Bordetella pertussis, a reemerging pathogen in pediatric respiratory infections. A study in Quito, Ecuador

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RSV: respiratory syncytial virus; RV/EV: rhinovirus/enterovirus; FluA: influenza A; FluB: influenza B; PIV: parainfluenza; AdV: adenovirus; HMPV: human metapneumovirus; HCoV: human coronavirus; B. pertussis: Bordetella pertussis." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Débora N. Marcone, Guadalupe Carballal, Noelia Reyes, Alejandro Ellis, Yamile Rubies, Santiago Vidaurreta, Marcela Echavarria" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Débora N." "apellidos" => "Marcone" ] 1 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "Carballal" ] 2 => array:2 [ "nombre" => "Noelia" "apellidos" => "Reyes" ] 3 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Ellis" ] 4 => array:2 [ "nombre" => "Yamile" "apellidos" => "Rubies" ] 5 => array:2 [ "nombre" => "Santiago" "apellidos" => "Vidaurreta" ] 6 => array:2 [ "nombre" => "Marcela" "apellidos" => "Echavarria" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754120300663?idApp=UINPBA00004N" "url" => "/03257541/0000005300000001/v1_202103140751/S0325754120300663/v1_202103140751/en/main.assets" ] "en" => array:22 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Bordetella pertussis, a reemerging pathogen in pediatric respiratory infections. A study in Quito, Ecuador" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "33" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Saidy Vásconez Noguera, Katherine Jaramillo, Andrés Zabala, José E. Villacís" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Saidy" "apellidos" => "Vásconez Noguera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Katherine" "apellidos" => "Jaramillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Andrés" "apellidos" => "Zabala" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:4 [ "nombre" => "José E." "apellidos" => "Villacís" "email" => array:1 [ 0 => "jevillacis@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Carrera de Bioquímica Clínica, Facultad de Medicina, Pontificia Universidad Católica del Ecuador , Quito, Ecuador" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Referencia Nacional de Resistencia a los Antimicrobianos, Instituto Nacional de Investigación en Salud Pública “Leopoldo Izquieta Pérez”, Quito, Ecuador" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bordetella pertussis, un patógeno reemergente en infecciones respiratorias pediátricas, un estudio en Quito, Ecuador" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2083 "Ancho" => 1341 "Tamanyo" => 132741 ] ] "descripcion" => array:1 [ "en" => "Amplification of IS481 and IS1001 to confirm the co-infection of Bordetella pertussis and Bordetella parapertussis (BP17-82). PCR products were analyzed in a 2% agarose gel by electrophoresis." ] ] ] "textoCompleto" => "IntroductionDuring the past years, a resurgence of pertussis cases has been observed worldwide and is considered a reemerging infectious disease by the World Health Organization (WHO)<a class="elsevierStyleCrossRefs" href="#bib0360">26,39,46</a>. This disease is present in developing and developed countries, despite high rates of vaccination. It is caused by gram-negative bacteria belonging to the genus Bordetella, namely, Bordetella pertussis and Bordetella parapertussis, the latter causing a less severe form of the disease<a class="elsevierStyleCrossRefs" href="#bib0245">3,10</a>.B. pertussis is known to cause more severe disease than B. parapertussis or Bordetella holmesii, while Bordetella bronchiseptica affects immunocompromised patients more frequently<a class="elsevierStyleCrossRef" href="#bib0410">36</a>. These three species of Bordetella share some virulence factors such as adhesins, fimbriae, filamentous hemagglutinin (FHA), pertactin (PRN), tracheal colonization factor, and tracheal cytotoxin. Conversely, pertussis toxin and serum resistance protein are expressed only by B. pertussis, and the type III secretion system is expressed only by B.bronchiseptica<a class="elsevierStyleCrossRef" href="#bib0415">37</a>.Among the virulence factors, it is possible to find adenylate cyclase toxin-hemolysin (CyaA), an adhesin that is frequently included as a component in acellular vaccines against B.pertussis<a class="elsevierStyleCrossRef" href="#bib0450">44</a>. Moreover, this factor is characterized by the presence of a hemolytic phenotype of virulent strains of B. pertussis. At present, it has been reported that the hemolytic phenotype in Bordetella is lost once other genes replace the toxin.The infection has shown a modified pattern of transmission in areas with high coverage of pertussis vaccination, which is likely due to a change in circulating B. pertussis strains<a class="elsevierStyleCrossRef" href="#bib0250">4</a>. However, according to some authors, the resurgence of pertussis cases is either a consequence of bacterial host adaptation or due to vaccine influence<a class="elsevierStyleCrossRef" href="#bib0245">3</a>. Of the vaccines available for the prevention