Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Active Surveillance of Pertussis in Infants Under 6 Months of Age: A Single Center Experience from 2011 to 2013

생후 6개월 미만의 영아에서 백일해에 대한 적극적인 감시활동: 2011-2013년 단일기관 연구

  • Han, Young Ik (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Choi, Ji Yeon (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Lee, Hyewon (Division of Microbiology, Gyeonggido Public Institute of Health and Environment) ;
  • Lee, Teak-Jin (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • 한영익 (CHA의과학대학교 분당차병원 소아청소년과) ;
  • 최지연 (CHA의과학대학교 분당차병원 소아청소년과) ;
  • 이혜원 (경기도 보건환경연구원 미생물분과) ;
  • 이택진 (CHA의과학대학교 분당차병원 소아청소년과)
  • Received : 2014.03.14
  • Accepted : 2014.05.13
  • Published : 2014.08.25
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Abstract

Purpose: The objective of this study was to assess and investigate the epidemiology of pertussis in infants under 6 months of age. Methods: A prospective study was conducted between October 1, 2011 and April 30, 2013 in CHA Bundang Medical Center, Seongnam, South Korea. Polymerase chain reaction (PCR) or culture was used to detect Bordetella pertussis in nasopharyngeal aspirates from case patients who were hospitalized for acute lower respiratory tract infection (LRTI). In addition, multiplex real-time PCR assays were also performed to detect 6 etiologic viruses, including adenovirus, human metapeumo-virus, influenza virus, parainfluenza virus, respiratory syncytial virus and rhinovirus. Results: Of the 79 enrolled case patients, whose median age was 2 months of age, the most common diagnoses uncovered in this study were acute bronchiolitis (60%) and pneumonia (28%). B. pertussis infection was found in 13 cases (16%), in which 7 (53%) was coinfected with respiratory syncytial virus and 1 (7%) with influenza A virus. Of the 13 patients with B. pertussis infection, 6 (46%) were not vaccinated with the diphtheria, tetanus toxoid, and acellular pertussis vaccine, while 6 (46%) received 1 dose, and 1 (8%) received 2 doses. Conclusion: B. pertussis infection was present in 16% of under 6 month-old infants, who were hospitalized for acute LRTI. Therefore, a nationwide epidemiological surveillance of pertussis, including institutions that cater to infants under 6 months of age is necessary and needed.

목적: 본 연구에서는 6개월 미만의 영아를 대상으로 백일해의 기초적인 역학조사를 확인하고자 단일 기관에서 실시하였다. 방법: 2011년 10월부터 2013년 4월까지 분당 차병원에 내원한 진찰 당시 호흡기계 증상을 보여서 입원한 생후 6개월 미만의 영아들을 대상으로 비인두 흡입물로 B. pertussis PCR 또는 배양검사를 시행하였다. 또한 respiratory syncytial virus, adenovirus, metapneumo-virus, rhinovirus, parainfluenza virus, influenza A, B virus 포함한 호흡기 바이러스들에 대한 multiplex RT-PCR 검사를 시행 후 분석하였다. 결과: 대상 환아 수는 총 79례였으며 환아 연령 중앙값은 2개월이었고 대부분 진단은 급성 세기관지염(60%)이거나 폐렴(28%)이었다. B. pertussis 이 확인된 경우는 13례(16%)였으며 환아 연령 중앙값은 2개월이었다. B. pertussis 이 확인된 13례 중 7례(53%)에서 respiratory syncytial virus가, 1례(7%)에서 influenza A virus가 확인되었다. B. pertussis 이 확인된 13증례 중 DTaP 접종력 없는 증례는 6례(46%)이었고 DTaP 백신 1회 접종한 증례는 6례(46%)이었고 DTaP 백신 2회 접종한 증례는 1례(8%)이었다. 결론: 호흡기계 증상들을 보이는 입원한 생후 6개월 미만의 영아의 원인 병원체 중 B. pertussis 이 16%를 차지하였다. 6개월 미만의 영아들에 대한 향후 전국적인 다 기관이 포함된 역학적 감시 활동이 필요할 것으로 사료된다.

