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Pertussis Surveillance in Sweden

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Pertussis Surveillance in Sweden Pertussis surveillance in Sweden 21st annual report Pertussis surveillance in Sweden 21st annual report Bindningar och jäv För Folkhälsomyndighetens egna experter och utredare som medverkat i rapporter bedöms eventuella intressekonflikter och jäv inom ramen for anställningsförhållandet. När det gäller externa experter och utredare som deltar i Folkhälsomyndighetens arbete med rapporter kräver myndigheten att de lämnar skriftliga jävsdeklarationer för potentiella intressekonflikter eller jäv. Sådana omständigheter kan föreligga om en expert t.ex. fått eller får ekonomisk ersättning från en aktör med intressen i utgången av den fråga som myndigheten behandlar eller om det finns ett tidigare eller pågående ställningstagande eller engagemang i den aktuella frågan på ett sådant sätt att det uppkommer misstanke om att opartiskheten inte kan upprätthållas. Folkhälsomyndigheten tar därefter ställning till om det finns några omständigheter som skulle försvåra en objektiv värdering av det framtagna materialet och därmed inverka på myndighetens möjligheter att agera sakligt och opartiskt. Bedömningen kan mynna ut i att experten kan anlitas för uppdraget alternativt att myndigheten föreslår vissa åtgärder beträffande expertens engagemang eller att experten inte bedöms kunna delta i det aktuella arbetet. De externa experter som medverkat i framtagandet av denna rapport har inför arbetet i enlighet med Folkhälsomyndighetens krav lämnat en deklaration av eventuella intressekonflikter och jäv. Folkhälsomyndigheten har därefter bedömt att det inte föreligger några omständigheter som skulle kunna äventyra myndighetens trovärdighet. Jävsdeklarationerna och eventuella kompletterande dokument utgör allmänna handlingar som normalt är offentliga handlingarna finns tillgängliga på Folkhälsomyndigheten. Denna titel kan laddas ner från: www.folkhalsomyndigheten.se/publicerat-material Citera gärna Folkhälsomyndighetens texter, men glöm inte att uppge källan. Bilder, fotografier och illustrationer är skyddade av upphovsrätten. Det innebär att du måste ha upphovsmannens tillstånd att använda dem. © Folkhälsomyndigheten, 2019 Artikelnummer: 19071 Förord (preface) Folkhälsomyndigheten har en förstärkt övervakning av kikhosta sedan de acellulära vaccinerna mot kikhosta introducerades i det nationella barnvaccinationsprogrammet i Sverige år 1996. Övervakningen innefattar incidens av rapporterade fall av kikhosta per åldersgrupp samt en uppföljning via strukturerade telefonintervjuer av alla rapporterade fall 0–20 år. Denna rapport innehåller resultaten för år 2018 samt analys från uppföljningen under de tjugoen åren som studien pågått. Kikhosta är en särskilt allvarlig och ibland livshotande sjukdom för ovaccinerade spädbarn under sex månader. Både sjukdomen kikhosta och vaccination mot kikhosta ger ett bra, men relativt kortvarigt skydd mot sjukdom. De senaste fyra årens ökade incidens av kikhosta i Sverige, trots hög vaccinationstäckning, och ökningen av kikhosta i andra länder har aktualiserat vikten av fortsatt förstärkt uppföljning av kikhosta i Sverige. Syftet med uppföljningen av kikhosta är att ge underlag för ändringar av vaccinationsprogrammet eller andra interventioner som kan skydda spädbarn mot kikhosta. Kunskap om sjukdomens epidemiologi och allvarlighetsgrad, vikten av provtagning och förebyggande antibiotikabehandling för de minsta barnen, sprids regelbundet via vetenskapliga publikationer, på Folkhälsomyndighetens webbplats och i samband med utbildningsdagar och kurser riktade till hälso- och sjukvårdspersonal. Målgruppen för årsrapporten är hälso- och sjukvårdspersonal, och då särskilt personal inom mödra-, barnhälso-vård, elvhälsa och barnsjukvård samt primärvård och smittskyddsenheter. Rapporten har skrivits av Bernice Aronsson (projektledare), Henrik Källberg, Emma Byström och Kerstin Drakes-Jämtberg. I den slutliga utformningen har enhetschef Adam Roth och utredare Sören Andersson deltagit. Folkhälsomyndigheten Britta Björkholm, Avdelningschef, Avdelningen för smittskydd och hälsoskydd Preface The Public Health Agency of Sweden has conducted enhanced surveillance of pertussis since 1996, when acellular vaccines were introduced into Sweden’s national immunisation programme for children. The surveillance includes the incidence of reported pertussis cases per age group and follow-up of all reported cases of pertussis in patients 0–20 years of age through structured telephone interviews. This report includes results for 2018, as well as analyses from the past 21 years of surveillance. Pertussis is particularly serious and sometimes life threatening for unvaccinated infants under the age of 6 months. Both pertussis infection and vaccination provide good but relatively short-lived