of the disease, the Center for Disease Control and Prevention (CDC) has recommended the use of the acellular vaccine as the primary choice for infants under one year of age, as it has been proved to be less reactogenic<a class="elsevierStyleCrossRef" href="#bib0280">10</a>.In Ecuador, based on the expanded immunization program (EPI), the pentavalent and trivalent whole-cell inactivated vaccines (WCV) are the pertussis vaccines being currently administered. However, in accordance with the biological drug release registry, there are also acellular pertussis vaccines (ACV) being provided by the private sector. Moreover, a decreased vaccination coverage has been observed; between 2001 and 2009 vaccination coverage was 100%; however, since 2009, this rate has been gradually decreasing<a class="elsevierStyleCrossRef" href="#bib0390">32</a>.Nowadays, health organizations aim at reducing the morbidity and mortality rates in lactating infants, who are under one year of age, as this population registers the majority of pertussis cases reported worldwide (88.7 out of 10000)<a class="elsevierStyleCrossRef" href="#bib0435">41</a>. To achieve this objective, vaccination strategies should be evaluated; vaccination and booster doses should be implemented to cover more than 90% of the population. Moreover, epidemiological surveillance systems of the disease should be improved so that an increased number of probable cases of pertussis are identified and diagnosed<a class="elsevierStyleCrossRef" href="#bib0360">26</a>. In Ecuador, the Ministry of Public Health through the SIVE-Alerta program performs a passive surveillance of the disease by notifying probable cases of B. pertussis infection. In 2015, 7 cases were reported and in 2016 there was an increase of 14 cases<a class="elsevierStyleCrossRef" href="#bib0405">35</a>. Since 2016 a rapid rise in the number of cases of B. pertussis infection has been observed; in fact, they have duplicated in comparison to the previous year, which could be suggestive of a new outbreak. Nonetheless, the confirmation of positive cases is hampered due to a lack of highly sensitive and more specific tests, such as the polymerase chain reaction (PCR)<a class="elsevierStyleCrossRefs" href="#bib0340">22,46</a>. This study aimed to identify the prevalence of B. pertussis, B. parapertussis and B. holmesii in infants under one year of age, who were reported as probable cases of whooping cough. Diagnosis was confirmed by microbiological culture and PCR, for faster and more specific laboratory diagnosis.MethodsPopulation samplingA cross-sectional study was carried out in the city of Quito, Ecuador, in coordination with the Instituto Nacional de Investigación en Salud Pública (INSPI). The Ecuadorian highland region was chosen for evaluation as it has reported the highest number of pertussis cases since 2016<a class="elsevierStyleCrossRef" href="#bib0405">35</a>. The samples to be analyzed consisted of 86 nasopharyngeal swabs from children between 0 to 12 months of age, who were described as probable cases of whooping cough after visiting the different health centers in the region.The study was limited to a type of observational study that analyzes data from a population, from the Epidemiological Surveillance System for this disease. This study involves data collected at a defined time. The study was reviewed and approved by the Human Research Ethics Committee of the Pontificia Universidad Católica del Ecuador, which categorized it as scientifically acceptable.SamplesSamples were received either as nasopharyngeal swabs in the Regan-Lowe Semi-solid Transport Medium (calcium alginate swab, one swab per nostril) or as nasopharyngeal aspirate specimens in a sterile bottle. The samples were analyzed by the gold standard method: microbiological culture, and by endpoint PCR. The latter followed an established protocol for the amplification of B. pertussis targets IS481 and ptxA-Pr, B. parapertussis IS1001 and B. holmessi hIS1001. This study was done from August 2016 to July 2017.Data collectionThe epidemiological chart of each sample was evaluated to retrieve relevant sociodemographic and clinical data. A database was created, including the following information for each sample: the age and gender of the patient, place of origin, type of sample, elapsed time from symptom onset to primary diagnosis, which was determined by the practitioner based on the clinical symptoms.Microbiological cultureNasopharyngeal swabs were cultured in Regan-Lowe medium (Becton Dickinson), containing 5% cephalexin, and were incubated in a humidity chamber at 37°C for 7–10 days. After this period, the presumptive Bordetella spp. colonies were subjected to further testing to differentiate B. pertussis from B. parapertussis. Microbiological and biochemical tests were used, including Gram staining, MacConkey agar, oxidase, and catalase tests.PCR for the detection of B. pertussis and B. parapertussisEach swab sample was suspended in 500μl of PBS, and genomic DNA was extracted using the High Pure PCR Template Preparation Kit (Roche Germany), according to the