidemiology in Switzerland
0
5
10
15
20
25
0
1-5
6-10
11-1
5
16-2
0
21-2
5
26-3
0
31-3
5
36-4
0
41-4
5
46-5
0
51-6
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61-7
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>70
Age category (years)
Prop
ortio
n of
tota
l num
ber o
f cas
es
repo
rted
durin
g th
e re
spec
tive
time
perio
d (%
)
1991-1999 2000-2006
manuscript in preparation
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SENTINELLA Network in SwitzerlandConclusions
A valuable tool to monitor pertussis disease activity in Switzerland
Further analyses are currently in progress
Probably limited utility by “observer bias” (only “typical cases” reported)
Supported by ongoing pediatric surveillance of hospitalized cases (since 2006)
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Pertussis Surveillance
Switzerland
Austria
Sweden
Germany
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Hospital-based active surveillance of childhood pertussis in Austria from 1996 to 2003
8-year prospective active surveillance of B. pertussis infection including all 44 nationwide paediatric departments
Immunisation schedule: 3 doses at 3-4-5 months followed by a single booster vaccination in the second year of age
Vaccines used1996 to 1997: wcP vaccine1998 to 1999: wcP and acP vaccine 2000 to 2003: aP only (Tetra-, Penta-,Hexavalent)
Rendi-Wagner P et al.- Vaccine. 2006;24(33-34):5960-5
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Pertussis hospitalisation incidence and vaccine coverage in Austria from 1996 to 2003
Rendi-Wagner P et al.- Vaccine. 2006;24(33-34):5960-5
wcP vaccine wcP and acP vaccine acP only
79% 86% 92%
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Pertussis Surveillance
Switzerland
Austria
Sweden
Germany
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Pertussis in Sweden – Data from long-term surveillance 1997-2007
To document long-term control of pertussis incidence using aP vaccines after re-introduction of pertussis vaccination in Sweden
To collect background data for timing of later booster dose(s)
Data from the 10-year Report (1 Oct 1997 – 31 Dec 2007)
Swedish National Surveillance System /Swedish Institute for Infectious Disease Control
CIRC.09/02/PPMH/204
1. Olin P, Hallander HO. Euro Surveill. 1999. 2. Gustafsson L, Carlsson RM. Ten Year Report 1997-2007. 3. Carlsson RM, Trollfors B. Vaccine 2009
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Enhanced prospective surveillance of pertussis disease
NATIONAL COHORT: All children in Sweden* born since January 1, 1996 [1]
ENHANCED SURVEILLANCE OF PERTUSSIS [1]Cases identified in national register of reportsConfirmation of B.pertussis by culture- or PCR, regardless symptoms Detailed documentation:
• vaccination history• clinical course• total duration of cough• presence of complications• hospital admissions• length of hospital stay• antibiotic treatment
* Except cohort from Göteborg area
Gustafsson L, Carlsson RM. Ten Year Report 1997-2007
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Pertussis cases reported in Sweden (1986-2007)
1979 – withdrawal of wcP vaccine in Sweden due to safety concerns [1] 1996 – introduction of aP vaccines, switching from DT to DTaP at 3-5-
12m; 3-dose coverage reached 98-99% within a year. [1]Gustafsson L, Carlsson RM. Ten Year Report 1997-2007
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Age-specific incidence of pertussis in Swedenbefore and after introduction of acP vaccines
Birth cohorts after introduction of acP had a much lower age-specific incidence of pertussis than had the corresponding age-groups before introduction of acP
The modest increase in pertussis incidence approximately 5 years after the aP doses were administered could suggest waning of protection.
