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To determine the proportion of children with an acute cough and laboratory evidence of Bordetella pertussis (B. pertussis) and B. parapertussis infection.A prospective study was done, including children aged 0 months to 16 years who attended the outpatient clinic of the Innsbruck University Hospital between November 1995 and December 1998. Diagnosis of B. pertussis infection was made in children with acute cough using culture, PCR and serology; diagnosis of B. parapertussis infection was made with PCR and culture.Of the 183 children enrolled in the study, 71 (38.8%) had a B. pertussis infection. Of these, 7 (3.8%) were diagnosed using culture, 24 (13.1%) with culture and PCR, 30 (16.4%) with PCR alone, and in 10 (5.4%) children, a seroconversion of IgG or IgA against pertussis toxin (PT) was observed. The estimated incidence was 1,432 cases per 100,000 children with a cough. PCR enhanced the detection rate of B. pertussis infection 1.7-fold. The sensitivity of culture tests was 16.9%, and that of PCR 29.5%. Using a positive culture as gold standard, the sensitivity of PCR was 77.4% and its specificity 83.6%. In 1% (2/183) of the patients, an infection with B. parapertussis was only diagnosed with PCR. Positivity of culture, PCR and serology depended on age, disease duration and vaccination history. Of the patients with B. pertussis infection, 62% (44/71) had not been vaccinated and 11.2% were too young to have received the first recommended dose.Mainly non- or incompletely vaccinated infants are infected with B. pertussis. Improving the vaccination schedule and enhancing vaccination coverage is essential if infection is to be controlled in this population. |
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