title: Underdetection and underreporting of pertussis in children attended in primary health care centers: Do surveillance systems require improvement?
abstract: Pertussis is an underestimated disease. Several European countries have developed models to account for underreporting of pertussis. The aim of this study was to estimate pertussis underdetection and underreporting in pediatric patients attending primary health care centers (PHCCs).
  
  
  
  We reviewed clinical records of PHCCs in Barcelona in 2012. Factors associated with underdetection and underreporting were analyzed by logistic regression. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated.
  
  
  
  We included 3,505 children aged < 7 years (mean age, 34  ±  20.7 months; range, 0-82 months) presenting with cough; 9.3% (326 out of 3,505) of patients also had ≥ 1 symptoms related to pertussis accompanied by cough for a duration ≥ 2 weeks. Of the 326 children receiving clinical criteria, only 31 (9.5%) were laboratory-confirmed and 6 (1.8%) were detected but not reported. There were 295 (90.5%) undetected suspected pertussis cases. Age ≥ 18 months (aOR, 8.51; 95% CI, 1.82-39.86), cyanosis (aOR, 6.71; 95% CI, 1.43-31.39), request for chest radiograph (aOR, 0.26; 95% CI, 0.07-0.99), and request for other laboratory tests (aOR, 5.39; 95% CI, 2.19-13.27) were associated with underdetection. Paroxysmal cough (aOR, 5.77; 95% CI, 1.05-31.76) and request for other laboratory tests (aOR, 2.91; 95% CI, 1.11-7.62) were associated with underreporting.
  
  
  
  Both underdetection and underreporting complicate the understanding of pertussis epidemiology. Correct assessment of pertussis symptoms and notification of cases must be improved to control pertussis.
authors.affiliation: CIBER Epidemiology and Public Health, Carlos III Institute of Health, Madrid, Spain; Epidemiology Department, Barcelona Public Health Agency, Barcelona, Spain; Department of Public Health, University of Barcelona, Barcelona, Spain. Electronic address: rsolanosilveira@gmail.com.
authors.forename: Rubén
authors.initials: R
authors.lastname: Solano
authors.affiliation: CIBER Epidemiology and Public Health, Carlos III Institute of Health, Madrid, Spain; Department of Public Health, University of Barcelona, Barcelona, Spain.
authors.forename: Inma
authors.initials: I
authors.lastname: Crespo
authors.affiliation: Evaluation and Quality Assessment Systems Unit, Primary Health Care Center, Catalan Institute of Health, Barcelona, Spain.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Fernández
authors.affiliation: Evaluation and Quality Assessment Systems Unit, Primary Health Care Center, Catalan Institute of Health, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Valero
authors.affiliation: La Sagrera Primary Health Care Center, Catalan Institute of Health, Barcelona, Spain.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Álvarez
authors.affiliation: CIBER Epidemiology and Public Health, Carlos III Institute of Health, Madrid, Spain; Public Health Agency of Catalonia, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Godoy
authors.affiliation: CIBER Epidemiology and Public Health, Carlos III Institute of Health, Madrid, Spain; Epidemiology Department, Barcelona Public Health Agency, Barcelona, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
authors.affiliation: CIBER Epidemiology and Public Health, Carlos III Institute of Health, Madrid, Spain; Department of Public Health, University of Barcelona, Barcelona, Spain.
authors.forename: Àngela
authors.initials: À
authors.lastname: Domínguez
mesh_terms: D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011320:Primary Health Care; D013030:Spain / Q000453:epidemiology; D014917:Whooping Cough / Q000175:diagnosis* / Q000453:epidemiology*
keywords: Disease notification; Epidemiology; Family physicians; Infection control; Pediatric infection; Whooping cough