manufacturer's instructions.To differentiate among the Bordetella species, specific primers were used for the following targets: IS481 and ptxA-Pr were used for the identification of B. pertussis, IS1001, for the identification of B. parapertussis, and the hIS1001 target for the identification of B.holmesii<a class="elsevierStyleCrossRefs" href="#bib0340">22,40</a> (<a class="elsevierStyleCrossRef" href="#sec0070">Table S1</a>). To amplify the bacterial genome, 1μl of the extracted DNA was added to 11.5μl of the master mix preparation (GoTaq®) to make up a final volume of 12.5μl. The conditions used in the thermocycler were the following: denaturation (5min at 94°C); annealing for IS481 (30s at 63.6°C); annealing for ptxA-Pr (30s at 55°C); annealing for IS1001 (30s at 60.4°C); and annealing for hIS1001 (30s at 63.6°C) extension (30s at 72°C); final extension (10min at 72°C); 25 cycles were used to amplify the genes.Statistical data analysisDescriptive statistics were used to analyze the clinical information of the patients, and the results obtained from the microbiological cultures and PCR. The non-parametric chi-square test (χ2) was used to compare the results obtained from the cultures and PCR to establish a diagnostic value. The parameters of sensitivity, specificity, positive predictive value and negative predictive value were also analyzed.ResultsOf the 86 samples of probable cases of whooping cough, 29 (35%) belonged to patients who were hospitalized in the pediatric unit at health centers in Quito. No significant difference was observed between genders, as 55% of patients were male, and 45% were female. The study included a population ranging from 0–12 months of age, which was distributed as follows: 59 patients were between 0–3 months old; 20, between 4–6 months old; 4, between 7–9 months old, and 3 between 10–12 months old. More than half of the samples used in the study, 62 of 86 (72%), came from patients going through the first 2 weeks since symptom onset, whereas 24 (28%) were past this time frame (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). From the epidemiological charts in our possession, it was not possible to verify the vaccination status or the antimicrobial treatment of the patients; therefore, these factors, if any, were not included in our analysis.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>From the samples that were analyzed, 23% (20 of 86) were found to be positive for B. pertussis by culturing, whereas the results obtained from PCR showed that 41% (30 of 86) of cases were positive for IS481 and ptxA-Pr, which are specific to B. pertussis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Moreover, one case was identified as a co-infection of B. pertussis and B. parapertussis, since both IS481 and IS1001 were amplified (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), while the hIS1001 did not amplify any sample (<a class="elsevierStyleCrossRef" href="#sec0070">Table S2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>By comparing the techniques used for the detection of the bacteria, it was observed that the polymerase chain reaction showed a sensitivity of 79% and a specificity of 71%. In contrast, the gold standard method showed 100% specificity, and 23% sensitivity (20/86) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Lastly, a correlation between the different stages of the disease and an identification of the bacteria in culture was analyzed, and a statistically significant result (p-value <0.05) was revealed for children whose swabs were collected between 1–15 days after the onset of symptoms, otherwise known as the catarrhal stage of the disease (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionWhooping cough is an endemic disease with eventual outbreaks and epidemic peaks, which manifest every 2 to 5 years<a class="elsevierStyleCrossRefs" href="#bib0295">13,26</a>. During the last decade, Latin America has reported a resurgence of pertussis post-vaccination era, the annual incidence of the disease continues to rise, and the pertussis-related mortality rate in infants younger than 6 months old is estimated at 0.2%<a class="elsevierStyleCrossRefs" href="#bib0275">9,14,38</a>.In our study, the majority of positive cases of B. pertussis infections corresponded to those infants belonging to the group of 0–3 months of age, reaching a prevalence of 65%. This percentage was similar to that identified in a study carried out in Peru, in which 70% of positive cases corresponded to infants younger than 3 months old<a class="elsevierStyleCrossRef" href="#bib0265">7</a> as one of the main risk factors for the disease at this age is incomplete vaccination<a class="elsevierStyleCrossRefs" href="#bib0240">2,9</a>. Nonetheless, it is worth mentioning that neither vaccination nor natural infection confers complete, lifelong immunity to the disease<a class="elsevierStyleCrossRef" href="#bib0440">42</a>; in fact, a minimum of two doses should be administered for vaccination to be effective. For this reason, lactating infants under 4 months of age are at an increased