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Doel: Inzicht verkrijgen in de ernst van kinkhoest in relatie tot de vaccinatiestatus en leeftijd. Methoden: In 1997 werd met behulp van pediatrische surveillance gegevens verzameld van ziekenhuisopnamen. Ook werden in 1997 additionele gegevens verzameld van aangiften bij de Inspectie van de Gezondheidszorg. Resultaten: Van de 180 ziekenhuisopnamen was 42% jonger dan 3 maanden en ongevaccineerd; 14% was 3-5 maanden oud waarvan 69% onvolledig gevaccineerd; 42% was 6 maanden en ouder waarvan 70% gevaccineerd. Bij 53% werd de diagnose bevestigd door positieve kweek of PCR; bij 44% door positieve serologie. Twee kinderen van 3 weken oud overleden. Alleen bij jonge ongevaccineerden kwamen convulsies (3%), encephalopathie (1%) en atelectase (1%) voor. Ten opzichte van gevaccineerden hadden ze vaker cyanose (77% vs. 40%) en apneu (22% vs. 5%) en waren langer opgenomen (12 vs. 5 dagen). Van de 507 aangiften was 6% jonger dan 1 jaar; 36% 1-4 jaar; 28% 5-9 jaar; 10% 10-14 jaar; 21% 15 jaar en ouder. Zeven procent was ongevaccineerd, 2% onvolledig gevaccineerd, 80% gevaccineerd en van 11% was dit onbekend. Bij 83% werd de diagnose bevestigd door positieve serologie. Paroxysmaal hoesten (93%), braken (78%), kinken (67%) en ademnood (61%) werden het vaakst gerapporteerd. Bij ongevaccineerde kinderen kwam ten opzichte van gevaccineerden cyanose (43% vs. 21%) en ziekenhuisopname (38% vs. 3%) vaker voor. De ernst van kinkhoest neemt af met de leeftijd. Conclusie: Ernstige kinkhoest met ziekenhuisopname komt vooral voor bij ongevaccineerden kinderen jonger dan 3 maanden. Ziekenhuisopname en klassieke kinkhoest komt ook voor bij recent gevaccineerde kinderen maar kinkhoest met ernstige complicaties is onwaarschijnlijk.

Abstract

Objective: To gain insight into the severity of pertussis in hospitalised cases and notifications in relation to the vaccination status and age. Methods: In 1997, hospitalisation data were collected through paediatric surveillance and additional data on notified cases through a questionnaire. Results: From data of 180 hospitalisation admissions collected,42% of the patients were younger than 3 months of age and not vaccinated; 14% were 3-5 months of age and of these, 69% were incompletely vaccinated; 42% were 6 months and older and of these, 70% were vaccinated. Fifty-three percent of the patients were diagnosed as having pertussis, confirmed by a positive culture or PCR, and 44% by positive serology. Two infants, three weeks of age, died. Convulsions (3%), atelectasis (1%) and encephalopathy (1%) occurred among only the very young unvaccinated infants. Young unvaccinated compared to vaccinated children had significantly more frequent cyanosis (77% vs. 40%) and apnoea (22% vs. 5%) and were longer hospitalised (median 12 days vs. 5 days). Additional data were collected from 507 notified cases of which 6% was younger than one year of age; 36% were 1-4 year; 28%, 5-9 years; 10%, 10-15 years; 21%, 16 years and older. Only 7% were unvaccinated; 2% were incompletely vaccinated; 80%, vaccinated and for 11%, the vaccination history was unknown. Eighty-three percent of the pertussis cases were confirmed by positive serology. Most frequently reported symptoms were paroxysmal cough (93%), vomiting (78%), whooping (67%) and shortness of breath (61%). Unvaccinated children reported more frequent cyanosis than vaccinated children (43% vs. 21%) and more hospitalisations (38% vs. 3%). The severity of disease decreased with age. Conclusion: Serious morbidity leading to hospitalisation was reported mainly in young unvaccinated infants less than three months of age. Yet, hospitalisation and classical pertussis also occurred in recently vaccinated children, but the clinical picture was less life threatening.

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