title: [Pertussis in fully vaccinated infants and children. Are new vaccination strategies required?].
abstract: OBJECTIVE
  To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children.
  
  
  METHODS
  The clinical histories and vaccination cards of patients under 16years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011.
  
  
  RESULTS
  Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5months of age and had received 1-2vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P<.001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P=.001). The case mortality rate among inpatients was 1.3%.
  
  
  CONCLUSIONS
  The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6months of age. More effective vaccines need to be developed.
authors.affiliation: Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España. Electronic address: fmoraga@acmcb.es.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Moraga-Llop
authors.affiliation: Servicio de Urgencias de Pediatría, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Natàlia
authors.initials: N
authors.lastname: Mendoza-Palomar
authors.affiliation: Servicio de Urgencias de Pediatría, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Antoni
authors.initials: A
authors.lastname: Muntaner-Alonso
authors.affiliation: Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Gemma
authors.initials: G
authors.lastname: Codina-Grau
authors.affiliation: Servicio de Urgencias de Pediatría, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Anna
authors.initials: A
authors.lastname: Fàbregas-Martori
authors.affiliation: Servicio de Medicina Preventiva y Epidemiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Magda
authors.initials: M
authors.lastname: Campins-Martí
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010567:Pertussis Vaccine / Q000008:administration & dosage; D012189:Retrospective Studies; D014917:Whooping Cough / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy
chemical_list: D010567:Pertussis Vaccine
keywords: Children; Epidemiology; Epidemiología; Niños; Pertussis; Pertussis vaccines; Tos ferina; Vacunas contra la tos ferina