Abstract
Pertussis is most severe among unvaccinated infants (< 1 year of age), and still leads to several reported deaths in the Netherlands every year. In order to avoid pertussis-related infant morbidity and mortality, pertussis surveillance data are used to guide pertussis control measures. However, more insight into the accuracy of pertussis surveillance and control, and into the range of healthcare and public health-related factors that impede this are needed. We analysed a unique combination of data sources from one Dutch region of 1.1 million residents, including data from laboratory databases and local public health notifications between 2010 and 2013. This large study (n = 12,090 pertussis tests) reveals possible misdiagnoses, substantial under-notification (18%, 412/2,301 laboratory positive episodes) and a delay between patient symptoms and notification to the local public health services (median 34 days, interquartile range (IQR): 27–54). It is likely that the misdiagnoses, under-notification and overall delay in surveillance data are not unique to this area of the Netherlands, and are generalisable to other countries in Europe. In addition to preventive measures such as maternal immunisation, based on current findings, we further recommend greater adherence to testing guidelines, standardisation of test interpretation guidelines, use of automatic notification systems and earlier preventive measures.
Highlights
Bordetella pertussis and Bordetella parapertussis infections are most severe among unvaccinated infants [1,2,3,4]
A quarter of possible episodes in all ages lacked a conclusive laboratory test result. These results show the possibility of misdiagnosis and the complexity of the pertussis diagnostic process both for healthcare providers (HCPs) and for the laboratories
While the number of notifications are the current basis for pertussis surveillance, the accuracy of this indicator for disease occurrence and as a management tool is likely poor
Summary
Bordetella pertussis and Bordetella parapertussis infections are most severe among unvaccinated infants [1,2,3,4]. The full implementation of general pertussis vaccination in the 1950s greatly reduced its incidence in the Netherlands [6] and led to a shift from cases in children to adults [5,7,8,9]. Even though worldwide vaccination coverage of 86% has been achieved [10], there were around 63,000 pertussis-linked deaths in children under 5 years of age in 2012 [11]. The Dutch incidence rate of symptomatic pertussis infections in 2011 was estimated to be 107 per 10,000 population [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
