Burden of disease and predictors of clinically diagnoses pertussis within a surveillance system, Guatemala, 2007-2011 Open Access
Nguyen, Antoinette Huu Mai-Truc (2012)
Abstract
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.
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