Does the economic recession influence the incidence of pertussis in a cosmopolitan European city?

Sílvia Brugueras, Cristina Rius, Joan-Pau Millet, Martí Casals, Joan A Caylà, Barcelona Pertussis Working Group, Pere Simón, Anna de Andrés, Roser Clos, Montse Ricart, Miriam Ros, Maria José Santomà, Pilar Gorrindo, Pilar Palau, Montse Cunillé, Eva Masdeu, Ingrid Avellanés, Jose Ángel Rodrigo, Gema Codina, Maria Teresa Martin, Juan José González, Sònia Brió, Jessica Del Carpio, Andrea Otero, Álvaro Díaz, Núria López, Montse Vaqué, Pere Sala, Marta Calsina, Yolanda Meije, Eulàlia Guasch, Maria Rosa Pascual, Carme Palasi, Anna Luz Moro, Manel Enrubia, Gemma Monsó, Joan Martí Solé, Paloma Rodríguez, Helena Pallarès, Antoni Salvà, Ángeles Ferrández, Ana María Hostalot, María Carmen Muñoz, Anna de Andrés, Sílvia Brugueras, Cristina Rius, Joan-Pau Millet, Martí Casals, Joan A Caylà, Barcelona Pertussis Working Group, Pere Simón, Anna de Andrés, Roser Clos, Montse Ricart, Miriam Ros, Maria José Santomà, Pilar Gorrindo, Pilar Palau, Montse Cunillé, Eva Masdeu, Ingrid Avellanés, Jose Ángel Rodrigo, Gema Codina, Maria Teresa Martin, Juan José González, Sònia Brió, Jessica Del Carpio, Andrea Otero, Álvaro Díaz, Núria López, Montse Vaqué, Pere Sala, Marta Calsina, Yolanda Meije, Eulàlia Guasch, Maria Rosa Pascual, Carme Palasi, Anna Luz Moro, Manel Enrubia, Gemma Monsó, Joan Martí Solé, Paloma Rodríguez, Helena Pallarès, Antoni Salvà, Ángeles Ferrández, Ana María Hostalot, María Carmen Muñoz, Anna de Andrés

Abstract

Background: 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. 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.

Methods: We 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).

Results: A 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.

Conclusions: The noteworthy increase in pertussis incidence does not seem to be due to the economic recession, but to other factors here described.

Keywords: Bordetella pertussis; Cities; Economic recession; Epidemiology; Pertussis vaccine; Whooping cough.

Conflict of interest statement

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Incidence of pertussis in Barcelona, 2000–2015. a Incidence of pertussis in Barcelona according to sex, 2000–2015. b Incidence of pertussis in Barcelona according to age group, 2000–2015. c Incidence of pertussis in Barcelona according to index of Disposable Household Income, 2000–2015. d Incidence of pertussis among under 15-year-olds according to country of origin, Barcelona 2011–2015