risk of contracting the infection<a class="elsevierStyleCrossRefs" href="#bib0260">6,42</a>.Recently, there has been a resurgence of cases of pertussis caused by B. pertussis, despite good vaccination coverage<a class="elsevierStyleCrossRefs" href="#bib0235">1,25</a>. This resurgence has been attributed to the introduction of the acellular vaccine (ACV)<a class="elsevierStyleCrossRef" href="#bib0400">34</a>. However, the genomic variation of pertactin (PRN) and pertussis toxin (Ptx) of B. pertussis has been described since the introduction of the whole-cell vaccine (WCV)<a class="elsevierStyleCrossRef" href="#bib0255">5</a>.Most strains used for the production of WCV and ACV express antigens such as PtxA2 or PtxA4 and Prn1 or Prn7, whereas circulating clinical isolates have other variants, namely, PtxA1 and Prn2 or Prn335. In addition, strains of B. pertussis have been isolated from countries with high vaccination coverage, which have lost antigens such as filamentous hemagglutinin (FHA), pertactin (Prn), Ptx subunit A (PtxA), serotype 2 fimbriae (Fim2), serotype 3 fimbriae (Fim3), and tracheal colonization factor (TcfA)<a class="elsevierStyleCrossRef" href="#bib0450">44</a>. While in countries with low vaccination coverage, the emergence of new cases of pertussis has been attributed to the presence of B. pertussis strains that express a new allele for the pertussis toxin promoter, which enhances the production of the pertussis toxin (Ptx)<a class="elsevierStyleCrossRef" href="#bib0400">34</a>.To this day, strains of B. pertussis that do not produce Prn have been isolated mainly in countries that report pertussis epidemics. In the United States, during an outbreak in 2012, it was recorded that more than 60% of isolates did not produce Prn43. Additionally; studies have shown that B. pertussis strains that do not produce Prn induce a stronger pro-inflammatory response, and increase cell death after infection<a class="elsevierStyleCrossRef" href="#bib0345">23</a>.Given that the symptoms of the disease tend to be non-specific, clinical data are vital for the adequate diagnosis of probable cases of pertussis<a class="elsevierStyleCrossRef" href="#bib0385">31</a>. In this study, none of the epidemiological charts contained information about the vaccination status of the patient, mother or other family members, which is necessary to monitor vaccination compliance. Furthermore, there is an immunity window of vulnerability for infants under 2 months of age<a class="elsevierStyleCrossRefs" href="#bib0285">11,19</a>. For this reason, the WHO considers maternal immunization as an effective strategy for the prevention of pertussis in infants, as passive immunization is reached after the transfer of maternal antibodies<a class="elsevierStyleCrossRefs" href="#bib0250">4,19,25</a>.In this study, two techniques were used for the detection of B. pertussis in our samples to evaluate the efficiency of the molecular technique PCR. It was identified that culturing yielded 23% of positive cases, whereas PCR detected 41%; this variation was expected since other studies estimated that without PCR, 9% to 26% of positive cases could be missed every year<a class="elsevierStyleCrossRef" href="#bib0315">17</a>.The results obtained from this study have shown that the application of PCR assays for the laboratory confirmation of B. pertussis and B. parapertussis, provides increased sensitivity, as it can detect minimum amounts of bacterial DNA from a sample. Moreover, to identify and differentiate among Bordetella species, two assays were used, each designed to amplify species-specific DNA sequences<a class="elsevierStyleCrossRefs" href="#bib0330">20,27,45</a>. For this reason, the CDC has recommended the use of PCR as the primary method for the detection of pertussis infection<a class="elsevierStyleCrossRefs" href="#bib0310">16,30</a>.A statistically significant correlation was observed in our study population between the catarrhal stage of the disease, which extends from day 1 to 15 after the onset of symptoms, an identification of the bacteria in culture<a class="elsevierStyleCrossRefs" href="#bib0360">26,29</a>. In contrast, the use of PCR as a laboratory diagnostic tool amplified the window for the detection of the microorganism; the onset of symptoms can extend from day 1 to 30, including the catarrhal stage of the disease as well as the paroxysmal stage 2.The different methodologies applied for the identification of pertussis allowed to extend the period in which the disease was detected, in comparison to the detection time of a test used in isolation<a class="elsevierStyleCrossRef" href="#bib0370">28</a>. Several health organizations such as the Minnesota Department of Health suggest that the optimal time for the detection of pertussis by culture should be calculated from samples collected during the first 2 weeks since the onset of symptoms<a class="elsevierStyleCrossRef" href="#bib0395">33</a>. Similarly, Leber AL in 2014 observed that cultures have a sensitivity of 12–60% if the analysis is performed at the beginning of the disease (<2 weeks)<a