Pertussis resurgence in Toronto, Canada: a population-based study including test-incidence feedback modeling
Pertussis resurgence in Toronto, Canada: a population-based study including test-incidence feedback modeling
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DOI：
10.1186/1471-2458-11-694
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发表时间：
2011-09-07
影响因子：
4.5
通讯作者：
Jamieson, Frances
中科院分区：
文献类型：
--
作者：
Fisman, David N.;Tang, Patrick;Jamieson, Frances
背景资料：百日咳继续挑战医疗专业人员;最近描述的发病率增加可能是由于年龄组效应，疫苗有效性或测试模式的变化。加拿大多伦多最近经历了百日咳发病率的增加，由于集中检测，为评价百日咳流行病学提供了理想的管辖区。我们评估了百日咳的趋势，在多伦多使用所有可用的标本数据，这使我们能够控制不断变化的测试模式和practices.Methods：数据包括所有百日咳培养和PCR检测记录大多伦多从1993年至2007年。我们估计发病率的趋势，使用泊松回归模型，疾病发病率和测试提交之间的复杂关系进行了探索与向量自回归models.Results：从1993年至2007年，26988标本提交测试，2545（9.4%）是积极的。百日咳发病率从1993年至2004年为每10万人2例，从2005年至2007年增加到每10万人10例，在引入新的、更灵敏的PCR检测方法后，检测标本提交量随之激增6倍。在调整测试体积后，发生率的相对变化不太明显。测试阳性和测试提交之间的双向反馈determined.Conclusions：多伦多的百日咳最近激增反映了当地疾病活动的真实增加，爆发的明显规模可能被放大越来越多地使用百日咳测试的临床医生，并提高测试的敏感性，自2005年以来。这些发现可能适用于百日咳流行病学的变化，已经注意到在北美其他地方。
Background: Pertussis continues to challenge medical professionals; recently described increases in incidence may be due to age-cohort effects, vaccine effectiveness, or changes in testing patterns. Toronto, Canada has recently experienced increases in pertussis incidence, and provides an ideal jurisdiction for evaluating pertussis epidemiology due to centralized testing. We evaluated pertussis trends in Toronto using all available specimen data, which allowed us to control for changing testing patterns and practices.Methods: Data included all pertussis culture and PCR test records for Greater Toronto from 1993 to 2007. We estimated incidence trends using Poisson regression models; complex relationships between disease incidence and test submission were explored with vector autoregressive models.Results: From 1993 to 2007, 26988 specimens were submitted for testing; 2545 (9.4%) were positive. Pertussis incidence was 2 per 100,000 from 1993 to 2004 and increased to 10 per 100,000 from 2005-2007, with a concomitant 6-fold surge in test specimen submissions after the introduction of a new, more sensitive PCR assay. The relative change in incidence was less marked after adjustment for testing volumes. Bidirectional feedbacks between test positivity and test submissions were identified.Conclusions: Toronto's recent surge in pertussis reflects a true increase in local disease activity; the apparent size of the outbreak has likely been magnified by increasing use of pertussis testing by clinicians, and by improved test sensitivity since 2005. These findings may be applicable to changes in pertussis epidemiology that have been noted elsewhere in North America.