title: Epidemiology of pertussis in Italy: disease trends over the last century.
abstract: We reviewed the epidemiology of pertussis in Italy over the last 125 years to identify disease trends and factors that could have influenced these trends. We described mortality rates (1888-2012), case fatality rates (1925-2012), cumulative incidence rates (1925-2013) and age-specific incidence rates (1974-2013). We compared data from routine surveillance with data from a paediatric sentinel surveillance system to estimate under-notification. Pertussis mortality decreased from 42.5 per 100,000 population in 1890 to no reported pertussis-related death after 2002. Incidence decreased from 86.3 per 100,000 in 1927 to 1 per 100,000 after 2008. Vaccine coverage increased from 32.8% in 1993 to about 96% after 2006. As for under-notification, mean sentinel/routine surveillance incidence ratio increased with age (from 1.8 in <1 year-olds to 12.9 in 10-14 year-olds). Pertussis mortality decreased before the introduction of immunisation. Incidence has decreased only after the introduction of pertussis vaccine and in particular after the achievement of a high immunisation coverage with acellular vaccines. Routine surveillance does not show an increase in cumulative incidence nor in ≥ 15 year-olds as reported by other countries. Underrecognition because of atypical presentation and the infrequent use of laboratory tests may be responsible for under-notification, and therefore affect incidence reports and management of immunisation programmes.
authors.affiliation: Bambino Gesu Children s Hospital, IRCCS, Rome, Italy.
authors.forename: M V
authors.initials: MV
authors.lastname: Gonfiantini
authors.forename: E
authors.initials: E
authors.lastname: Carloni
authors.forename: F
authors.initials: F
authors.lastname: Gesualdo
authors.forename: E
authors.initials: E
authors.lastname: Pandolfi
authors.forename: E
authors.initials: E
authors.lastname: Agricola
authors.forename: E
authors.initials: E
authors.lastname: Rizzuto
authors.forename: S
authors.initials: S
authors.lastname: Iannazzo
authors.forename: M L
authors.initials: ML
authors.lastname: Ciofi Degli Atti
authors.forename: A
authors.initials: A
authors.lastname: Villani
authors.forename: A E
authors.initials: AE
authors.lastname: Tozzi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001886:Bordetella pertussis; D002648:Child; D002675:Child, Preschool; D005260:Female; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D017589:Immunization Programs / Q000266:history; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010567:Pertussis Vaccine / Q000008:administration & dosage* / Q000266:history; D018571:Sentinel Surveillance; D014917:Whooping Cough / Q000453:epidemiology* / Q000266:history
chemical_list: D010567:Pertussis Vaccine