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Alarm Thresholds for Pertussis Outbreaks in Iran: National Data Analysis
Yousef Alimohamadi, Seyed Mohsen Zahraei, Manoochehr Karami, Mehdi Yaseri, Mojtaba Lotfizad, Kourosh Holakouie-Naieni
Osong Public Health Res Perspect. 2020;11(5):309-318.   Published online October 22, 2020
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  • 65 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF

The purpose of the current study was to determine the upper threshold number of cases for which pertussis infection would reach an outbreak level nationally in Iran.


Data on suspected cases of pertussis from the 25th February 2012 to the 23rd March 2018 from the Center for Disease Control and Prevention in Iran was used. The national upper threshold level was estimated using the exponentially weighted moving average (EWMA) method and the Poisson regression method.


In total, 2,577 (33.6%) and 1,714 (22.3%) cases were reported in the Spring and Summer respectively. There were 1,417 (18.5%) and 1,971 (25.6%) cases reported in the Autumn and Winter, respectively. The overall upper threshold using the EWMA and the Poisson regression methods, was estimated as a daily occurrence of 8 (7.55) and 7.50 (4.48–11.06) suspected cases per 10,000,000 people, respectively. The daily seasonal thresholds estimated by the EWMA and the Poisson regression methods were 10, 7, 6, 8 cases and 10, 7, 7, 9 cases for the Spring, Summer, Autumn, and Winter, respectively.


The overall and seasonal estimated thresholds by the 2 methods were similar. Therefore, the estimated thresholds of 6–10 cases in a day, per 10,000,000 people could be used to detect pertussis outbreaks and epidemics by health policymakers.


Citations to this article as recorded by  
  • Immunogenicity and Safety of a Newly Developed Tetanus-Diphtheria Toxoid (Td) in Healthy Korean Adolescents: a Multi-center, Randomized, Double-blind, Active-Controlled Phase 3 Trial
    Ui Yoon Choi, Ki Hwan Kim, Jin Lee, Byung Wook Eun, Hwang Min Kim, Kyung-Yil Lee, Dong Ho Kim, Sang Hyuk Ma, Jina Lee, Jong-Hyun Kim
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
Comparing Seasonal Pattern of Laboratory Confirmed Cases of Pertussis with Clinically Suspected Cases
Golam Reza Ghorbani, Seyed Mohsen Zahraei, Mahmood Moosazadeh, Mahdi Afshari, Fahimeh Doosti
Osong Public Health Res Perspect. 2016;7(2):131-137.   Published online April 30, 2016
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  • 21 Download
  • 12 Crossref
AbstractAbstract PDF
During recent decades, there has been limited attention on the seasonal pattern of pertussis within a high vaccine coverage population. This study aimed to compare the seasonal patterns of clinical suspected pertussis cases with those of laboratory confirmed cases in Iran.
The current study was conducted using time series methods. Time variables included months and seasons during 2011–2013. The effects of seasons and months on the incidence of pertussis were estimated using analysis of variance or Kruskal–Wallis.
The maximum average incidence of clinically confirmed pertussis was 23.3 in July (p = 0.04), but the maximum incidence of clinical suspected pertussis was 115.7 in May (p = 0.6). The maximum seasonal incidences of confirmed and clinical pertussis cases were reported in summer (average: 12, p = 0.004), and winter (average: 108.1; p = 0.4), respectively.
The present study showed that the seasonal pattern of laboratory confirmed pertussis cases is highly definite and different from the pattern of clinical suspected cases.


