Systematic review and meta-analysis of pertussis epidemiology in Latin America and the Caribbean: 1980–2015

OBJECTIVES. In Latin America and the Caribbean (LAC), pertussis disease incidence has reportedly increased since 2000 despite high vaccine coverage. A systematic review of pertussis literature and a meta-analysis was conducted to understand the burden of disease in LAC. METHODS. A systematic literature review was completed, using relevant search terms. Original articles describing pertussis epidemiology and vaccine coverage in LAC published between 1980 and 2015 were identified. Applying a Bayesian meta-analysis random-effects model, we calculated pooled estimates and corresponding 95% credible intervals (95% CrIs) for pertussis incidence, case fatality ratio (CFR), pertussis prevalence among contacts, and coverage with three doses of diphtheria, tetanus, and pertussis (DTP) vaccine (DTP3). RESULTS. A total of 59 studies meeting our selection criteria were identified, representing 15 countries. Of the 59, 15 of them provided incidence data, with 7 of the 15 reporting a pertussis case definition. The pertussis incidence estimate for the 1980–1999 period was 17.8 cases per 100 000 persons (95% CrI: 5.9–29.7); for the 2000–2015 period, it was 2.5 cases per 100 000 persons (95% CrI: 1.8–3.2). For the 1980–2015 period, the CFR, in 19 studies reviewed, was 3.9% (95% CrI: 2.9%–4.9%); for that same period, in 5 studies reviewed, pertussis prevalence among contacts was 24.9% (95% CrI: 13.7%–36.1%). Pooled DTP3 vaccine coverage estimates, in a total of 20 studies reviewed for the following three time periods, were: 1980–1990, 72.4% (95% CrI: 64.6%–80.2%); 1991–2000, 79.0% (95% CrI: 66.1%–91.9%); and 2001–2015, 90.0% (95% CrI: 87.7%–92.3%). CONCLUSION. A decrease in pertussis incidence and an achievement of moderately high DTP3 vaccine coverage since the early 2000s was observed. The review highlights the need for increased publication of pertussis data at the country level and for LAC as a whole in order to better understand the true burden of the disease. Application of a standardized case definition and use of active case finding would aid in obtaining more accurate estimates of the disease burden in LAC.