title: Epidemiology of pertussis in two Ibero-American countries with different vaccination policies: lessons derived from different surveillance systems.
abstract: Pertussis is a re-emerging disease worldwide despite its high vaccination coverage. European and Latin-American countries have used different surveillance and vaccination policies against pertussis. We compared the epidemiology of this disease in two Ibero-American countries with different vaccination and surveillance policies.
  
  
  
  We compared the epidemiology of pertussis in Spain and the Dominican Republic (DR). We present a 10-year observational study of reported pertussis based on suspected and/or probable cases of pertussis identified by the national mandatory reporting system in both countries between 2005 and 2014. Both countries have a similar case definition for pertussis surveillance, although Spain applies laboratory testing, and uses real time PCR and/or culture for case confirmation while in DR only probable and/or suspected cases are reported. We analyzed incidence, hospitalization, case-fatality rates, mortality and vaccination coverage.
  
  
  
  The average annual incidence in children aged <1 year was 3.40/100,000 population in Spain and 12.15/100,000 in DR (p = 0.01). While the incidence in DR was generally higher than in Spain, in 2011 it was six times higher in Spain than in DR. The highest infant mortality in Spain was 0.017/100,000 in 2011, and the highest in DR was 0.08/100,000 in 2014 (p = 0.01). The proportion of hospitalized cases per year among children <1 year varied between 22.0% and 93.7% in Spain, and between 1.1% and 29.4% in DR (p = 0.0002), while mortality varied from 0 to 0.017 and 0 to 0.08 per 100,000 population in Spain and DR, respectively (p = 0.001). Vaccination coverage was 96.5% in Spain and 82.2% in DR (p = 0.001).
  
  
  
  Pertussis is a public health problem in both countries. Surveillance, prevention and control measures should be improved, especially in DR. Current vaccination programs are not sufficient for preventing continued pertussis transmission, even in Spain which has high vaccination coverage.
authors.affiliation: CIBER Epidemiology and Public Health (CIBERESP), Epidemiology Service-Barcelona Public Health Agency, Pl. Lesseps 1, 08023, Barcelona, Spain. rsolanosilveira@gmail.com.|Department of Public Health, University of Barcelona, Barcelona, Spain. rsolanosilveira@gmail.com.|Epidemiology Service, Barcelona Public Health Agency, Barcelona, Spain. rsolanosilveira@gmail.com.
authors.forename: Rubén
authors.initials: R
authors.lastname: Solano
authors.affiliation: CIBER Epidemiology and Public Health (CIBERESP), Epidemiology Service-Barcelona Public Health Agency, Pl. Lesseps 1, 08023, Barcelona, Spain.|National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain.
authors.forename: Josefa
authors.initials: J
authors.lastname: Masa-Calles
authors.affiliation: Extended Immunizations Programme, Dominican Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic.
authors.forename: Zacarías
authors.initials: Z
authors.lastname: Garib
authors.affiliation: Extended Immunizations Programme, Dominican Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic.
authors.forename: Patricia
authors.initials: P
authors.lastname: Grullón
authors.affiliation: Extended Immunizations Programme, Dominican Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic.
authors.forename: Sandy L
authors.initials: SL
authors.lastname: Santiago
authors.affiliation: Extended Immunizations Programme, Dominican Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic.
authors.forename: Altagracia
authors.initials: A
authors.lastname: Brache
authors.affiliation: CIBER Epidemiology and Public Health (CIBERESP), Epidemiology Service-Barcelona Public Health Agency, Pl. Lesseps 1, 08023, Barcelona, Spain.|Department of Public Health, University of Barcelona, Barcelona, Spain.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Domínguez
authors.affiliation: CIBER Epidemiology and Public Health (CIBERESP), Epidemiology Service-Barcelona Public Health Agency, Pl. Lesseps 1, 08023, Barcelona, Spain.|Epidemiology Service, Barcelona Public Health Agency, Barcelona, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D004293:Dominican Republic / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D008297:Male; D019221:Mandatory Reporting; D010567:Pertussis Vaccine / Q000008:administration & dosage; D011159:Population Surveillance / Q000379:methods; D013030:Spain / Q000453:epidemiology; D014611:Vaccination; D014917:Whooping Cough / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D010567:Pertussis Vaccine
keywords: Bordetella pertussis; Dominican Republic; Infectious disease epidemiology; Spain; Surveillance; Whooping cough