protection against the disease. The increased incidence of pertussis in Sweden during the last five years, despite high vaccination coverage, and the increase in pertussis in other countries has accentuated the importance of enhanced follow-up of pertussis cases. The aim of the surveillance of pertussis is to provide knowledge to make informed changes in the national immunisation programme or other interventions to protect infants. Surveillance data on pertussis epidemiology, on severe disease progression, and on the importance of laboratory testing and prophylactic antibiotic treatment of infants, are disseminated regularly through scientific articles on the Public Health Agency’s website and at conferences and in courses aimed at health care professionals. This report is written for health care professionals, particularly those working in maternal and child health care, school health care (elevhälsan), and primary care, and those working in the counties’ Departments of Communicable Disease Control and Prevention. The report was written by Bernice Aronsson (project leader), Henrik Källberg, Emma Byström, and Kerstin Drakes-Jämtberg. Head of Unit Adam Roth and analyst Sören Andersson participated in the final revisions of the report. The Public Health Agency of Sweden Britta Björkholm, Head of the Department of Communicable Disease Control and Health Protection Content Förord(preface) ........................... 3 Abbreviations ............................. 6 Summary ............................... 12 1 Background 13 1.1 The national immunisation programme, pertussis vaccine trials, and the mass vaccination project. 13 1.1.1 Pertussis vaccine Trial I and Trial II . 14 1.1.2 Gothenburg mass vaccination project . 15 1.2 Vaccination registration and vaccine coverage in Sweden . 16 1.3 Pertussis vaccines included in NIP . 18 1.4 The enhanced pertussis surveillance study in Sweden . 20 1.5 Data sources and Methods . 20 1.5.1 SmiNet - mandatory reporting of pertussis cases in Sweden ......................... 20 1.5.2 Collection of data and inclusion criteria in the enhanced surveillance study of pertussis . 21 1.6 Diagnostics ........................... 24 1.6.1 Diagnostic methods . 24 1.6.2 Case definition in the enhanced pertussis surveillance study........................... 27 1.6.3 Sample size considerations and the calculation of incidences ........................ 27 2 Results 28 2.1 Number and incidence of reported pertussis cases to SmiNet inallages ............................ 28 2.1.1 Incidence and number of cases of pertussis distributed by age, time intervals, and vaccination program . 32 2.1.2 Incidence and cases on a monthly basis . 33 2.1.3 Geographic differences in Sweden for laboratory-confirmed pertussis cases . 35 2.1.4 Incidence of pertussis cases reported to SmiNet in defined age-groups before and after the introduction of DTaP vaccination . 36 2.2 Pertussis in fully vaccinated children 1–18 years of age . 39 2.3 Pertussis in infants . 42 2.3.1 Cases of pertussis in infants and among children older than 1 year of age, distributed by age and vaccination status . 43 2.3.2 Incidence of pertussis in infancy by year and after changes to the national immunisation programme . 46 2.3.3 Severity of pertussis cases in infants and among cases in children 1–20 years of age . 48 2.3.4 The rate of complications due to pertussis by age . 49 2.3.5 Severity of pertussis in infant cases less than 6 months of age at the start of the pertussis episode . 50 2.3.6 Hospital admission due to pertussis in all infant pertussis cases .......................... 51 2.3.7 Complications due to pertussis in all infant cases by hospitalisation . 53 2.3.8 Hospital admission by age and vaccination status . 53 2.3.9 Spasmodic cough . 55 Duration of spasmodic cough, age and vaccination status at episodestart....................... 55 Complication in relation to age and vaccination status at the pertussis episode . 56 2.3.10 Case contact study of pertussis in infants . 58 2.4 Evaluation of recommendations . 58 2.4.1 Timing of vaccinations . 58 2.4.2 Treatment of pertussis in infants and in children above1yearofage. 60 2.4.3 Time between the onset of pertussis disease and diagnosis......................... 61 2.4.4 Number of times parents have sought medical care for their sick child before a pertussis diagnosis was established. ....................... 62 2.4.5 Number of samples analysed for pertussis . 62 3 Discussion 63 4 Plan for continued work 69 4.1 Scientific publications and presentations . 70 4.2 Limitations............................ 71 5 Administration 72 6 Published reports based on the enhanced surveillance data 73 7 References 75 Abbreviations aP Acellular pertussis (vaccine) CHC Child health care DTaP Diphtheria-, tetanus, and acellular pertussis vaccine dTap Diphtheria, tetanus,
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