Keywords

References

  1. Christie CD, Marx ML, Marchant CD, Reising SF. The 1993 epidemic of pertussis in Cincinnati. Resurgence of disease in a highly immunized population of children. N Engl J Med 1994;331:16-21. https://doi.org/10.1056/NEJM199407073310104
  2. Edwards KM. Overview of pertussis: focus on epidemiology, sources of infection, and long term protection after infant vaccination. Pediatr Infect Dis J 2005;24:104-8. https://doi.org/10.1097/01.inf.0000166154.47013.47
  3. Korea Centers for Disease Control and Prevention. Increasing incidence of pertussis in Korea, 2009. PHWR 2009;2:709.
  4. Nuolivirta K, Koponen P, He Q, Halkosalo A, Korppi M, Vesikari T, et al. Bordetella pertussis infection is common in nonvaccinated infants admitted for bronchiolitis. Pediatr Infect Dis J 2010;29:1013-5.
  5. Centers for Disease Control and Prevention. Pertussis Epidemic-Washington, 2012. MMWR Morb Mortal Wkly Rep 2012;61:517-22.
  6. European surveillance network for vaccine-preventable diseases. Pertussis Surveillance Report 2010. Available online: www.euvac.net/graphics/euvac/pdf/pertussis_2010.pdf (accessed on 05 August 2011).
  7. Health Protection Agency (HPA). Laboratory-confirmed cases of pertussis reported to the enhanced pertussis surveillance programme (England and Wales): Quarterly reports for July-September and October-December 2011;Annual report for 2011. Health protection report. 2012;6. London: HPA;24 Feb 2012.
  8. Korea Centers for Disease Control and Prevention. Status of pertussis incidences in Korea, 2012. PHWR 2013;6:569-73.
  9. Yoo S, Ahn KO, Park EH, Cho HS, Park CY, Lee HR. Epidemiologic and clinical features of pertussis in children (2000.3-2001.3). J Korean Pediatr Soc 2002;45:603-8.
  10. Lee KS, Son JS, Chung EH, Hong KB, Lee MJ, Yu JS, et al. Prevalence and clinical characteristics of pertussis in children, Cheonan, Korea. Korean J Pediatr Infect Dis 2009;16:175-82.
  11. Kim SJ, Kim SE, Kim JH, Lee JH, Oh JH, Koh DK, et al. The clinical features of pertussis in infancy. Korea J Pediatr Infect Dis 2009;16:167-74.
  12. Korea Centers for Disease Control and Prevention. Report of Yeongam Pertussis epidemiological investigation in Korea. PHWR 2012;5:510-2.
  13. Heininger U, Cherry JD. Pertussis immunisation in adolescents and adults- Bordetella pertussis epidemiology should guide vaccine recommendations. Expert Opin Biol Ther 2006:685-97.
  14. Tan T, Trindale E, Skowronski D. Epidemiology of pertussis. Pediatr Infect Dis J 2005;24:10-8. https://doi.org/10.1097/01.inf.0000148930.41928.0d
  15. Forsyth K, Campins-Marti M, Caro J. New pertussis vaccination strategies beyond infancy: recommendations by the global pertussis initiative. Clin Infect Dis 2004;39:1802-9. https://doi.org/10.1086/426020
  16. Cherry JD. Why do pertussis vaccines fail? Pediatrics 2012;129:968-70. https://doi.org/10.1542/peds.2011-2594
  17. Schmitt HJ, Wirsing von Konig CH, Neiss A, Bogaerts H, Bock HL, Schulte-Wissermann H, et al. Efficacy of acellular pertussis vaccine in early childhood after household exposure. JAMA 1996;275:37-41. https://doi.org/10.1001/jama.1996.03530250041024
  18. Liese JG, Meschievitz CK, Harzer E, Froeschle J, Hosbach P, Hoppe JE, et al. Efficacy of a two-component acellular pertussis vaccine in infants. Pediatr Infect Dis J 1997;16:1038-44. https://doi.org/10.1097/00006454-199711000-00007
  19. Simondon F, Preziosi MP, Yam A, Kane CT, Chabirand L, Iteman I, et al. A randomized double-blind trial comparing a two-component acellular to a whole-cell pertussis vaccine in Senegal. Vaccine 1997;15:1606-12. https://doi.org/10.1016/S0264-410X(97)00100-X
  20. Olin P, Rasmussen F, Gustafsson L, Hallander HO, Heijbel H. Randomised controlled trial of two-component, threecomponent, and five-component acellular pertussis vaccines compared with whole-cell pertussis vaccine. Lancet 1997;350:1569-77. https://doi.org/10.1016/S0140-6736(97)06508-2
  21. Stehr K, Cherry JD, Heininger U, Schmitt-Grohe S, Uberall M, Laussucq S, et al. A comparative efficacy trial in Germany in infants who received either the Lederle/Takeda acellular pertussis component DTP (DTaP) vaccine, the Lederle whole-cell component DTP vaccine, or DT vaccine. Pediatrics 1998;101:1-11. https://doi.org/10.1542/peds.101.1.1
  22. Winter K, Harriman K, Zipprich J, Schechter R, Talarico J, Watt J, et al. California pertussis epidemic, 2010. J Pediatr 2012;161:1091-6. https://doi.org/10.1016/j.jpeds.2012.05.041
  23. Tsang RS, Lau AK, Sill ML, Halperin SA, Van Caeseele P, Jamieson F, et al. Polymorphisms of the fimbria fim3 gene of Bordetella pertussis strains isolated in Canada. J Clin Microbiol 2004;42:5364-7. https://doi.org/10.1128/JCM.42.11.5364-5367.2004
  24. Packard ER, Parton R, Coote JG, Fry NK. Sequence variation and conservation invirulence-related genes of Bordetella pertussis isolates from the UK. J Med Microb 2004;53:355-65. https://doi.org/10.1099/jmm.0.05515-0
  25. Mastrantonio P, Spigaglia P, van Oirschot H, van der Heide HG, Heuvelman K, Stefanelli P, et al. Antigenic variants in Bordetella pertussis strains isolated from vaccinated and unvaccinated children. Microbiol 1999;145:2069-75. https://doi.org/10.1099/13500872-145-8-2069
  26. Mooi FR, van Oirschot H, Heuvelman K, van der Heide HGJ, Gaastra W, Willems RJL. Polymorphism in the Bordetella pertussis virulence factors P.69/pertactinand pertussis toxin in the Netherlands: temporal trends and evidence of vaccine-driven evolution. Infect Immun 1998;66:670-5.
  27. Forsyth K, Tan T, Wirsing Von Kirsig C. Potential strategies to reduce the burden of pertussis. Pediatr Infect Dis J 2005;24:69-74. https://doi.org/10.1097/01.inf.0000160917.29723.03
  28. Crowcroft NS, Booy R, Harrison T. Severe and unrecognised: pertussis in UK infants. Arch Dis Child 2003;88:802-6. https://doi.org/10.1136/adc.88.9.802
  29. Gall SA, Myers J, Pichichero M. Maternal immunization with tetanus-diphtheria-pertussis vaccine: effect on maternal and neonatal serum antibody levels. Am J Obstet Gynecol 2011;204:334.
  30. Cherry JD. Epidemic pertussis in 2012-The resurgence of a vaccine-preventable disease. N Engl J Med 2012;367:785-7. https://doi.org/10.1056/NEJMp1209051

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