title: Importance of Enhanced Surveillance for Prevention of Pertussis in Children.
abstract: BACKGROUND
  Bordetella pertussis infection causes considerable morbidity, even in countries with high vaccination coverage. Surveillance of pertussis is usually passive and based on mandatory reporting. We assessed the epidemiologic and clinical characteristics of pertussis cases detected by passive or enhanced surveillance.
  
  
  METHODS
  A prospective population-based study was carried out from January 2012 to December 2013 in Catalonia and Navarre, 2 Spanish regions with a total population of 8.2 million. For each confirmed case, variables of age, sex, clinical symptoms, laboratory results and vaccination status were investigated. Associations between the variables studied and the type of surveillance were assessed by odds ratio (OR) and its 95% confidence interval (CI). Logistic regression was used to estimate adjusted OR (aOR).
  
  
  RESULTS
  In children <18 years of age, passive surveillance was the most important source of detection (95.7% in <1 year). In children 5-10 years of age, passive surveillance detected 67.5% of cases. In those ≥18 years, enhanced surveillance was the most frequent source of case detection (82.5%). Inspiratory whoop (aOR: 1.94; 95% CI: 1.40-2.70), apnea (aOR: 1.92; 95% CI: 1.28-2.87) and posttussive vomiting (aOR: 1.43; 95% CI: 1.04-1.96) were symptoms included in the clinical case definition that were associated with passive surveillance.
  
  
  CONCLUSIONS
  Underreporting of symptomatic cases is important not only in adults, but also in children >1 year of age and suggests that providing clinics with free, fast laboratory diagnostic tests, together with enhanced surveillance of family contacts of any age is necessary to better determine existing cases. Enhanced surveillance may be helpful to better understand transmission patterns in the family and in the community.
authors: From the *Departament de Salut Pública, Universitat de Barcelona, Barcelona, Spain; †CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; ‡Agència de Salut Pública de Catalunya, Barcelona, Spain; §Instituto de Salud Pública de Navarra, Pamplona, Spain; and ¶Agència de Salut Pública de Barcelona, Barcelona, Spain.
authors: Angela
authors: A
authors: Domínguez
authors: Pere
authors: P
authors: Godoy
authors: Diana
authors: D
authors: Toledo
authors: Núria
authors: N
authors: Soldevila
authors: Manuel
authors: M
authors: García-Cenoz
authors: Gloria
authors: G
authors: Farrús
authors: Inma
authors: I
authors: Crespo
authors: Joan A
authors: JA
authors: Caylà
authors: Maria Rosa
authors: MR
authors: Sala
authors: Neus
authors: N
authors: Camps
authors: Irene
authors: I
authors: Barrabeig
authors: Josep
authors: J
authors: Alvarez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003954:Diagnostic Services / Q000458:organization & administration; D003955:Diagnostic Tests, Routine / Q000379:methods; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014917:Whooping Cough / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control* / Q000635:transmission