Burden of disease and predictors of clinically diagnoses pertussis within a surveillance system, Guatemala, 2007-2011 Open Access

Nguyen, Antoinette Huu Mai-Truc (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/db78tc124?locale=en


Background: Pertussis, or whooping cough, is a highly contagious respiratory infection that remains a cause of severe debilitating illness in young children. Pertussis is often diagnosed based only on clinical signs, symptoms, vitals and basic laboratory values. Since the incidence of pertussis, especially among early infants, within our surveillance system in Guatemala, the aim of this study is to determine the burden of clinical pertussis. Since many pertussis cases are diagnosed clinically without laboratory confirmation, this study also explores the predictors of pertussis.

Methods: We utilized surveillance data from the Vigilancia Comunitaria (ViCo) project in Guatemala which collected biological samples, demographic, risk factor and health history information to identify patients admitted with symptoms suggesting diarrhea, respiratory disease or unspecified febrile illness. Incidence rate analyses was calculated for the total ViCo population while vaccine efficacy analyses was only calculated for children <5 years of age. We used multivariate logistic regression to determine the predictors of pertussis.

Results: The total ViCo population included 64,999 persons while sub-analysis for predictor selection and modeling were computed on a population of 9,152 persons. We determined an annual incidence (cases per 100,000 population) of 283 in the total ViCo population and 320 among children <1 year of age. There was an initial peak in incidence among children <2-5 months of age (625) that then declined to a trough among children 2-4 years (119). A second peak (1095) was observed among those ≥65 years of age. The DTP vaccine efficacy among children <5 years of age was 54.97%. The following predictors were significantly associated with pertussis: age, health facility, department, cough duration, vomiting (α=0.05).

Conclusion: In conclusion, diagnosing pertussis in infants is crucial since the burden of disease and rates of complication and death are highest in this population. From our analysis, the burden of disease, especially among early infants, is significant in our surveillance system in Guatemala. Further studies should be completed to examine the relationship between clinical and lab-confirmed diagnosis, which would help elucidate the sensitivity and specificity of a clinical case definition in a non-outbreak setting with limited resources for laboratory confirmation.

Table of Contents

Introduction 1 Methods 3 Results 11 Discussion 17 References 20 Tables and Figures 22 Appendices 45

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