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Estudo da tosse convulsa em crianças e adultos : caracterização epidemiológica e fatores associados
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A tosse convulsa também conhecida como Pertussis, causada pela bactéria Bordetella pertussis (BP), tem uma maior incidência em crianças com idade até 1 ano. Dentre os sinais e sintomas mais comuns da tosse convulsa temos: pneumonia, atelectasia, perda de peso, encefalopatia, sendo a pneumonia a complicação mais frequente. Em 2012, foram notificados mais de 140 000 casos de tosse convulsa nos países mais desenvolvidos.
Em Portugal, entre 2015 e 2016, foram registadas três mortes de crianças menores de 1 ano por complicações causadas pela tosse convulsa. No início de 2017 foi introduzido no Programa Nacional de Vacinação a vacina contra a tosse convulsa nas grávidas, sendo distribuída gratuitamente nos centros de saúde. Apesar da disponibilidade de vacinas eficazes, a tosse convulsa permanece como uma das dez maiores causas de mortalidade em crianças com idade inferior a 1 ano no mundo.
Este estudo teve como objetivo, caracterizar o perfil epidemiológico dos casos de tosse convulsa em Portugal (2014 -2016) e eventuais fatores associados ao internamento hospitalar e à não vacinação.
Para o efeito, foi feita uma revisão bibliográfica e um estudo observacional transversal com componente analítico. Foram utilizados os dados de tosse convulsa registados no período de 2014 a 2016, constantes na base de dados das doenças de declaração obrigatória do SINAVE (DGS). Foram incluídos casos de todas as idades, incluindo lactentes entre 28 dias e um ano, e indivíduos com tosse por qualquer período que apresentasse história de contato próximo com caso confirmado de tosse convulsa pelo critério laboratorial. No que concerne ao aspeto vacinal foi verificado se as datas de inoculação eram posteriores as datas de início dos sintomas.
Os dados consistiram num conjunto de 854 casos notificados de tosse convulsa, sendo 52 notificações no ano de 2014, 239 em 2015 e 563 em 2016. Dos casos analisados, verificou-se que os indivíduos de sexo masculino e crianças menores de 1 ano tiveram maior número de casos notificados. Relativamente às distribuições dos casos por áreas geográficas verificou-se que a região Norte teve um maior número notificado de casos de tosse convulsa, constatou-se que a grande maioria destes tinham nacionalidade portuguesa. Nos casos notificados observaram-se 553 (64,8%) internamentos. No total dos casos notificados, 444 (51,2%) eram vacinados, adicionalmente, após verificação das datas de vacinação, contatou-se que 391 casos (45,8%) eram não vacinados, 59 eram potenciais casos vacinais (adquiriram a doença após a vacinação), 13 casos foram vacinados depois de serem casos, e 18 tinham estado vacinal desconhecido. No que se refere a ligação epidemiológica, a maioria dos casos notificados tiveram situação desconhecida.
Para estudar os aspetos da gravidade da doença optou-se por estudar os fatores potencialmente associados à ausência de vacinação e à ocorrência de internamento.
Os fatores que se revelaram associados à ausência de vacinação foram a idade, o internamento e a nacionalidade dos indivíduos. Relativamente à idade (p <0,001), verificou-se que para indivíduos com idade entre dois e cinco anos existe uma chance acrescida de serem não vacinados antes de serem casos, sem que a respetiva chance se diferencie estatisticamente do da chance observada nos indivíduos com menos de um ano de idade. Nos indivíduos com mais de 5 anos a chance de serem casos vacinados é significativamente maior do que a observada nos indivíduos com menos de um ano de idade. O internamento mostrou-se associado à ausência de vacinação (p < 0,001), efetivamente ser vacinado reduz 5,88 vezes a chance de ser internado. A nacionalidade dos indivíduos notificados como casos mostrou associação (p = 0,045), evidenciando chance acrescida de serem vacinados os casos em indivíduos de nacionalidade estrangeira comparativamente com o que acontece com os casos portugueses.
