BMC Med Inform Decis Mak - Relationship between the population incidence of pertussis in children in New South Wales, Australia and emergency department visits with cough: a time series analysis.

Tópicos

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Resumo

CKGROUND: Little is known about the potential of syndromic surveillance to provide early warning of pertussis outbreaks. We conducted a time series analysis to assess whether an emergency department (ED) cough syndrome would respond to changes in the incidence of pertussis in children aged under 10 years in New South Wales (NSW), Australia, and to evaluate the timing of any association. A further aim was to assess the lag between the onset of pertussis symptoms and case notification in the infectious diseases surveillance system in NSW.METHODS: Using routinely collected data, we prepared a daily count time series of visits to NSW EDs assigned a provisional diagnosis of cough. Separate daily series were prepared for three independent variables: notifications of cases of pertussis and influenza and ED visits with bronchiolitis (a proxy measure of respiratory syncytial virus (RSV) infection). The study period was 1/1/2007-31/12/2010. A negative binomial multivariate model was used to assess associations between the outcome and independent variables. We also evaluated the median delay in days between the estimated onset of a case of pertussis and the date the local public health authority was notified of that case.RESULTS: When notified pertussis increased by 10 cases in one day, ED visits with cough increased by 5.2% (95% confidence interval (CI): 0.5%-10.0%) seven days later. Daily increases in the other independent variables had a smaller impact on cough visits. When notified influenza increased by 10 cases in one day, ED visits with cough increased by 0.8% (95% CI: 0%-1.7%) seven days later. When ED visits with bronchiolitis increased by 10 visits in one day, ED visits with cough increased by 4.8% (95% CI: 1.2%-8.6%) one day earlier. The median interval between estimated onset of pertussis and case notification was seven days.CONCLUSIONS: Pertussis appears to be an important driver of ED visits with cough in children aged under 10 years. However, the median delay in notification of cases of pertussis was similar to the lag in the pertussis-associated short-term increases in ED visits with cough. Elevations in RSV and influenza activity may also explain increases in the ED cough syndrome. Real time monitoring of ED visits with cough in children is therefore unlikely to consistently detect a potential outbreak of pertussis before passive surveillance.

Resumo Limpo

ckground littl known potenti syndrom surveil provid earli warn pertussi outbreak conduct time seri analysi assess whether emerg depart ed cough syndrom respond chang incid pertussi children age year new south wale nsw australia evalu time associ aim assess lag onset pertussi symptom case notif infecti diseas surveil system nswmethod use routin collect data prepar daili count time seri visit nsw ed assign provision diagnosi cough separ daili seri prepar three independ variabl notif case pertussi influenza ed visit bronchiol proxi measur respiratori syncyti virus rsv infect studi period negat binomi multivari model use assess associ outcom independ variabl also evalu median delay day estim onset case pertussi date local public health author notifi caseresult notifi pertussi increas case one day ed visit cough increas confid interv ci seven day later daili increas independ variabl smaller impact cough visit notifi influenza increas case one day ed visit cough increas ci seven day later ed visit bronchiol increas visit one day ed visit cough increas ci one day earlier median interv estim onset pertussi case notif seven daysconclus pertussi appear import driver ed visit cough children age year howev median delay notif case pertussi similar lag pertussisassoci shortterm increas ed visit cough elev rsv influenza activ may also explain increas ed cough syndrom real time monitor ed visit cough children therefor unlik consist detect potenti outbreak pertussi passiv surveil

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