Pertussis Surveillance Examples from Europe

Transcription

1 Pertussis Surveillance Examples from Europe Johannes G. Liese Pediatric Infectious Diseases and Immunology University Childrens Hospital Julius-Maximilians-University, Würzburg, Germany 1

2 2

3 Pertussis Surveillance Switzerland Austria Sweden Germany 3

4 Pertussis Surveillance Switzerland Austria Sweden Germany 4

5 SENTINELLA Network in Switzerland 5 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)

6 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 6

7 SENTINELLA Network in Switzerland Year Cases per 100 consultations Number of PCR positive (black) and PCR negative (grey) cases manuscript in preparation

8 Yearly Estimated Pertussis Incidence in Switzerland (Sentinella ) Per 100, Prospective studies:

9 9 Pertussis Epidemiology in Switzerland >70 Age category (years) manuscript in preparation Proportion of total number of cases reported during the respective time period (%)

10 SENTINELLA Network in Switzerland Conclusions 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) 10

11 Pertussis Surveillance Switzerland Austria Sweden Germany 11

12 12

13 Hospital-based active surveillance of childhood pertussis in Austria from 1996 to year prospective active surveillance of B. pertussis infection including all 44 nationwide paediatric departments Immunisation schedule: 3 doses at months followed by a single booster vaccination in the second year of age Vaccines used 1996 to 1997: wcp vaccine 1998 to 1999: wcp and acp vaccine 2000 to 2003: ap only (Tetra-, Penta-,Hexavalent) 13 Rendi-Wagner P et al.- Vaccine. 2006;24(33-34):5960-5

14 Pertussis hospitalisation incidence and vaccine coverage in Austria from 1996 to 2003 wcp vaccine wcp and acp vaccine acp only 79% 86% 92% 14 Rendi-Wagner P et al.- Vaccine. 2006;24(33-34):5960-5

15 Pertussis Surveillance Switzerland Austria Sweden Germany 15

16 Pertussis in Sweden Data from long-term surveillance 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 Dec 2007) Swedish National Surveillance System /Swedish Institute for Infectious Disease Control Olin P, Hallander HO. Euro Surveill Gustafsson L, Carlsson RM. Ten Year Report Carlsson RM, Trollfors B. Vaccine 2009 CIRC.09/02/PPMH/204

17 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 reports Confirmation 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 17 Gustafsson L, Carlsson RM. Ten Year Report

18 Pertussis cases reported in Sweden ( ) 1979 withdrawal of wcp vaccine in Sweden due to safety concerns [1] 1996 introduction of ap vaccines, switching from DT to DTaP at m; 3-dose coverage reached 98-99% within a year. [1] 18 Gustafsson L, Carlsson RM. Ten Year Report

19 Age-specific incidence of pertussis in Sweden before 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. 19 Gustafsson L, Carlsson RM. Ten Year Report

20 Sweden: Incidence of pertussis episodes, hospitalisation, and complications Higher risk of pertussis-related hospital admissions/complications Among infants who are unvaccinated before 3m Or with only 1 dose of ap from 3 to <5m Gustafsson L, Carlsson RM. Ten Year Report

21 Sweden: Incidence of pertussis in National compared to DT-2aP-Hib-Polio cohort: DT-2aP-Hib-Polio Vaccine 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] 21 Gustafsson L, Carlsson RM. Ten Year Report

22 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 = per 100,000 ( ) After acp introduction = 6-16 per 100,000 ( ) 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 22 1, 1997 December 31, [3] Gustafsson L, Carlsson RM. Appendix 2 to Ten-year Report;October 1, 1997 until December 31, 2007

23 Pertussis Surveillance Switzerland Austria Sweden Germany 23

24 Incidence of notified pertussis cases (Germany: FWG/FEG) 24 Hellenbrand W et al. BMC Infectious Diseases 2009

25 Incidence of Pertussis East Germany Pertussis cases / 100,000 inhabitants , , ,4 12, , , C. Huelße / Robert-Koch Institut / Epidemiologisches Bulletin Nr Hellenbrand W et al. BMC Infectious Diseases 2009

26 Confirmation of cases Laboratory confirmed: 93.8% Epidemiological link: 1.9% Clinical case only: 4.4% 26 Hellenbrand W et al. BMC Infectious Diseases 2009

27 Laboratory confirmation of cases Culture: 1.0% PCR: 9.8% Increase in antibodies: 26.9% Single high titre: 56.2% 27 Hellenbrand W et al. BMC Infectious Diseases 2009

28 Age distribution of notified cases in former East Germany 28 Hellenbrand W et al. BMC Infectious Diseases 2009

29 Age distribution of Pertussis East Germany % 22% 25% 60% 10% 13% 12% 3% 0 - <1 1 - <5 5 - < < < <65 >65 Age 29 C. Huelße / Robert-Koch Institut / Epidemiologisches Bulletin Nr

30 Notified cases in former East German states: Saxony (Fig. B) introduced pre-school booster in 1998 Brandenburg, Mecklenburg Western Pomerania, Saxony Anhalt and Thuringia: no preschool booster Saxony with preschool booster 30 Hellenbrand W et al. BMC Infectious Diseases 2009

31 Hospitalized cases in former East Germany (FEG) and former West Germany (FWG) 31 Hellenbrand W et al. BMC Infectious Diseases 2009

32 32

33 Vaccination Strategies in Germany Vaccination advisory board (STIKO) 1976 to 1991 No pertussis vaccination Endemic pertussis 1994 Rapid uptake and high coverage after licensure of ap-vaccines pertussis incidence observed in adolescents pertussis incidence in infants pertussis incidence in school age children pertussis incidence in adults doses pertussis vaccine schedule in all infants and toddlers 2000 all adolescents 9-17 yrs (1 dose) health and childcare workers (every 10 years) 2004 Cocoon strategy Preschool booster First adult dose recommended STIKO Robert-Koch-Institut Epidemiologisches Bulletin

34 Vaccination Calendar (STIKO) for Infants, Children, and Adolescents in Germany Age in months Age in years Vaccine Birth DTaP TdaP B B Hib IPV B HB (1.) P Pneumococc dose ap in contacts of neonates (Cocoon strategy) + 1 dose ap ten year after adolescent dose Meningococc. 1. MMR Varicella 1. (2.) P 34 STIKO Robert-Koch-Institut Epidemiologisches Bulletin

35 Pertussis Surveillance Examples from Europe Switzerland Surveilance in a high endemic country Austria Effectiveness of acp program against pertussis hospitalization Sweden Effectiveness of 2- and 3-component acp vaccine in reducing the burden of pertussis disease Germany Development of vaccine recommendations following changes in epidemiology 35

36 36