THE 1993 EPIDEMIC OF PERTUSSIS IN CINCINNATI - RESURGENCE OF DISEASE IN A HIGHLY IMMUNIZED POPULATION OF CHILDREN
THE 1993 EPIDEMIC OF PERTUSSIS IN CINCINNATI - RESURGENCE OF DISEASE IN A HIGHLY IMMUNIZED POPULATION OF CHILDREN
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DOI：
10.1056/nejm199407073310104
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发表时间：
1994-07-07
影响因子：
158.5
通讯作者：
REISING, SF
中科院分区：
文献类型：
--
作者：
CHRISTIE, CDC;MARX, ML;REISING, SF
背景资料。1993年，百日咳在美国死灰复燃。共报告病例6335例，为26年来最多。采用主动微生物监测方法，对1993年大辛辛那提市百日咳疫情进行了调查。该地区170万人口由一家儿童医院和百日咳实验室提供服务。我们前瞻性地跟踪了1993年7月至9月新诊断的百日咳患者，以确定该疾病的流行特征。从1979年到1992年，累计有542例百日咳病例。1993年确诊352例，比1992年增加259%。63%的病例培养出百日咳杆菌阳性，18%的病例仅在直接荧光抗体检测中呈阳性，19%的病例被临床诊断。疫情于夏季在郊区爆发，并在整个大辛辛那提地区蔓延。在7月至9月确诊的255例病例中(195例超出了过去14年每月20例的最高基线水平)，75%是白人患者，67%的患者有私人保险或自掏腰包支付医疗费用。与1979-1992年相比，1993年的发病率从较小的婴儿向较大的儿童转移；按年龄组划分的病例百分比如下：0-6个月、1979-1992年的53%和1993年的35%(P
Background. In 1993 there was a resurgence of pertussis in the United States. Altogether, 6335 cases were reported, the most in 26 years.Methods. Using active microbiologic surveillance, we investigated the epidemic of pertussis in Greater Cincinnati in 1993. The population of 1.7 million in this area is served by a single children's hospital and pertussis laboratory. We prospectively followed patients given a new diagnosis of pertussis in July through September 1993 to determine the characteristics of the epidemic.Results. From 1979 to 1992, there was a cumulative total of 542 cases of pertussis. In 1993, 352 cases were diagnosed, an increase of 259 percent over the 1992 total. Sixty-three percent of the cases had positive cultures for Bordetella pertussis, 18 percent were positive on direct fluorescent-antibody testing only, and 19 percent were diagnosed clinically. The outbreak began in the suburbs during the summer and spread through Greater Cincinnati. Of 255 total cases diagnosed in July through September (195 excess cases over the maximal base-line level of 20 per month in the previous 14 years), 75 percent were in white patients and 67 percent of the patients had private insurance or paid for care out of pocket. In 1993, as compared with 1979 through 1992, there was a shift in incidence from younger infants to older children; the percentages of cases according to age group were as follows: 0 to 6 months, 53 percent from 1979 through 1992 and 35 percent in 1993 (P