References

    1. European Centre for Disease Prevention and Control . Annual epidemiological report 2014 - vaccine-preventable diseases. Stockholm: ECDC; 2014.
    1. Wendelboe AM, Njamkepo E, Bourillon A, Floret DD, Gaudelus J, Gerber M, et al. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J. 2007;26(4):293–299. doi: 10.1097/01.inf.0000258699.64164.6d.
    1. Tan T, Dalby T, Forsyth K, Halperin SA, Heininger U, Hozbor D, et al. Pertussis across the globe: recent epidemiologic trends from 2000 to 2013. Pediatr Infect Dis J. 2015;34(9):e222–e232. doi: 10.1097/INF.0000000000000795.
    1. Heininger U, André P, Chlibek R, Kristufkova Z, Kutsar K, Mangarov A, et al. Comparative epidemiologic characteristics of pertussis in 10 central and eastern European countries, 2000-2013. PLoS One. 2016;11(6):e0155949. doi: 10.1371/journal.pone.0155949.
    1. Sabbe M, Vandermeulen C. The resurgence of mumps and pertussis. Hum Vaccin Immunother. 2016;12(4):955–959. doi: 10.1080/21645515.2015.1113357.
    1. Sizaire V, Garrido-Estepa M, Masa-Calles J, Martinez de Aragon MV. Increase of pertussis incidence in 2010 to 2012 after 12 years of low circulation in Spain. Euro Surveill. 2014;19(32).
    1. Sealey KL, Belcher T, Preston A. Bordetella pertussis epidemiology and evolution in the light of pertussis resurgence. Infect Genet Evol. 2016;40:136–143. doi: 10.1016/j.meegid.2016.02.032.
    1. Domenech de Cellès M, Magpantay FM, King AA, Rohani P. The pertussis enigma: reconciling epidemiology, immunology and evolution. Proc Biol Sci. 2016;283(1822).
    1. Clark TA. Changing pertussis epidemiology: everything old is new again. J Infect Dis. 2014;209:978–981. doi: 10.1093/infdis/jiu001.
    1. Rechel B, Suhrcke M, Tsolova S, Suk JE, Desai M, McKee M, et al. Economic crisis and communicable disease control in Europe: a scoping study among national experts. Health Policy [Internet]. Elsevier Ireland Ltd; 2011 Dec [cited 2017 January 23];103(2–3):168–75. Available from: .
    1. Suhrcke M, Stuckler D, Suk JE, Desai M, Senek M, McKee M, et al. The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence. PLoS One [Internet]. 2011 Jan [cited ];6(6):e20724.
    1. Ajuntament de Barcelona. Departament d'Estadística. Available at:
    1. Generalitat de Catalunya. Departament de Salut. Definició de cas de les malalties de declaració obligatòria. 11a ed. Barcelona: Generalitat de Catalunya; 2006. Available at:
    1. Moraga-Llop FA, Campins-Martí M. Vacuna de la tos ferina. Reemergencia de la enfermedad y nuevas estrategias de vacunación. Enferm Infecc Microbiol Clin. 2015;33(3):190–196. doi: 10.1016/j.eimc.2015.02.001.
    1. Martí C, Casas E, Jorge Juan A, Martí J, Conde J, Figuerola G, et al. Distribució territorial de la Renda Familiar per càpita a Barcelona. Ajuntament de Barcelona; 2007. Available at: (accessed 14 Oct 2016).
    1. Reichman LB. The U-shaped curve of concern. Am Rev Respir Dis. 1991;144(4):741–742. doi: 10.1164/ajrccm/144.4.741.
    1. Broutin H, Guégan JF, Elguero E, Simondon F, Cazelles B. Large-scale comparative analysis of pertussis population dynamics: periodicity, synchrony, and impact of vaccination. Am J Epidemiol. 2005;161(12):1159–1167. doi: 10.1093/aje/kwi141.
    1. Real Decreto-ley 16/2012, de 20 de abril, de medidas urgentes para garantizar la sostenibilidad del Sistema Nacional de Salud y mejorar la calidad y seguridad de sus prestaciones. (Boletín Oficial del Estado, número 98, de 24 de abril de 2012).
    1. Salmon DA, Dudley MZ, Glanz JM, Omer SB. Vaccine Hesitancy. Causes, Consequences, and a Call to Action. Am J Prev Med. 2015;49(6S4):S391–S398. doi: 10.1016/j.amepre.2015.06.009.
    1. Moraga-Llop FA, Mendoza N, Muntaner A, Codina G, Fàbregas A, Campins M. Pertussis in fully vaccinated infants and children. Are new vaccination strategies required? Enferm Infecc Microbiol Clin. 2014;32(4):236–241. doi: 10.1016/j.eimc.2013.04.007.
    1. Bolotin S, Harvill ET, Crowcroft NS. What to do about pertussis vaccines? Linking what we know about pertussis vaccine effectiveness, immunology and disease transmission to create a better vaccine. Pathog Dis. 2015;73(8).
