Association between the COVID-19 pandemic and pertussis in France using multiple nationwide data sources

  1. Soraya Matczak
  2. Corinne Levy
  3. Camille Fortas
  4. Jérémie F. Cohen
  5. Stéphane Béchet
  6. Fatima Aït El Belghiti
  7. Sophie Guillot
  8. Sabine Trombert-Paolantoni
  9. Véronique Jacomo
  10. Yann Savitch
  11. Juliette Paireau
  12. Sylvain Brisse
  13. Nicole Guiso
  14. Daniel Lévy-Bruhl
  15. Robert Cohen
  16. Julie Toubiana

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

Interventions to mitigate coronavirus disease 19 (COVID-19) pandemic may impact other respiratory diseases such as pertussis. We aimed to study the course of pertussis in France over an 8-year period and its association with COVID-19 mitigation strategies, using multiple nationwide data sources.

Methods

We analyzed the number of French pertussis cases between 2013 and 2020, using the PCR test results from nationwide outpatient laboratories (Source 1) and the pediatric network of 41 hospitals (Source 2), and using the reports of an office-based pediatric national network (Source 3). We conducted a quasi-experimental interrupted time-series analysis, relying on negative binomial regression models. The models accounted for seasonality, long-term cycles, and secular trend, and included a binary variable for the first national lockdown (ordered on March 16, 2021).

Results

We identified 19,039 cases of pertussis from the three data sources during the study period. There was a significant decrease of pertussis cases following the implementation of mitigation measures, with adjusted incidence rate ratios of 0.102 (95% CI 0.040-0.256) and 0.216 (95% CI 0.071-0.656) for Source 1 and Source 2, respectively. The association was confirmed in Source 3 (median of 1 [IQR 0-2] vs. 0 [IQR 0-0] pertussis cases per month before and after lockdown, respectively, p=0.0048).

Conclusion

The drastic reduction of outpatient and hospitalized cases of pertussis strongly suggests an impact of COVID-19 mitigation measures and their consequences on pertussis epidemiology. Pertussis vaccination recommendations should be carefully followed, and disease monitoring should be continued to detect any resurgence after relaxation of mitigation measures.

Funding

There was no specific funding for the study.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.07.16.21260367: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We used Stata/SE 15.0 (StataCorp LP, College Station, TX, USA) for all analyses.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations. First, measurement bias is present in Sources 1 and 2 as our pertussis case definition only considered positive PCRs. We therefore might have missed cases diagnosed by serology (sometimes prescribed even if not recommended), or based on clinical grounds, especially during the 1st lockdown (from mid-March to May, 2020), when transportation was limited, office-based physicians unreachable, and private laboratories overwhelmed by the implementation of large-scale SARS-CoV-2 testing. Second, we cannot determine whether the decrease of pertussis cases observed here was due to decreased pertussis circulation or reduced testing. However, the similar decrease observed in hospitalized cases in the youngest population does not favor the latter hypothesis, and access retriction to outpatient testing was mostly limited to the first lockdown period. Third, we may have lacked statistical power to detect a significant decrease in the proportion of positive cases, as the post-lockdown period was relatively short compared to the pre-lockdown period (i.e., 9 months vs. 87 months, respectively), and negative PCR tests results were not available from data Source 2. In conclusion, this national-level study shows a strong association between the COVID-19 pandemic and pertussis in France, with an unprecedented drop of pertussis cases. Pertussis should be closely monitored to detect any resurgence in the community when social distancing restrictions will be relaxed, as wel...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04318431CompletedPrevalence of SARS -Cov2 Carriage in Asymptomatic and Mildly…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.07.16.21260367v1 on medRxiv