class="elsevierStyleCrossRef" href="#bib0375">29</a>, that is, during the catarrhal stage of the disease, when there is an increased bacterial load that favors the diagnosis by culture. Moreover, Leite et al. note that in their study the sensitivity of cultures and PCR decreased after the second week since the onset of symptoms, dropping from 70% and 80% respectively to 10% and 21%<a class="elsevierStyleCrossRef" href="#bib0380">30</a>. Infections caused by B. pertussis and B. parapertussis that cause a pertussis-like syndrome or co-infection might be undistinguishable<a class="elsevierStyleCrossRef" href="#bib0320">18</a>. For this reason, a laboratory diagnosis of the etiological agent is necessary. Recently, studies have shown that the prevalence of B. parapertussis infections has increased<a class="elsevierStyleCrossRef" href="#bib0270">8</a>; however, the pertussis vaccine provides little to no protection against B. parapertussis infection. Based on this fact, the information obtained from this research will be made available to healthcare professionals, so that decisions are made in the clinical-epidemiological setting by taking into account the frequencies identified here for the first time.The reemergence of pertussis is a public health concern that poses a significant challenge to existing health policies. This emphasizes that there is an atypical clinical diagnosis, as the disease manifests itself differently depending on the age, stage of the disease, immunological status, or region where it is located; these factors, therefore, complicate the epidemiological surveillance of the disease in Ecuador.In this study, we analyzed the effectiveness of laboratory diagnostic tools for the identification of pertussis. It was observed that the use of PCR was more sensitive for the detection of the bacteria than culturing, probably because it can detect and amplify a single copy of bacterial DNA<a class="elsevierStyleCrossRefs" href="#bib0335">21,24</a>. It is therefore likely that the negative results yielded by culture might have been false-negatives, which further supports the increased sensitivity of PCR (79%) over the cultures<a class="elsevierStyleCrossRefs" href="#bib0290">12,15</a>. Finally, the results from the study suggest the incorporation of PCR testing as a tool for early detection of whooping cough in hospitals and epidemiological surveillance in Ecuador. We provided a rapid and accurate diagnosis of the disease to reduce the time response for the treatment of the infection, especially for infants under three months of age, considering that clinical suspicion alone is often not enough to accurately diagnose the disease<a class="elsevierStyleCrossRefs" href="#bib0445">43,45,46</a>.Ethics approvalThis study has been reviewed and approved by the Ethics Committee of Human Research of the PUCE, considering it scientifically acceptable.Conflict of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1480253" "titulo" => "Highlights" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres1480252" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1348091" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres1480251" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0015" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1348090" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Population sampling" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Samples" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Microbiological culture" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "PCR for the detection of B. pertussis and B. parapertussis" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical data analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Ethics approval" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack519247" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-13" "fechaAceptado" => "2020-07-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1348091" "palabras" => array:5 [ 0 => "Whooping cough" 1 => "Pertussis" 2 => "Bordetella pertussis" 3 => "Bordetella parapertussis" 4 => "Infection" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1348090" "palabras" => array:4 [ 0 => "Tosferina" 1 => "Bordetella pertussis" 2 => "Bordetella parapertussis" 3 => "Infección" ] ] ] ] "tieneResumen" => true "highlights" => array:2 [ "titulo" => "Highlights" "resumen" => "<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Presence of positive cases of B. pertussis infections in pediatric population ranging from 0-12 months of age of Quito, Ecuador.</li><li class="elsevierStyleListItem" id="lsti0010">•Accurate diagnosis of the disease to reduce the time response for the treatment of the infection.