    1. Sheridan SL, Ware RS, Grimwood K, Lambert SB. Reduced risk of pertussis in whole-cell compared to acellular vaccine recipients is not confounded by age or receipt of booster-doses. Vaccine. 2015;33(39):5027–5030. doi: 10.1016/j.vaccine.2015.08.021.
    1. Fulton TR, Phadke VK, Orenstein WA, Hinman AR, Johnson WD, Omer SB. Protective effect of contemporary pertussis vaccines: a systematic review and meta-analysis. Clin Infect Dis. 2016;62(9):1100–1110. doi: 10.1093/cid/ciw051.
    1. van Gent M, Heuvelman CJ, van der Heide HG, Hallander HO, Advani A, Guiso N, et al. Analysis of Bordetella pertussis clinical isolates circulating in European countries during the period 1998-2012. Eur J Clin Microbiol Infect Dis. 2015;34(4):821–830. doi: 10.1007/s10096-014-2297-2.
    1. Althouse BM, Scarpino SV. Asymptomatic transmission and the resurgence of Bordetella pertussis. BMC Med. 2015;13:146. doi: 10.1186/s12916-015-0382-8.
    1. Barkoff AM, Gröndahl-Yli-Hannuksela K, He Q. Seroprevalence studies of pertussis: what have we learned from different immunized populations. Pathog Dis. 2015;73(7).
    1. Schwartz KL, Kwong JC, Deeks SL, Campitelli MA, Jamieson FB, Marchand-Austin A, et al. Effectiveness of pertussis vaccination and duration of immunity. CMAJ. 2016;188(16):E399–E406. doi: 10.1503/cmaj.160193.
    1. Klein NP, Bartlett J, Rowhani-Rahbar A, Fireman B, Baxter R. Waning protection after fifth dose of acellular pertussis vaccine in children. N Engl J Med. 2012;367(11):1012–1019. doi: 10.1056/NEJMoa1200850.
    1. de Greeff SC, Mooi FR, Westerhof A, Verbakel JMM, Peeters MF, Heuvelman CJ, et al. Pertussis disease burden in the household: how to protect young infants. Clin Infect Dis. 2010;50:1339–1345. doi: 10.1086/652281.
    1. van der Maas NA, Mooi FR, de Greeff SC, Berbers GA, Spaendonck MA, de Melker HE. Pertussis in the Netherlands, is the current vaccination strategy sufficient to reduce disease burden in young infants? Vaccine. 2013;31(41):4541–4547. doi: 10.1016/j.vaccine.2013.07.060.
    1. Crespo I, Cardeñosa N, Godoy P, Carmona G, Sala MR, Barrabeig I, et al. Epidemiology of pertussis in a country with high vaccination coverage. Vaccine. 2011;29:4244–4248. doi: 10.1016/j.vaccine.2011.03.065.
    1. Hellenbrand W, Beier D, Jensen E, Littmann M, Meyer C, Oppermann H, et al. The epidemiology of pertussis in Germany: past and present. BMC Infect Dis. 2009;9:22. doi: 10.1186/1471-2334-9-22.
    1. de Greeff SC, de Melker HE, van Gageldonk PGM, Schellekens JFP, van der Klis FRM, Mollema L, et al. Seroprevalence of pertussis in the Netherlands: evidence for increased circulation of Bordetella pertussis. PLoS One. 2010;5:e14183. doi: 10.1371/journal.pone.0014183.
    1. Suhrcke M, Stuckler D, Suk JE, Desai M, Senek M, McKee M, et al. The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence. PLoS One. 2011;6(6):e20724. doi: 10.1371/journal.pone.0020724.
    1. Levri KM, Reynolds L, Liko J, Dott M, Robinson BF, Cieslak PR. Risk factors for pertussis among Hispanic infants: metropolitan Portland, Oregon, 2010-2012. Pediatr Infect Dis J. 2016;35(5):488–493. doi: 10.1097/INF.0000000000001061.
    1. Zamir CS, Dahan DB, Shoob H. Pertussis in infants under one year old: risk markers and vaccination status--a case-control study. Vaccine. 2015;33(17):2073–2078. doi: 10.1016/j.vaccine.2015.02.050.
    1. Rajmil L, Fernandez de Sanmamed MJ, Choonara I, Faresjö T, Hjern A, Kozyrskyj AL, et al. Impact of the 2008 economic and financial crisis on child health: a systematic review. Int J Environ Res Public Health. 2014;11(6):6528–6546. doi: 10.3390/ijerph110606528.
    1. Declaración de Helsinki de la AMM. Principios éticos para las investigaciones médicas en seres humanos. [Internet]. Asociación Médica Mundial; 2013. Available at:
    1. Ley Orgánica 15/1999, de 13 de diciembre, de Protección de Datos de Carácter Personal. [Internet]. Madrid: Noticias jurídicas; 2011. Available at:

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren