Increasing incidence of pertussis in Brazil: a retrospective study using surveillance data.
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.
Regional Office Oswaldo Cruz Foundation (Fiocruz), Teresina, Piauí, Brazil. lucasmeloguimaraes@gmail.com.|Laboratory of Epidemiology and Molecular Systematics, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil. lucasmeloguimaraes@gmail.com.
Lucas Melo
LM
Guimarães
Federal Institute of Education, Science and Technology of Piauí (IFPI), Teresina, Piauí, Brazil. eduilson@ifpi.edu.br.
Eduilson Lívio Neves da Costa
EL
Carneiro
Regional Office Oswaldo Cruz Foundation (Fiocruz), Teresina, Piauí, Brazil. guaratiba@ioc.fiocruz.br.|Laboratory of Epidemiology and Molecular Systematics, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil. guaratiba@ioc.fiocruz.br.
Filipe Anibal
FA
Carvalho-Costa
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010567:Pertussis Vaccine / Q000008:administration & dosage; D011634:Public Health; D012189:Retrospective Studies; D012621:Seasons; D014917:Whooping Cough / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
D010567:Pertussis Vaccine