</li></ul>This work emphasizes the need for an active surveillance for the early detection of Bordetella infections." ] "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Bordetella pertussis is the causative agent of pertussis, which mainly affects unvaccinated children, while Bordetella parapertussis causes a disease presenting clinical characteristics that are indistinguishable from whooping cough. Despite high vaccination coverage, pertussis remains a public health concern worldwide, with approximately 140000 cases reported annually. Here we determined the prevalence of B. pertussis and B. parapertussis infection among infants under one year of age by polymerase chain reaction (PCR); our aim being to identify whether the data obtained relates to the relevant sociodemographic and clinical data. The study included 86 samples of nasopharyngeal swabs from infants aged between 0–12 months, who were reported as probable cases of whooping cough by the health centers around the Ecuadorian highlands, from August 2016 to July 2017. The nasopharyngeal swabs were cultured and microbiological and molecular analyses were performed. B. pertussis was identified by PCR in 41% of the samples (30/86), more than half of which corresponded to infants aged between 0–3 months. Moreover, a statistically significant correlation (p<0.05) between the identification of bacteria in culture and the catarrhal stage of the disease was observed. The results obtained from the study highlighted the need for an active national surveillance of pertussis, in particular for laboratory testing, to provide a highly sensitive and more specific diagnosis of Bordetella infection." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Bordetella pertussis es el agente causal de la tosferina, que afecta principalmente a población pediátrica no vacunada; mientras que Bordetella parapertussis ocasiona un cuadro clínico similar indistinguible de tosferina. A pesar de la alta cobertura de vacunación, pertussis sigue siendo un problema de salud pública a nivel mundial, con aproximadamente 140.000 casos reportados anualmente. Se determinó la prevalencia de la infección por B. pertussis y B. parapertussis en niños menores de un año, por reacción en cadena de la polimerasa (PCR), y se identificó la relación entre los datos obtenidos y los datos sociodemográficos y clínicos relevantes. El estudio incluyó 86 muestras nasofaríngeas de menores entre 0 a 12 meses de edad, quienes fueron reportados como casos probables de tosferina por centros de salud de la región Sierra de Ecuador, desde agosto de 2016 hasta julio de 2017. Las muestras nasofaríngeas fueron analizadas mediante el método de cultivo, pruebas microbiológicas y moleculares. Se identificó B. pertussis por PCR en el 41% de muestras (30/86), más de la mitad de estas muestras correspondieron a niños de entre 0 y tres meses de edad. Además, se identificó una correlación estadísticamente significativa (p < 0,05) entre la detección de las bacterias mediante cultivo y la fase catarral de la enfermedad. Con base en estos resultados, es necesario mejorar el sistema de vigilancia epidemiológica del país, principalmente, en la confirmación de casos por laboratorio, para una detección altamente sensible y específica del microorganismo causante de la tosferina." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 592 "Ancho" => 2091 "Tamanyo" => 117157 ] ] "descripcion" => array:1 [ "en" => "Amplification of IS481, ptxA-Pr and IS1001 of Bordetella pertussis. PCR products were analyzed in a 2% agarose gel by electrophoresis." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2083 "Ancho" => 1341 "Tamanyo" => 132741 ] ] "descripcion" => array:1 [ "en" => "Amplification of IS481 and IS1001 to confirm the co-infection of Bordetella pertussis and Bordetella parapertussis (BP17-82). PCR products were analyzed in a 2% agarose gel by electrophoresis." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "The data was retrieved from the epidemiological charts of patients reported as probable cases of whooping cough in Quito, Ecuador." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (months)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4–6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7–9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10–12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onset of symptoms (days)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6–10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11–15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16–20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21–25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medical care</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalized \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ambulatory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Season</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rainy (winter) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dry (summer) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TOTAL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2547159.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the study population." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "2 × 2 Contingency table: Sensitivity = (15/19) = 78.9%; Specificity = (47/66) = 71.2%; PPV = (15/44) = 44.1%; NPV = (47/51) = 92.1%." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Culture</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Negative \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="middle">PCR</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TOTAL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2547158.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of culture and PCR for the detection of Bordetella pertussis." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Onset of symptoms (days) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Culture</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive for B. pertussis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Negative for B. pertussis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6–10 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.20% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11–15 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.40% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16–20 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.30% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21–25 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.60% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pearson's chi-squared test (χ2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">χ2 value: 9457; df.: 4; p-value: 0.04</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2547160.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlation between the onset of symptoms of the population under study, and the detection of Bordetella pertussis by culture." ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 25414 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:46 [ 0 => array:3 [ "identificador" => "bib0235" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neonatal immunity to Bordetella pertussis infection and current prevention strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Argondizo-Correia" 1 => "A.K.S. Rodrigues" 2 => "C.A. de Brito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Immunol Res" "fecha" => "2019" "volumen" => "10" "paginaInicial" => "1" "paginaFinal" => "10" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0240" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increase in pertussis cases along with high prevalence of two emerging genotypes of Bordetella pertussis in Perú, 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Bailon" 1 => "N. León-Janampa" 2 => "C. Padilla" 3 => "D. Hozbor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12879-016-1700-2" "Revista" => array:5 [ "tituloSerie" => "BMC Infect Dis" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27530444" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0245" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis: a re-emerging disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. Benamrouche" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Eur J Clin Microbiol Infect Dis" "fecha" => "2017" "volumen" => "1" "paginaInicial" => "3" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0250" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bordetella pertussis, B. parapertussis, vaccines and cycles of whooping cough" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Bouchez" 1 => "N. Guiso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Pathog Dis" "fecha" => "2015" "volumen" => "73" "paginaInicial" => "7" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0255" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of Bordetella pertussis pertactin and pertussis toxin types from Queensland Australia, 1999–2003" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Byrne" 1 => "A.T. Slack" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2334-6-1" "Revista" => array:5 [ "tituloSerie" => "BMC Infect Dis" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16390553" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0260" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tendencia de la mortalidad y la morbilidad por tos ferina en Colombia, 2002–2012" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Cardona" 1 => "M.O. Garzón" 2 => "M. Calle" 3 => "M.C. Agudelo" 4 => "Á. Segura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7705/biomedica.v36i3.3117" "Revista" => array:6 [ "tituloSerie" => "Biomedica" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "397" "paginaFinal" => "405" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27869387" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0265" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection of Bordetella pertussis using a PCR test in infants younger than one year old hospitalized with whooping cough in five Peruvian hospitals" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "M.E. Castillo" 1 => "C. Bada" 2 => "O. del Aguila" 3 => "V. Petrozzi-Helasvuo" 4 => "V. Casabona-Ore" 5 => "I. Reyes" 6 => "J. del Valle-Mendoza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2015.10.020" "Revista" => array:6 [ "tituloSerie" => "Int J Infect Dis" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "36" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26523641" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0270" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patterns