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INCREASING INCIDENCE OF PERTUSSIS IN BRAZIL: A RETROSPECTIVE STUDY USING SURVEILLANCE DATA
Affilliation
Fundação Oswaldo Cruz. Escritório Regional. Teresina, PI, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Epidemiologia e Sistemática Molecular. Rio de Janeiro, RJ, Brasil.
Instituto Federal de Educação, Ciência e Tecnologia do Piauí (IFPI). Teresina, PI, Brasil.
Fundação Oswaldo Cruz. Escritório Regional. Teresina, PI, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Epidemiologia e Sistemática Molecular. Rio de Janeiro, RJ, Brasil.
Instituto Federal de Educação, Ciência e Tecnologia do Piauí (IFPI). Teresina, PI, Brasil.
Fundação Oswaldo Cruz. Escritório Regional. Teresina, PI, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Epidemiologia e Sistemática Molecular. Rio de Janeiro, RJ, Brasil.
Abstract
Background: Many countries have reported an increase in the incidence of pertussis, which has become a global
public health concern.
Methods: In this study, the epidemiology of pertussis in Brazil was assessed retrospectively using surveillance data
gathered from case notification forms from 2007 to 2014.
Results: From 2007 to 2014, 80,068 suspected cases of pertussis were reported in Brazil. Of these, 24,612 (32 %)
were confirmed by various criteria. The annual distribution of confirmed cases demonstrated a significant increase
in incidence rate since 2012. A seasonal pattern in which cases occur most frequently between the end of spring
and midsummer has been identified. Among the confirmed cases, 34.5 % occurred in infants aged 0–2 months,
22.4 % occurred in infants aged 3–6 months, 21 % occurred in children aged 7 months to 4 years, and 8 % were
reported in adults >21 years. Of the confirmed cases, 47.2 % met only clinical criteria, 15.5 % met clinical and
epidemiological criteria, and 36.6 % were confirmed in a laboratory. The overall case fatality rate was 2.1 %,
reaching 4.7 % among infants aged 0–2 months. The complications most commonly reported in the notification
forms were pneumonia, encephalitis, dehydration, otitis, and malnutrition. Of the confirmed cases, 23.1 % occurred
in subjects who received at least 3 doses of the pertussis vaccine. Within this group, there were 1098 infants aged 7
to 15 months and 2079 children aged 16 months to 4 years. In 2012, 18 states did not achieve 95 % immunization
coverage, a number that dropped to 10 and 6 in 2013 and 2014, respectively.
Conclusions: Brazil’s main challenges in facing pertussis resurgence will be to offer the best quality medical
attention to reduce mortality, to improve the infrastructure for laboratory diagnosis and to increase vaccination
coverage. Additional studies to assess the effectiveness of the current vaccination schedule and basic research on
the genetics and evolution of circulating B. pertussis strains are also needed.
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