Citations to this article as recorded by  
  • Pertussis seasonal variation in Northern Vietnam: the evidence from a tertiary hospital
    Nhung TH Pham, Quyen TT Bui, Dien M Tran, Mattias Larsson, Mai P Pham, Linus Olson
    BMC Public Health.2024;[Epub]     CrossRef
  • Population-Based Study of Pertussis Incidence and Risk Factors among Persons >50 Years of Age, Australia
    Rodney Pearce, Jing Chen, Ken L. Chin, Adrienne Guignard, Leah-Anne Latorre, C. Raina MacIntyre, Brittany Schoeninger, Sumitra Shantakumar
    Emerging Infectious Diseases.2024;[Epub]     CrossRef
  • Bordetella pertussis in School-Age Children, Adolescents, and Adults: A Systematic Review of Epidemiology, Burden, and Mortality in the Middle East
    Denis Macina, Keith E. Evans
    Infectious Diseases and Therapy.2021; 10(2): 719.     CrossRef
  • Pertussis epidemiology and effect of vaccination among diagnosed children at Vietnam, 2015‐2018
    Nhung T. H. Pham, Nhan D. T. Le, Ngai K. Le, Khoa D. Nguyen, Mattias Larsson, Linus Olson, Dien M. Tran
    Acta Paediatrica.2020; 109(12): 2685.     CrossRef
  • Spatial distribution of vaccine-preventable diseases in central Iran in 2015–2018: A GIS-based study
    Abolfazl Mohammadbeigi, Abedin Saghafipour, Nahid Jesri, Fatemeh Zahra Tarkhan, Moharram Karami Jooshin
    Heliyon.2020; 6(9): e05102.     CrossRef
  • The comparative performance of wavelet‐based outbreak detector, exponential weighted moving average, and Poisson regression‐based methods in detection of pertussis outbreaks in Iranian infants: A simulation‐based study
    Yousef Alimohamadi, Seyed Mohsen Zahraei, Manoochehr Karami, Mehdi Yaseri, Mojtaba Lotfizad, Kourosh Holakouie‐Naieni
    Pediatric Pulmonology.2020; 55(12): 3497.     CrossRef
  • Alarm Thresholds for Pertussis Outbreaks in Iran: National Data Analysis
    Yousef Alimohamadi, Seyed Mohsen Zahraei, Manoochehr Karami, Mehdi Yaseri, Mojtaba Lotfizad, Kourosh Holakouie-Naieni
    Osong Public Health and Research Perspectives.2020; 11(5): 309.     CrossRef
  • The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis
    Rudzani Muloiwa, Benjamin M. Kagina, Mark E. Engel, Gregory D. Hussey
    BMC Medicine.2020;[Epub]     CrossRef
  • Sommergrippe: Mehr als ein Mythos!
    Johannes Bogner
    MMW - Fortschritte der Medizin.2019; 161(12): 39.     CrossRef
  • Estimating seasonal variation in Australian pertussis notifications from 1991 to 2016: evidence of spring to summer peaks
    R. N. F. Leong, J. G. Wood, R. M. Turner, A. T. Newall
    Epidemiology and Infection.2019;[Epub]     CrossRef
  • Time series modeling of pertussis incidence in China from 2004 to 2018 with a novel wavelet based SARIMA-NAR hybrid model
    Yongbin Wang, Chunjie Xu, Zhende Wang, Shengkui Zhang, Ying Zhu, Juxiang Yuan, Lei Lin
    PLOS ONE.2018; 13(12): e0208404.     CrossRef
  • Identification of Etiologic Agents of the Pertussis-like Syndrome in Children by Real-time PCR Method
    Shima Mahmoudi, Maryam Banar, Babak Pourakbari, Hediyeh Sadat Alavi, Hamid Eshaghi, Alireza Aziz Ahari, Setareh Mamishi
    Prague Medical Report.2018; 119(1): 61.     CrossRef
Multilocus Sequence Analysis of Housekeeping Genes and Antigenic Determinant Genes in Bordetella pertussis Strains Isolated in Korea
Sang-Oun Jung, Yu Mi Moon, So-Hyeon Kim, Hwa Young Sung, Seung-Jik Kwon, Yeon Ho Kang, Jae Yon Yu
Osong Public Health Res Perspect. 2011;2(2):115-126.   Published online June 30, 2011
  • 3,365 View
  • 16 Download
  • 3 Crossref
AbstractAbstract PDF
To confirm genotype diversities of clinical isolates of Bordetella pertussis and to evaluate the risk of pertussis outbreak in Korea.
Seven housekeeping genes and 10 antigenic determinant genes from clinical B. pertussis isolates were analyzed by Multilocus sequence typing (MLST).
More variant pattern was observed in antigenic determinant genes. Especially, PtxS1 gene was the most variant gene; five genotypes were observed from eight global genotypes. In the bacterial type, the number of observed sequence types in the isolates was seven and the most frequent form was type 1 (79.6%). This major sequence type also showed a time-dependent transition pattern. Older isolates (1968 and 1975) showed type 1 and 6 in housekeeping genes and antigenic determinant genes, respectively. However, these were changed to type 2 and 1 in isolates 1999–2008. This transition was mainly attributed to genotype change of PtxS1 and Fim3 gene; the tendency of genotype change was to avoid vaccine-derived genotype. In addition, there was second transition in 2009. In this period, only the sequence type of antigenic determinant genes was changed to type 2. Based Upon Related Sequence Types (BURST) analysis confirmed that there were two clonal complexes (ACCI and ACCII) in the Korean isolates. Moreover, the recently increased sequence type was revealed as AST2 derived from AST 3 in ACCI.
Genotype changes in Korean distributing strains are still progressing and there was a specific driving force in antigenic determinant genes. Therefore continuous surveillance of genotype change of the distributing strains should be performed to confirm interrelationship of genotype change with vaccine immunity.


Citations to this article as recorded by  
  • Characterization of Bordetella pertussis Strains Isolated from India
    Shweta Alai, Manish Gautam, Sonali Palkar, Jitendra Oswal, Sunil Gairola, Dhiraj P. Dhotre
    Pathogens.2022; 11(7): 794.     CrossRef
  • Variation in Bordetella pertussis Susceptibility to Erythromycin and Virulence-Related Genotype Changes in China (1970-2014)
    Ying Yang, Kaihu Yao, Xiang Ma, Wei Shi, Lin Yuan, Yonghong Yang, Daniela Flavia Hozbor
    PLOS ONE.2015; 10(9): e0138941.     CrossRef
  • Recent Trends of Antigenic Variation inBordetella pertussisIsolates in Korea
    So-Hyun Kim, Jin Lee, Hwa Young Sung, Jae Yon Yu, Seong Han Kim, Mi Sun Park, Sang-Oun Jung
    Journal of Korean Medical Science.2014; 29(3): 328.     CrossRef

PHRP : Osong Public Health and Research Perspectives