Whooping cough surveillance in French hospital Renacoq net: Data from 1996 to 2010 E. Belchior1, I. Bonmarin1, S. Guillot2,Y. Savitch1, D. Levy-Bruhl1, N. Guiso2 and the Renacoq participants3 1/ Institut de veille sanitaire (InVS), Saint-Maurice, France – 2/ Centre national de référence de la coqueluche et autres bordetelloses, Institut Pasteur, Paris, France – 3/ Paediatricians and microbiologists from the Renacoq network: Dr Delesalle Dr Aboutara (Charleville-Mézières) ; Dr Chardon, Dr Thevenieau (Aix-en-Provence) ; Pr La Scola, Pr Garnier (Marseille), Dr Leclercq, Pr Brouard (Caen), Dr Paris, Dr Guillot (Lisieux), Dr Sanyas (La Rochelle) ; Dr Duez, Dr Perez-martin (Dijon) ; Dr Vaucel, Dr Idres, Dr Halna (Saint-Brieuc) ; Dr Couetdic, Dr Leroy (Besançon) ; Dr Le Lay-Rogues, Dr Hery-Arnaud, Dr Le Gall, Dr Lefranc (Brest) ; Dr Lehours, Dr Sarlangue (Bordeaux) ; Dr Brun, Dr Filleron (Montpellier) ; Dr Lanotte, Pr Goudeau, Dr Hasselmann, Dr Cosson (Tours) ; Dr Croize, Dr Pelloux, Dr Bost-Bru, (Grenoble) ; Dr Gibaud, Dr Gras-Le Guen (Nantes) ; Dr Le Coustumier, Dr Wilhelm, Dr Leneveu (Cahors) ; Pr Cottin, Dr Troussier (Angers) ; Dr Lebrun, Dr Chomienne (Cholet) ; Dr Brasme, Dr Brunel (Reims) ; Pr Lozniewski, Dr Maurer, Dr Le Tacon (Nancy) ; Dr Dessein, Dr Hue (Lille) ; Dr Delepoulle (Dunkerque) ; Dr Vervel (Compiègne) ; Dr Romaszko, Pr Richard-Bonnet, Dr Delmas, Dr Heraud (Clermont-Ferrand) ; Dr Courtade, Dr Laffort (Pau) ; Dr Scheftel, Pr Fischbach (Strasbourg) ; Dr De Briel, Dr Souply, Dr Kretz (Colmar) ; Pr Etienne, Pr Vandenesch, Dr Gillet (Lyon) ; Dr Coude, Dr Chevalier (Le Mans) ; Dr Descamps, Dr Pop-Jora (Paris-hôpital Trousseau) ; Pr Bingen, Dr Bonacorsi, Dr Lorrot (Paris-hôpital Robert Debré) ; Pr Abadie (Paris-hôpital Necker) ; Dr Leluan, Dr Lahrach (Fécamp) ; Pr Pons, Dr Lemee, Dr Pestel-Caron, Dr Lubrano (Rouen) ; Dr Rousseau, Dr Pautard (Amiens) ; Dr Jensen, Dr Cointin (Avignon) ; Dr Garnier, Dr Constanty (Limoges) ; Dr Danekova (Colombes) ; Pr Gaudelus, Dr Pellan (Bondy) ; Dr Aberrane, Dr Madhi (Créteil) ; Dr Bret, Dr Guigon, Dr Guinard (Orléans)

Context

FIGURE 2 700

• High vaccine coverage with 3 doses coverage over 95% for more than 20 years and with 4 doses coverage at 24 months of age around 90% for 15 years • Change in the epidemiology of pertussis: infection affecting children too young to be vaccinated and persons no longer protected by the vaccine or natural infection

• Pertussis vaccine recommendations - Vaccine schedule . Primary course of 3 doses at 2-3-4 months old . First booster dose at 16-18 months old . Second booster dose at 11-13 years old since 1998 - New pertussis vaccine recommendations . Adults who are planning to become parents (“Cocooning strategy”) and Health care workers (HCW) around newborns since 2004 . All HCW, adults 26-28 years old and those who didn't get any booster in the last ten years since 2008 - Acellular vaccines available since 1998 and whole cell vaccine no more available since 2005 - Vaccination reimbursed (100% for more than 90% of the targeted population)

Materials and methods • Renacoq: 42 French voluntary hospitals (≈1/3 paediatric admissions) since 1996 • General reporting by Microbiologists - Results of pertussis culture and PCR performed, 0-16 years old • Enhanced surveillance by Paediatricians - Case definitions . Laboratory confirmed case defined as a positive culture or PCR . Clinical case defined as a cough lasting more than 21 days with at least one of the following symptoms: whoop, vomiting after paroxysms, apnoeas, cyanosis, lymphocytosis . Epidemiological case defined by a link with a laboratory confirmed case.

- Data collected only for under-6 months old children, standardized form (demographic, clinical, microbiological data, vaccination status) contact tracing by interviewing the family • National Reference Laboratory (Institut Pasteur, Paris) - Isolates collection and laboratory results confirmation • French Institute for Public Health Surveillance (InVS, Saint-Maurice) - Coordination, data analysis and retro-information • Assessment of national incidence of under-3 months pertussis cases as they are virtually all hospitalized and a correction is made for network coverage

Results • High average participations (1999-2010): 97% of the labs, 86% of the paediatricians • General reporting: 3,414 cases among infants