Pertussis sources of infection and routes of transmission in the vaccination era.
Pertussis sources of infection and routes of transmission in the vaccination era.
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DOI：
10.1097/01.inf.0000160909.24879.e6
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发表时间：
2005-05-01
期刊：
影响因子：
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通讯作者：
Gardner, Pierce
中科院分区：
文献类型：
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作者：
Schellekens, Joop;von Konig, Carl-Heinz Wirsing;Gardner, Pierce
百日咳疫苗接种降低了百日咳杆菌的感染压力（部分群体免疫），但B.由于疫苗诱导的和自然获得的免疫力减弱，百日咳一直持续存在。报告的B发病率增加。已注意到年龄较大的儿童、青少年和年轻人感染百日咳，导致人们认为该疾病在这些年龄组中死灰复燃。不管这种复苏是否是真实的，人们越来越认识到老年群体在传播B方面发挥着重要作用。在未完全接种疫苗的婴儿中，百日咳感染率仍很高，百日咳继续导致严重和致命的疾病，尽管发病率比接种疫苗前低得多。一些研究表明，母亲尤其是婴儿的重要感染源。青少年、祖父母和卫生保健工作者也可以发挥作用。相比之下，大多数青少年从同学和朋友那里获得感染，而成年人的主要来源是儿童和工作同事。此外，教师、儿童保育工作者和卫生保健工作者接触和传播B的风险可能会增加。百日咳感染目前的免疫策略不足以控制B的传播。百日咳，部分原因是对当前儿科免疫指南的依从性不佳。除了努力提高儿童百日咳免疫接种率外，还应考虑将百日咳免疫接种扩大到特定群体。除了降低目标群体的发病率外，这些战略还可以减少婴儿百日咳发病率和死亡率的剩余负担。
Vaccination against pertussis has resulted in reduction of the infection pressure of Bordetella pertussis (partial herd immunity), but the circulation of B. pertussis has persisted as a consequence of waning of vaccine-induced and naturally acquired immunity. An increase in the reported incidence of B. pertussis infection in older children, adolescents and young adults has been noted, resulting in a perceived resurgence of the disease in these age groups. Regardless of whether this resurgence is real or not, older groups are increasingly recognized as playing an important role in transmitting B. pertussis infection to incompletely immunized infants, in whom pertussis disease continues to cause severe and fatal illness, albeit at much lower levels than in the prevaccine era. Several studies have suggested that mothers, in particular, are a significant source of infection for infants. Adolescents, grandparents and health care workers can also play a role. By contrast, most adolescents acquire the infection from schoolmates and friends, whereas for adults the main sources are children and work colleagues. Furthermore teachers, child care workers and health care workers could be at increased risk of being exposed to, and transmitting, B. pertussis infection. Current immunization strategies inadequately control the circulation of B. pertussis, in part because of suboptimal adherence to current pediatric immunization guidelines. In addition to efforts to improve pertussis immunization rates in children, the expansion of pertussis immunization to target specific groups should be considered. Besides reducing morbidity in the targeted groups, these strategies could decrease the residual burden of pertussis morbidity and mortality in infants.