The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis

 

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dc.contributor.author Muloiwa, Rudzani
dc.contributor.author Kagina, Benjamin M
dc.contributor.author Engel, Mark E
dc.contributor.author Hussey, Gregory D
dc.date.accessioned 2021-03-31T08:54:36Z
dc.date.available 2021-03-31T08:54:36Z
dc.date.issued 2020-08-28
dc.identifier.citation Muloiwa, R., Kagina, B.M., Engel, M.E. & Hussey, G.D. 2020. The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis. <i>BMC Medicine.</i> 18(1) http://hdl.handle.net/11427/33204 en_ZA
dc.identifier.uri https://doi.org/10.1186/s12916-020-01699-3
dc.identifier.uri http://hdl.handle.net/11427/33204
dc.description.abstract Abstract Background An effective vaccine against Bordetella pertussis was introduced into the Expanded Programme on Immunisation (EPI) by WHO in 1974, leading to a substantial global reduction in pertussis morbidity and mortality. In low- and middle-income countries (LMICs), however, the epidemiology of pertussis remains largely unknown. This impacts negatively on pertussis control strategies in these countries. This study aimed to systematically and comprehensively review published literature on the burden of laboratory-confirmed pertussis in LMICs over the 45 years of EPI. Methods Electronic databases were searched for relevant literature (1974 to December 2018) using common and MeSH terms for pertussis. Studies using PCR, culture or paired serology to confirm Bordetella pertussis and parapertussis in symptomatic individuals were included if they had clearly defined numerators and denominators to determine prevalence and mortality rates. Results Eighty-two studies (49,167 participants) made the inclusion criteria. All six WHO regions were represented with most of the studies published after 2010 and involving mainly upper middle-income countries (n = 63; 77%). PCR was the main diagnostic test after the year 2000. The overall median point prevalence of PCR-confirmed Bordetella pertussis was 11% (interquartile range (IQR), 5–27%), while culture-confirmed was 3% (IQR 1–9%) and paired serology a median of 17% (IQR 3–23%) over the period. On average, culture underestimated prevalence by 85% (RR = 0.15, 95% CI, 0.10–0.22) compared to PCR in the same studies. Risk of pertussis increased with HIV exposure [RR, 1.4 (95% CI, 1.0–2.0)] and infection [RR, 2.4 (95% CI, 1.1–5.1)]. HIV infection and exposure were also related to higher pertussis incidences, higher rates of hospitalisation and pertussis-related deaths. Pertussis mortality and case fatality rates were 0.8% (95% CI, 0.4–1.4%) and 6.5% (95% CI, 4.0–9.5%), respectively. Most deaths occurred in infants less than 6 months of age. Conclusions Despite the widespread use of pertussis vaccines, the prevalence of pertussis remains high in LMIC over the last three decades. There is a need to increase access to PCR-based diagnostic confirmation in order to improve surveillance. Disease control measures in LMICs must take into account the persistent significant infant mortality and increased disease burden associated with HIV infection and exposure.
dc.source BMC Medicine
dc.source.uri https://bmcmedicine.biomedcentral.com/
dc.subject Pertussis
dc.subject Burden
dc.subject Prevalence
dc.subject Incidence
dc.subject Mortality
dc.subject Case fatality
dc.subject HIV
dc.subject Low- and middle-income countries (LMIC)
dc.title The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis
dc.type Journal Article
dc.date.updated 2020-08-30T03:23:58Z
dc.language.rfc3066 en
dc.rights.holder The Author(s)
dc.source.journalvolume 18
dc.source.journalvolume 233
dc.source.journalissue 1
dc.identifier.apacitation Muloiwa, R., Kagina, B. M., Engel, M. E., & Hussey, G. D. (2020). The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis. <i>BMC Medicine</i>, 18(1), http://hdl.handle.net/11427/33204 en_ZA
dc.identifier.chicagocitation Muloiwa, Rudzani, Benjamin M Kagina, Mark E Engel, and Gregory D Hussey "The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis." <i>BMC Medicine</i> 18, 1. (2020) http://hdl.handle.net/11427/33204 en_ZA
dc.identifier.vancouvercitation Muloiwa R, Kagina BM, Engel ME, Hussey GD. The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis. BMC Medicine. 2020;18(1) http://hdl.handle.net/11427/33204. en_ZA
dc.identifier.ris TY - Journal Article AU - Muloiwa, Rudzani AU - Kagina, Benjamin M AU - Engel, Mark E AU - Hussey, Gregory D AB - Abstract Background An effective vaccine against Bordetella pertussis was introduced into the Expanded Programme on Immunisation (EPI) by WHO in 1974, leading to a substantial global reduction in pertussis morbidity and mortality. In low- and middle-income countries (LMICs), however, the epidemiology of pertussis remains largely unknown. This impacts negatively on pertussis control strategies in these countries. This study aimed to systematically and comprehensively review published literature on the burden of laboratory-confirmed pertussis in LMICs over the 45 years of EPI. Methods Electronic databases were searched for relevant literature (1974 to December 2018) using common and MeSH terms for pertussis. Studies using PCR, culture or paired serology to confirm Bordetella pertussis and parapertussis in symptomatic individuals were included if they had clearly defined numerators and denominators to determine prevalence and mortality rates. Results Eighty-two studies (49,167 participants) made the inclusion criteria. All six WHO regions were represented with most of the studies published after 2010 and involving mainly upper middle-income countries (n = 63; 77%). PCR was the main diagnostic test after the year 2000. The overall median point prevalence of PCR-confirmed Bordetella pertussis was 11% (interquartile range (IQR), 5–27%), while culture-confirmed was 3% (IQR 1–9%) and paired serology a median of 17% (IQR 3–23%) over the period. On average, culture underestimated prevalence by 85% (RR = 0.15, 95% CI, 0.10–0.22) compared to PCR in the same studies. Risk of pertussis increased with HIV exposure [RR, 1.4 (95% CI, 1.0–2.0)] and infection [RR, 2.4 (95% CI, 1.1–5.1)]. HIV infection and exposure were also related to higher pertussis incidences, higher rates of hospitalisation and pertussis-related deaths. Pertussis mortality and case fatality rates were 0.8% (95% CI, 0.4–1.4%) and 6.5% (95% CI, 4.0–9.5%), respectively. Most deaths occurred in infants less than 6 months of age. Conclusions Despite the widespread use of pertussis vaccines, the prevalence of pertussis remains high in LMIC over the last three decades. There is a need to increase access to PCR-based diagnostic confirmation in order to improve surveillance. Disease control measures in LMICs must take into account the persistent significant infant mortality and increased disease burden associated with HIV infection and exposure. DA - 2020-08-28 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Medicine KW - Pertussis KW - Burden KW - Prevalence KW - Incidence KW - Mortality KW - Case fatality KW - HIV KW - Low- and middle-income countries (LMIC) LK - https://open.uct.ac.za PY - 2020 T1 - The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis TI - The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis UR - http://hdl.handle.net/11427/33204 ER - en_ZA


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