Os fatores que se mostraram associados ao internamento dos casos notificados com tosse convulsa foram a idade, o estado vacinal e a região. A variável idade revelou-se associada ao internamento (p<0,001), tendo os indivíduos até ao um ano de idade maior chance de internamento. Verificou-se que os casos notificados pela região centro e pelas regiões autónomas têm menor chance de internamento que as restantes regiões.
Conclui-se que os casos de tosse convulsa abrangeram todo o território Português, as faixas etárias mais notificadas foram as crianças até um ano de idade. A maioria dos casos notificados não estão associados a surtos, e preencheram critérios laboratoriais, segundo a definição de caso da DGS. São os indivíduos não vacinados e aqueles com idades até um ano de idade que apresentam maiores chances de internamento.
Whooping cough, also known as Pertussis, caused by the bacterium Bordetella pertussis (BP), has a higher incidence in children aged up to 1 year. Most common signs and symptoms of whooping cough are; pneumonia, atelectasis, loss of weight, encephalopathy, being the most frequent complication, pneumonia. In 2012, were notified more than 140 000 cases of whooping cough in the most developed countries. In Portugal, and between 2015 and 2016, were registered three deaths of children under 1 year from complications caused by whooping cough. At the beginning of 2017 was inducted into the National Vaccination Program the whooping cough vaccine in pregnant women, being distributed free of charge in health centers. Despite the availability of effective vaccines, pertussis remains as one of the ten leading causes of mortality in children under the age of 1 year. This study aimed to characterize the epidemiological profile of the cases of whooping cough in Portugal (2014-2016) and any factors associated with the severity of the disease. To this end, we performed a literature review and a cross-sectional observational study with analytical component. We used the data of whooping cough from, 2014 to 2016 listed in the database of notifiable diseases of SINAVE (DGS). We have included cases of all ages, including infants between 28 days and one year, and individuals with cough for any period whit history of close contact with a confirmed case of Pertussis by laboratory criteria. With regard to the vaccine, we checked if inoculation dates were later than dates of onset of symptoms. The data consisted in a set of 854 reported cases of whooping cough, being 52 notifications in year 2014, 239 in 2015 and 563 in 2016. Of the cases analyzed, it was found that male individuals and children under 1 year had a higher number of reported cases. With respect to distributions of cases by geographical areas it was found that the North had a greater number of notified cases of whooping cough, it was noted that the vast majority of these had Portuguese nationality. In reported cases, 553 were observed (64.8%) hospital admissions. The total number of reported cases, 444 (51.2%) were vaccinated, in addition, after checking the dates of vaccination, 391 cases (45.8%) were not vaccinated, 59 were potential vaccine cases (acquired the disease after vaccination), 13 cases were vaccinated after being cases, and 18 had unknown vaccination status. With regard to epidemiological link, most of the reported cases had unknown situation. The factors that have been associated to the lack of vaccination were age, hospitalization and the nationality of individuals. With respect to age (p < 0.001) it was found that for individuals between the ages of two and five years there is an increased probability of being non-vaccinated before being diagnosed, without being statistically different from that observed in individuals with less than a year old. In individuals with more than 5 years the probability of being vaccinated cases is significantly higher than observed in individuals with less than a year old. Hospital stay was shown to be associated with the absence of vaccination (p < 0.001), effectively being vaccinated reduces 5.88 times the likelihood of being hospitalized. The nationality of the individuals notified as cases showed association (p = 0.045), showing increased probability of being vaccinated cases in individuals of foreign nationality by comparison with what happens with the Portuguese cases. The factors that were associated with the hospital admission of the reported cases with whooping cough were age, vaccination status and the region. The variable age proved to be associated with hospitalization (p < 0.001) individuals up to one year of age more likely. The absence of vaccination involves an increase in the likelihood of hospitalization 5.887 times higher (p < 0.001), the cases notified by the Centre and the Autonomous regions had a lower likelihood of hospitalization than the remaining regions. It is concluded that the cases of whooping cough were registered in the entire Portuguese territory, ages more notified were children up to one year of age. Most reported cases are not associated with outbreaks, while filling laboratory criteria, according to the case DGS’ definition. The non-vaccinated individuals and those aged up to one year of age are the cases most likely to be hospitalized.
