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Recommended case classifications of pertussis

Clinically-confirmed

A clinically-confirmed case is diagnosed as pertussis by a physician of a person with a cough lasting at least two weeks with at least one of the following symptoms: paroxysms (i.e. fits) of coughing; inspiratory whooping; post-tussive vomiting (i.e. vomiting immediately after coughing) without another apparent cause. The case is not laboratory-confirmed.

Laboratory-confirmed

A laboratory-confirmed case meets the clinical case definition and is laboratory-confirmed by isolation of Bordetella pertussis or detection of genomic sequences by means of the polymerase chain reaction (PCR) or positive paired serology.

Laboratory confirmation is not readily available in most countries. Therefore, disease surveillance is based mainly on clinical diagnosis of cases. Monitoring the number of infants who have received the third dose of diphtheria toxoid-containing vaccine (DPT3) is important.

Surveillance of pertussis consists of a routine monthly report of aggregated data on clinical cases in countries with DPT3 coverage less than 90%. Reported data should be stratified by age. In countries with DPT3 coverage equal to or higher than 90%, case-based surveillance is recommended. Immediate investigation of all pertussis outbreaks with collection of case-based data is also recommended. In addition, sentinel surveillance is recommended in a few major hospitals to collect more in-depth information than that obtained through routine surveillance.

Global and regional data and statistics

WHO-recommended surveillance standard of pertussis
 
Disease surveillance PDF Imprimer
 
Disease surveillance PDF Imprimer

In the Eastern Mediterranean Region, rubella surveillance is integrated with measles laboratory case based surveillance. The performance indicators for rubella surveillance are linked to those for measles  surveillance performance indicators.

Rubella infection is diagnosed by detection of rubella IgM antibodies using ELISA assay.

Countries with high incidence test first for measles and negative specimens are then tested for rubella. Countries with low measles incidence  test the specimen for measles and rubella simultaneously.  . The Region is considering setting target date for rubella elimination.
 
Disease surveillance PDF Imprimer

The clinical features of rotavirus gastroenteritis do not differ from those of gastroenteritis caused by other pathogens; therefore, confirmation of rotavirus infection by laboratory testing of fecal specimens is necessary for reliable rotavirus surveillance. 

 A regional network for surveillance of rotavirus among children less than 5 years of age was established in the Eastern Mediterranean Region in 2005 that aims to:  

provide quality data necessary for studying the burden of the diseases caused by each of these organisms and, hence, assist evidence-based decision on the necessity of introduction of the currently available Hib and pneumococcal conjugate vaccines;  

- provide quality data to guide clinical management and detect and monitor antimicrobial susceptibility patterns; 

- help monitor disease burden to evaluate impact and effectiveness of new bacterial conjugate vaccination programmes when implemented; and 

- build national capacity for long-term laboratory based surveillance for communicable diseases in the EMR countries.

Based on the regional standard Operational Procedures of rotavirus gastroenteritis in the Eastern Mediterranean Region, the case description of rotavirus gastroenteritis disease is:

 Suspected case: A child aged less than 5 years of age, who is admitted to a designated sentinel hospital for treatment of gastroenteritis

 Confirmed case: A suspected case in whose stool the presence of rotavirus is demonstrated by means of an enzyme immunoassay.

Surveillance of rotavirus gastroenteritis in the region consists of case based report for diarrhoea cases reported from designated sentinel sites and routine monthly reports of line list of less than 5 years gastroenteritis cases. Surveillance of rotavirus gastroenteritis also includes case based and aggregate stool Specimen Transfer and Investigation Request Forms for admitted patients.

 Monitoring the number of children under 5 who received the rotavirus containing vaccine in the countries as part of the routine immunization is also important.

Eastern Mediterranean Rotavirus Gastroenteritis Surveillance Network (EMRSN): Standard Operating Procedures (SOPs), 2011. [Draft Document - pdf 382 Kb]

Surveillance Performance Indicators

 

 
 
Disease surveillance PDF Imprimer

Surveillance of tetanus in the WHO Eastern Mediterranean Region consists of facility-based routine monthly reports of total tetanus and neonatal tetanus cases and deaths. Monitoring the proportion of infants who received the third dose of tetanus toxoid-containing vaccine (DPT3) and the proportion of pregnant women who received at least two doses of tetanus toxoid-containing vaccine (TT2+), as well as protection at birth, is followed in countries of the Region.  

Surveillance and coverage of tetanus toxoid-containing vaccine among children and pregnant women for each country in the Region
 
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