Hospital admissions for pertussis in Spain, 1995–1998
Introduction
Immunization programs designed to protect young children against pertussis started in 1944 [1]. The incidence of pertussis has been greatly reduced by mass vaccination, but even in countries with high vaccination coverage, the disease is still present [2]. In Spain, universal vaccination against pertussis was introduced in 1965, reaching 94% coverage in 1997 [3]. Vaccination coverage for primary immunization with three doses of DTP in the first year of life is high and a booster dose at 15–18 months is recommended. A recently published cross sectional study had shown a prevalence of antibodies to Pertussis Toxin of 35% in the age group 5–12 years and of 52% in the age group 30–39 years, without a further increase thereafter [4]. These data suggest that there is widespread circulation of the organism in the population and that pertussis infection will likely to be frequent in adolescents and young adults [4]. Although hospitalization, complications and mortality in adolescents and adults are rare, they may serve as a reservoir for B. pertussis and play an important role in the transmission to the very young infant [5], [6]. To assess the incidence of pertussis is difficult, because a reliable etiologic diagnosis can only be established in a minority of cases [5]. Nonetheless, a reasonable approach to the burden of pertussis can be obtained from information on the hospitalizations, even though hospital admission will represent only the severe cases and vary substantially among different countries. This epidemiological survey was undertaken to estimate the annual burden of hospitalizations for pertussis in Spain during a four-year period 1995–1998.
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Material and methods
This study was based on the national surveillance system for hospital data (Conjunto Mı́nimo de Datos; CMBD) maintained by the Ministry of Health [7]. This system uses clinical codes for the Spanish version of the 9th International Classification of Diseases (Modificación Clı́nica Clasificación Internacional de Enfermedades; CIE-9-MC) and covers an estimated 83% of public hospitals [7], [8]. Information on private hospitals is available only for a few autonomous regions, but these hospitals
Results
A total of 2216 hospitalizations for pertussis was recorded during the study period 1995–1998. Table 1 shows the average number of hospitalizations and incidence by group of age and by year. Eighty-nine percent of the cases were <1 year of age (incidence of 78 per 100,000 population) and 95% were ≤5 years of age (incidence of 28 per 100,000 population). Overall, the annual incidence was 1.7 per 100,000 population, with the highest incidence reported in Andalucı́a and Extremadura (about three
Discussion
Pertussis is a national reportable disease in Spain since 1982 and 8686 cases were officially reported during the 1995–1998 period [11], [12]. In this study a total of 2216 cases of hospitalization by pertussis were reported, that represents an estimated hospitalization rate of 25% of the reported cases. The overall annual incidence of hospitalization was about 1.7 per 100,000; but of 78 and 28 per 100,000 children <1 year and ≤ 5 years in age, respectively. These results accord with studies in
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2012, VaccineCitation Excerpt :The comparative high mortality rate is further highlighted by the observation made from a study of hospitalised patients with pertussis in Spain (during 1995–1998) [32]. The case-fatality ratio was found to be higher in hospitalised persons with pertussis >50 years of age (28.6%) compared with those who were 1–5 years of age (1.4%) [32] (Table 2). A detailed survey among 800 adults, 25 years or older, in British Columbia, Canada found that 59% of respondents were willing to receive free pertussis immunisation; increasing to 76% after being informed of the communicability and severity of pertussis illness and the safety, efficacy and convenience of vaccine and 87% if recommended by their physician [50].
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