哮喘联盟

   摘要
   副百日咳与百日咳均由杆菌引起，两者具有相似的临床症状。波兰医生对副百日咳既没有常规诊断流程也未进行提前预防。本研究旨在探索波兰副百日咳的发病率以及疾病诊断预测因素。研究方法：2009年7月至2011年4月，对78个全科门诊的就诊患者进行回顾性队列研究，纳入其中大于3岁且咳嗽症状持续两周以上的患者。采访患者并收集其鼻咽拭子样本，通过实时PCR确诊。根据每个全科门诊的观察时间分配患者数，从而统计副百日咳的发病率。通过与测试结果阴性的患者进行比较，，从而评估得到PCR确诊副百日咳的预测因素。统计学方法采用Logistic回归，并计算OR值及其95%置信区间（CI）。研究结果：1231名患者中共有78名符合入组标准。发病率为39/100000人年（95%CI 31-49）,3～5岁儿童发病率最高，达到140/100000（95%CI 74-239）,20～39岁人群发病率最低，为24/100000（95%CI 13-40）。3～5岁男童（7.1; 2.1-25.3）、40岁以上妇女 (4.1; 1.4-11.7) 、住房拥挤的家庭成员(4.3; 1.4-12.9)以及与长期咳嗽患者有接触的人群(2.3; 1.1-4.5) 副百日咳患病风险更高。结果提示，因长期咳嗽至全科医生处就诊的学龄前儿童及40岁以上妇女，应优先考虑进行实验室检查以明确诊断。在还未发明相关疫苗的情况下，与副百日咳患者密切接触后及时采取暴露后预防将会是一种适当的预防措施。
 

（刘国梁 审校）
Eur J ClinMicrobiol Infect Dis. 2014 Jul 31. [Epub ahead of print]

 

Incidence and factors predicting whooping cough due to parapertussis diagnosis among patients referred to general practitioners, Poland, 2009-2011.
 

Tomialoic R1, Stefanoff P, Paradowska-Stankiewicz I, Zasada A, Sadkowska-Todys M.
 

Abstract
Parapertussis leads to similar symptoms as pertussis, both being caused by bacteria from the genus Bordetella. Poland does not routinely diagnose nor conduct surveillance for parapertussis. We estimated parapertussis incidence and determined predictors of parapertussis diagnosis in the Polish population. Between July 2009 and April 2011, we conducted a prospective cohort study among patients attending 78 general practices. We included patients aged ≥3 years, with cough lasting >2 weeks, interviewed patients and collected a nasopharyngeal swab. We confirmed cases by real-time PCR. We estimated parapertussis incidence rates by dividing the number of cases by the summed person-time of observation in respective practices. We assessed predictors of PCR-confirmed parapertussis by comparing cases with patients testing negative. Using logistic regression, we calculated odds ratios (ORs) and 95 % confidence intervals (95%CI). We identified 78 cases among 1,231 patients meeting inclusion criteria. The incidence rate was 39/100,000 person-years (95%CI 31-49). The highest rates (140/100,000; 95%CI 74-239), were among children 3-5 years of age and the lowest (24/100,000; 95%CI 13-40) among persons aged 20-39 years of age. Boys aged 3-5 years (7.1; 2.1-25.3) and women aged >40 years (4.1; 1.4-11.7) or living in crowded households (4.3; 1.4-12.9) or contacting persons with prolonged cough (2.3; 1.1-4.5) were more likely to be diagnosed. Our results suggest that laboratory diagnosis could be prioritized for children in the preschool age and women aged over 40 who were referred to their GP with prolonged cough. In the absence of vaccine, post-exposure prophylaxis for close contacts of parapertussis cases could an adequate preventative measure.

 
Eur J ClinMicrobiol Infect Dis. 2014 Jul 31. [Epub ahead of print]