Abstract
BackgroundIn the last few years, pertussis has re-emerged worldwide. The aim of this article is to study how the incidence of the disease has evolved in Barcelona city over a 16-year period, and determine which factors are associated with the evolution of the disease. We discuss the causes of the observed changes considering different possibilities such as vaccination coverage, vaccine effectiveness, increased surveillance or the effect of the current economic recession.MethodsWe performed a cross-sectional, observational, population-based descriptive study using data for the 2000–2015 period from the notifiable diseases register maintained by Barcelona Public Health Agency. We used Poisson regression to compute adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI).ResultsA total of 1791 cases were registered. The incidence of the disease increased throughout the city from 2011 onwards. While children under 1 year of age had the highest-incidence and were the most at risk (aOR = 27.18, CI:23.51–31.44), we found that the age of affected children was higher in the last years. Incidence proportion (PRR) was lower among foreign-born children than native children (PRR = 0.43 CI:0.32–0.58). In the whole-cell vaccine period (2000–2004), the percentage of cases under 1 year of age who received the vaccine was lower than in 2005–2015 when the acellular vaccine was used (p = 0.01), suggesting a lower efficacy of the acellular vaccine. However, vaccination coverage in children under 6 years remained high (~ 90%), and there were no significant year-to-year variations (p = 0.757). Moreover, there did not appear to be any significant restrictions in medical care. According to the index of disposable household income (DHI), pertussis incidence increased from 2011 onwards in all neighbourhoods and remained higher in those with lower DHI.ConclusionsThe noteworthy increase in pertussis incidence does not seem to be due to the economic recession, but to other factors here described.
Highlights
In the last few years, pertussis has re-emerged worldwide
Vaccination coverage remained high, we found that the proportion of cases with unknown vaccination status increased during the 2011–2015 period, a period in which cases were found to be generally older
Analysing vaccination percentage according to disposable household income (DHI), we found that richer neighbourhoods included a higher percentage of non-vaccinated cases, as well as a higher percentage of non-vaccinated children under 6 years and under 1 year (p < 0.05)
Summary
In the last few years, pertussis has re-emerged worldwide. The aim of this article is to study how the incidence of the disease has evolved in Barcelona city over a 16-year period, and determine which factors are associated with the evolution of the disease. Clinical symptoms include paroxysmal cough and inspiratory stridor, which may be followed by periods of apnea [1]. It is more common and is associated with more. Pertussis is a Notifiable Disease (ND) that continues to be a public health issue worldwide despite broad vaccination coverage [3,4,5]. Brugueras et al BMC Public Health (2019) 19:144 countries, including Spain, The Netherlands, Denmark, Belgium, Ireland and the United Kingdom (UK) witnessed an increase in incidence from 2011 onwards, while that in Italy and Greece has remain generally stable [1, 6, 7]. Several reports indicate that this is not a global re-emergence of the disease [3, 7,8,9]
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