pertussis resurgence in toronto, canada a population-based study including test-incidence feedback modeling百日咳复兴在多伦多,加拿大以人群为基础的研究包括test-incidence反馈建模.pdfVIP

Fisman et al. BMC Public Health 2011, 11:694 /1471-2458/11/694 RESEARCH ARTICLE Open Access Pertussis resurgence in Toronto, Canada: a population-based study including test-incidence feedback modeling 1,2,3* 4 1 5,6 7 4,5,8 David N Fisman , Patrick Tang , Tanya Hauck , Susan Richardson , Steven J Drews , Donald E Low and Frances Jamieson4,5 Abstract Background: Pertussis continues to challenge medical professionals; recently described increases in incidence may be due to age-cohort effects, vaccine effectiveness, or changes in testing patterns. Toronto, Canada has recently experienced increases in pertussis incidence, and provides an ideal jurisdiction for evaluating pertussis epidemiology due to centralized testing. We evaluated pertussis trends in Toronto using all available specimen data, which allowed us to control for changing testing patterns and practices. Methods: Data included all pertussis culture and PCR test records for Greater Toronto from 1993 to 2007. We estimated incidence trends using Poisson regression models; complex relationships between disease incidence and test submission were explored with vector autoregressive models. Results: From 1993 to 2007, 26988 specimens were submitted for testing; 2545 (9.4%) were positive. Pertussis incidence was 2 per 100,000 from 1993 to 2004 and increased to 10 per 100,000 from 2005-2007, with a concomitant 6-fold surge in test specimen submissions after the introduction of a new, more sensitive PCR assay. The relative change in incidence was less marked after adjustment for testing volumes. Bidirectional feedbacks between test positivity and test submissions were identified. Conclusions: Toronto’s recent su