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Surto de tosse convulsa na Região de Lisboa e Vale do Tejo durante o ano 2012
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RESUMO - Introdução: A tosse convulsa permanece um grave problema de saúde publica em
Portugal e em todo mundo e continua a ser uma das principais causas de morte entre
as doenças evitáveis pela vacinação. Apesar de altas taxas de cobertura vacinal em
países desenvolvidos, incluindo Portugal, tem-se registado nos últimos anos um
aumento de casos de tosse convulsa. A tosse convulsa é uma infeção respiratória,
altamente contagiosa e endémica, causada pela bactéria Bordetella pertussis ou
Bordetella parapertussis. A doença caracteriza-se por uma tosse paroxística e estridor.
Objetivo: descrever e caracterizar o surto de tosse convulsa ocorrido na Região de
Lisboa e Vale do Tejo no período entre 01 de janeiro e 31 de dezembro de 2012.
Métodos: realizou-se um estudo epidemiológico observacional, descritivo, transversal
com análise de informação retrospetiva.
Resultados: no período estudado foram contabilizados 81 casos de tosse convulsa,
principalmente lactentes menores de seis meses de idade (n=70: 86,4%), (dos quais 9
eram casos prováveis (11,1%) e 72 confirmados (88,9%). Observaram-se casos em
adultos com necessidade de internamento. O primeiro caso ocorreu na segunda semana
de janeiro, mas a maior incidência de casos registou-se entre 01 de maio e 29 de julho
de 2012 com ligeira predominância no sexo feminino. A taxa de incidência observada
foi de 2,2/100.000 hab. A maioria dos doentes com tosse convulsa residiam no concelho
de Lisboa (n = 16; 19.8%). Foram internadas 69 pessoas, principalmente lactentes com
idade inferior a 3 meses e com duração média de 11 dias. Em 33% (n=24) dos
internamentos registaram-se complicações, sendo a pneumonia a complicação mais
frequente (n=21; 31,8%). Há associação estatisticamente significativa a idade (p=0,000)
e o estado de imunização (p=0,000) dos doentes com tosse convulsa e a hospitalização.
Ocorreram dois óbitos que corresponde a uma taxa de letalidade de 2,5%.
Conclusão: os lactentes com idade inferior a seis meses, que ainda não estão
imunizados ou sem a promovacinação completa foram os mais afetados e apresentaram
elevados números de internamentos, complicações e mortalidade. A gravidade da
doença está ligada diretamente com a idade e o estado de imunização. Os membros da
família foram identificados como fonte de contagio importante, principalmente os pais
e/ou irmãos mais velhos. Em maioria dos casos a duração da tosse foi menor do que 14
dias.
SUMMARY - Introduction: Whooping cough remains a serious public health problem in Portugal and around the world, remaining a leading cause of death among vaccine-preventable diseases. Despite the high rates of vaccine coverage in developed countries, including Portugal, there has been an increase in cases of pertussis in recent years. Whooping cough is a highly contagious and endemic respiratory infection caused by the bacteria Bordetella pertussis or Bordetella parapertussis. The disease is characterized by a paroxysmal cough and stridor. Objective: to describe and characterize the outbreak of whooping cough that occurred in the Lisbon and Tagus Valley Region between January 1st and December 31st, 2012. Methods: An observational, descriptive, cross-sectional epidemiological study with retrospective information analysis was performed. Results: 81 cases of pertussis were recorded during the study period, It mainly affected infants under 6 months old (n = 71, 86.4%), 9 of which (11.1%) were probable cases and 72 (88.9%) were confirmed cases. Cases were observed in adults requiring hospitalization. The first case occurred in the second week of January, but the highest incidence occurred between May 1st and July 29th, 2012, with a slight predominance in females. The observed incidence rate was 1.4 / 10,000 inhabitants. The majority of patients with whooping cough lived in the municipality of Lisbon (n = 16; 19.8%). Sixtynine people were hospitalized, mainly infants under 3 months old, with an average hospitalization period of 11 days. Complications occurred in 33% (n = 24) of hospitalizations, with pneumonia being the most frequent complication (n=21; 31,8%). There was a statistically significant association between age (p <0.001) and immunization status (p <0.001) of the patients with whooping cough and hospitalization. There were two deaths which corresponded to a case fatality rate of 2.5%. Conclusion: infants under six months old, who are not yet immunized or without full primary vaccination were the most affected and presented higher numbers of hospitalizations, complications and mortality. The severity of the disease was directly linked to age and immunization status. Family members were identified as an important source of infection, especially parents and / or older siblings. The majority of cases had whooping cough duration shorter than 14 days.
SUMMARY - Introduction: Whooping cough remains a serious public health problem in Portugal and around the world, remaining a leading cause of death among vaccine-preventable diseases. Despite the high rates of vaccine coverage in developed countries, including Portugal, there has been an increase in cases of pertussis in recent years. Whooping cough is a highly contagious and endemic respiratory infection caused by the bacteria Bordetella pertussis or Bordetella parapertussis. The disease is characterized by a paroxysmal cough and stridor. Objective: to describe and characterize the outbreak of whooping cough that occurred in the Lisbon and Tagus Valley Region between January 1st and December 31st, 2012. Methods: An observational, descriptive, cross-sectional epidemiological study with retrospective information analysis was performed. Results: 81 cases of pertussis were recorded during the study period, It mainly affected infants under 6 months old (n = 71, 86.4%), 9 of which (11.1%) were probable cases and 72 (88.9%) were confirmed cases. Cases were observed in adults requiring hospitalization. The first case occurred in the second week of January, but the highest incidence occurred between May 1st and July 29th, 2012, with a slight predominance in females. The observed incidence rate was 1.4 / 10,000 inhabitants. The majority of patients with whooping cough lived in the municipality of Lisbon (n = 16; 19.8%). Sixtynine people were hospitalized, mainly infants under 3 months old, with an average hospitalization period of 11 days. Complications occurred in 33% (n = 24) of hospitalizations, with pneumonia being the most frequent complication (n=21; 31,8%). There was a statistically significant association between age (p <0.001) and immunization status (p <0.001) of the patients with whooping cough and hospitalization. There were two deaths which corresponded to a case fatality rate of 2.5%. Conclusion: infants under six months old, who are not yet immunized or without full primary vaccination were the most affected and presented higher numbers of hospitalizations, complications and mortality. The severity of the disease was directly linked to age and immunization status. Family members were identified as an important source of infection, especially parents and / or older siblings. The majority of cases had whooping cough duration shorter than 14 days.
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Tosse convulsa Bordetella pertússis Surto Lactentes Internamento Lisboa e Vale do Tejo Whooping cough Bordetella pertussis Outbreak Infants hospitalization Lisbon and Tagus Valley