Gustafsson L, Carlsson RM. Ten Year Report 1997-2007
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Sweden: Incidence of pertussis episodes, hospitalisation, and complications
Higher risk of pertussis-related hospital admissions/complications Among infants who are unvaccinated before 3mOr with only 1 dose of aP from 3 to <5m
Gustafsson L, Carlsson RM. Ten Year Report 1997-2007
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Sweden: Incidence of pertussis in National compared to DT-2aP-Hib-Polio cohort: 1997-2007
The reduced incidence rates of pertussis seen in the DT-2aP-Hib-Polio Vaccine cohort are similar to the rates observed in the national cohort. [1,3]
Gustafsson L, Carlsson RM. Ten Year Report 1997-2007
DT-2aP-Hib-Polio Vaccine
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Sweden: Summary of experience with aP combined vaccines
The introduction of acP vaccines has reduced the incidence of pertussis in Sweden [1]
Before vaccine reintroduction = 121-150 per 100,000 (1993-1995)After acP introduction = 6-16 per 100,000 (2001-2007)
PentaximTM is effective in preventing pertussis in infants and children. [1,3]
The age-specific incidence rates of pertussis seen in the Pentaxim™ cohort are similar to the rates observed in the national cohort
[1] Gustafsson L, Carlsson RM. TEN YEAR REPORT – Pertussis surveillance in Sweden progress report October 1, 1997 – December 31, 2007. [3] Gustafsson L, Carlsson RM. Appendix 2 to Ten-year Report;October 1, 1997 until December 31, 2007
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Pertussis Surveillance
Switzerland
Austria
Sweden
Germany
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Incidence of notified pertussis cases 1947-2007 (Germany: FWG/FEG)
Hellenbrand W et al. BMC Infectious Diseases 2009
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Incidence of Pertussis East Germany 1983 – 2005
19900,4
200020,4
19801,0
12,3
200639,3
200528,3
1980 1990 2000
C. Huelße / Robert-Koch Institut / Epidemiologisches Bulletin Nr. 23 – 2005
Hellenbrand W et al. BMC Infectious Diseases 2009
20070
5
10
15
20
25
30
35
40
45
Pert
ussi
s ca
ses
/ 100
,000
inha
bita
nts
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Confirmation of cases 2002-2007
Laboratory confirmed: 93.8%
Epidemiological link: 1.9%
Clinical case only: 4.4%
Hellenbrand W et al. BMC Infectious Diseases 2009
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Laboratory confirmation of cases 2002-2007
Culture:1.0%
PCR:9.8%
Increase in antibodies:26.9%
Single high titre:56.2%
Hellenbrand W et al. BMC Infectious Diseases 2009
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Age distribution of notified cases in former East Germany
Hellenbrand W et al. BMC Infectious Diseases 2009
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Age distribution of Pertussis East Germany 2001 – 2006
10%
3%
24%
13%
22%
25%
12%
0 - <1 1 - <5 5 - <15 15 - <25 25 - <45 45 - <65 >65 Age
C. Huelße / Robert-Koch Institut / Epidemiologisches Bulletin Nr. 23 – 2005
60%
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Notified cases in former East German states: Saxony (Fig. B) introduced pre-school booster in 1998
Saxonywith preschool booster
Brandenburg, Mecklenburg WesternPomerania, Saxony Anhalt and Thuringia:
no preschool booster
Hellenbrand W et al. BMC Infectious Diseases 2009
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Hospitalized cases in former East Germany (FEG) and former West Germany (FWG)
Hellenbrand W et al. BMC Infectious Diseases 2009
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Vaccination Strategies in Germany Vaccination advisory board (STIKO)
1976 to 1991No pertussis vaccinationEndemic pertussis
1994 Rapid uptake and high coverage after licensure of aP-vaccines
1995-1999pertussis incidence
observed in adolescents
1999-2003pertussis incidence in
infants 2000-2006
pertussis incidence in school age children
pertussis incidence in adults
19914 doses pertussis vaccine schedule in all infants and toddlers
2000all adolescents 9-17 yrs (1 dose)health and childcare workers
(every 10 years)2004
Cocoon strategy2006
Preschool booster 2009
First adult dose recommended
STIKO Robert-Koch-Institut Epidemiologisches Bulletin 2000 - 2009
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Vaccination Calendar (STIKO) for Infants, Children, and Adolescents in Germany - 2009
Age in months Age in years
Vaccine Birth 2 3 4 11-14 15-23 5-6 9-17
DTaP 1. 2. 3. 4. TdaP B B
Hib 1. 2. 3. 4.
IPV 1. 2. 3. 4. B
HB (1.) 1. 2. 3. 4. P
Pneumococc. 1. 2. 3. 4.
Meningococc. 1.
MMR 1. 2.
Varicella 1. (2.) P
+ 1 dose aP in contacts of neonates (Cocoon strategy)
STIKO Robert-Koch-Institut Epidemiologisches Bulletin 2000 - 2009
+ 1 dose aP ten year after adolescent dose
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Pertussis SurveillanceExamples from Europe
Switzerland Surveilance in a high endemic country
Austria Effectiveness of acP program against pertussis hospitalization
SwedenEffectiveness of 2- and 3-component acP vaccine in reducing the burden of pertussis disease
GermanyDevelopment of vaccine recommendations following changes in epidemiology
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