Date Published: September 16, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Maria Theodoridou, Georgia Dargenta, Maria Aptouramani, Panagiotis Papastergiou, Anna Katsiaflaka, Kalliopi Theodoridou, Christos Hadjichristodoulou.
To study the epidemiology of pertussis in Greece and epidemiologic changes throughout a period of twenty-nine years, we conducted a retrospective analysis of available data of pertussis cases for the past twenty-nine years (1980–2008) and a prospective analysis of hospitalized pertussis cases from a children’s hospital in Athens for eight years (2001–2008). From 1980 through 2008, the incidence of pertussis in Greece declined from 11.2 to 0.05 cases per 100,000. Epidemic cycles occurring every 3 to 5 years were observed. Since pertussis circulation cannot be fully controlled by present immunization programs, efforts should be made to vaccinate infants at the recommended age, early diagnose, treatment as well as contact tracing of pertussis cases. Control of pertussis in social susceptible populations is necessary. A national program with adolescent and adult booster could decrease the circulation of B. pertussis. Despite an overall decrease for pertussis cases, pertussis is still a present and future challenge of public health service in Greece.
Pertussis remains one of the most frequent vaccine preventable diseases worldwide. Pertussis is still an important infectious disease with high morbidity and mortality worldwide, especially among infants in whom it is one of the leading causes of mortality. Although most often a persistent but relatively benign respiratory illness, pertussis can result in serious consequences, such as pneumonia, seizures, encephalopathy, and death, especially among infants. Despite high immunization rates in infants and children in many countries, pertussis remains endemic, with epidemics superimposed every 3–5 years [1–3]. Although the inception of childhood pertussis immunization programs has significantly reduced the occurrence of the disease in children, waning vaccine-induced immunity from the old vaccine permits the disease to affect adolescents and adults (after about 7 to 20 years from natural infection and 4 to 12 years from immunization), who in turn transmit the disease to nonimmunized or incompletely immunized infants who are more vulnerable to disease-related complications and higher mortality [4, 5]. Moreover, there is a clear lack of awareness regarding loss of immunity and occurrence of the disease in older patients.
In order to identify pertussis trends in Greece, epidemiological parameters of pertussis were collected from all available sources including notification data from the Ministry of Health and Social Solidarity, the Hellenic Centre of Disease Control and Prevention (KEELPNO) and hospitalization data from “Agia Sofia” a Children’s Hospital in Athens.
The past thirty years data on pertussis morbidity in Greece demonstrates a decrease in endemic. Small epidemic cycles were noted every three to four years, an epidemiological characteristic which has been extensively described in the literature . The increase in vaccination coverage at high levels during the study period , the implementation of surveillance and a series of occasional vaccination programmes focused on groups such member of the Roma community and other ethnic minorities during the last decades were important factors for the observed decreased morbidity of pertussis.
The annual incidence of pertussis in Greece was delineated in the last decades. Pertussis circulation cannot be controlled by present immunization programs. Control of pertussis in social susceptible populations (Roma and emigrants), universal recommendation for an additional adolescent booster, vaccination of persons with close contact to infants as well as contact tracing could further reduce morbidity. Despite an overall decrease for pertussis cases, pertussis is still a present and future challenge of public health service in Greece.