Whooping cough, also known as Pertussis, caused by the bacterium Bordetella pertussis (BP), has a higher incidence in children aged up to 1 year. Most common signs and symptoms of whooping cough are; pneumonia, atelectasis, loss of weight, encephalopathy, being the most frequent complication, pneumonia. In 2012, were notified more than 140 000 cases of whooping cough in the most developed countries. In Portugal, and between 2015 and 2016, were registered three deaths of children under 1 year from complications caused by whooping cough. At the beginning of 2017 was inducted into the National Vaccination Program the whooping cough vaccine in pregnant women, being distributed free of charge in health centers. Despite the availability of effective vaccines, pertussis remains as one of the ten leading causes of mortality in children under the age of 1 year. This study aimed to characterize the epidemiological profile of the cases of whooping cough in Portugal (2014-2016) and any factors associated with the severity of the disease. To this end, we performed a literature review and a cross-sectional observational study with analytical component. We used the data of whooping cough from, 2014 to 2016 listed in the database of notifiable diseases of SINAVE (DGS). We have included cases of all ages, including infants between 28 days and one year, and individuals with cough for any period whit history of close contact with a confirmed case of Pertussis by laboratory criteria. With regard to the vaccine, we checked if inoculation dates were later than dates of onset of symptoms. The data consisted in a set of 854 reported cases of whooping cough, being 52 notifications in year 2014, 239 in 2015 and 563 in 2016. Of the cases analyzed, it was found that male individuals and children under 1 year had a higher number of reported cases. With respect to distributions of cases by geographical areas it was found that the North had a greater number of notified cases of whooping cough, it was noted that the vast majority of these had Portuguese nationality. In reported cases, 553 were observed (64.8%) hospital admissions. The total number of reported cases, 444 (51.2%) were vaccinated, in addition, after checking the dates of vaccination, 391 cases (45.8%) were not vaccinated, 59 were potential vaccine cases (acquired the disease after vaccination), 13 cases were vaccinated after being cases, and 18 had unknown vaccination status. With regard to epidemiological link, most of the reported cases had unknown situation. The factors that have been associated to the lack of vaccination were age, hospitalization and the nationality of individuals. With respect to age (p < 0.001) it was found that for individuals between the ages of two and five years there is an increased probability of being non-vaccinated before being diagnosed, without being statistically different from that observed in individuals with less than a year old. In individuals with more than 5 years the probability of being vaccinated cases is significantly higher than observed in individuals with less than a year old. Hospital stay was shown to be associated with the absence of vaccination (p < 0.001), effectively being vaccinated reduces 5.88 times the likelihood of being hospitalized. The nationality of the individuals notified as cases showed association (p = 0.045), showing increased probability of being vaccinated cases in individuals of foreign nationality by comparison with what happens with the Portuguese cases. The factors that were associated with the hospital admission of the reported cases with whooping cough were age, vaccination status and the region. The variable age proved to be associated with hospitalization (p < 0.001) individuals up to one year of age more likely. The absence of vaccination involves an increase in the likelihood of hospitalization 5.887 times higher (p < 0.001), the cases notified by the Centre and the Autonomous regions had a lower likelihood of hospitalization than the remaining regions. It is concluded that the cases of whooping cough were registered in the entire Portuguese territory, ages more notified were children up to one year of age. Most reported cases are not associated with outbreaks, while filling laboratory criteria, according to the case DGS’ definition. The non-vaccinated individuals and those aged up to one year of age are the cases most likely to be hospitalized.
Descrição
Tese de mestrado, Epidemiologia, Universidade de Lisboa, Faculdade de Medicina, 2019
Palavras-chave
Tosse convulsa Caracterização epidemiológica Fatores associados Teses de mestrado - 2019