of Bordetella parapertussis respiratory illnesses: 2008–2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.D. Cherry" 1 => "B.L. Seaton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cir860" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2012" "volumen" => "54" "paginaInicial" => "534" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22156857" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0275" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis re-emergence in the post-vaccination era" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Chiappini" 1 => "A. Stival" 2 => "L. Galli" 3 => "M. de Martino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2334-13-1" "Revista" => array:5 [ "tituloSerie" => "BMC Infect Dis" "fecha" => "2013" "volumen" => "13" "paginaInicial" => "1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23280237" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0280" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reemergence of pertussis in the highly vaccinated population of The Netherlands: observations on surveillance data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. de Melker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid0604.000404" "Revista" => array:6 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2000" "volumen" => "6" "paginaInicial" => "348" "paginaFinal" => "357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10905967" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0285" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bordetella pertussis in children hospitalized with a respiratory infection: clinical characteristics and pathogen detection in household contacts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:10 [ 0 => "J. del Valle-Mendoza" 1 => "W. Silva-Caso" 2 => "M.A. Aguilar-Luis" 3 => "C. del Valle-Vargas" 4 => "E. Cieza-Mora" 5 => "J. Martins-Luna" 6 => "R. Aquino-Ortega" 7 => "A. Silva-Vásquez" 8 => "J. Bazán-Mayra" 9 => "P. Weilg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13104-018-3405-7" "Revista" => array:5 [ "tituloSerie" => "BMC Res Notes" "fecha" => "2018" "volumen" => "11" "paginaInicial" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29776433" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0290" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of culture and PCR for detection of Bordetella pertussis and Bordetella parapertussis under routine laboratory conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.M. Dragsted" 1 => "B. Dohn" 2 => "J. Madsen" 3 => "J.S. Jensen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmm.0.45585-0" "Revista" => array:6 [ "tituloSerie" => "J Med Microbiol" "fecha" => "2004" "volumen" => "53" "paginaInicial" => "749" "paginaFinal" => "754" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15272061" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0295" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Annual Epidemiological Report 2012. Reporting on 2010 surveillance data and 2011 epidemic intelligence data" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "European Centre for Disease Prevention and Control" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2013" "editorial" => "ECDC" "editorialLocalizacion" => "Stockholm" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0300" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis in Latin America: epidemiology and control strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.H. Falleiros Arlant" 1 => "A. de Colsa" 2 => "D. Flores" 3 => "J. Brea" 4 => "M.L. Avila Aguero" 5 => "D.F. Hozbor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1586/14787210.2014.948846" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Anti Infect Ther" "fecha" => "2014" "volumen" => "12" "paginaInicial" => "1265" "paginaFinal" => "1275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25139010" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0305" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio comparativo de la sensibilidad entre el cultivo y la reacción en cadena de la polimerasa para la detección de Bordetella pertussis a partir de muestras de hisopado nasofaríngeo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "Z. Farías" 1 => "C. Rodríguez" 2 => "D. Marcano" 3 => "E. Spadola" 4 => "D. Payares" 5 => "N. Cuaical" 6 => "C. Ugarte" 7 => "N. Salgado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Inst Nac Hig." "fecha" => "2015" "volumen" => "46" "paginaInicial" => "38" "paginaFinal" => "50" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0310" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis: manual for the surveillance of vaccine-preventable diseases [Online]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Faulkner" 1 => "T. Skoff" 2 => "S. Martin" 3 => "P. Cassiday" 4 => "M.L. Tondella" 5 => "J. Liang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2017" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0315" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of PCR in the diagnosis of pertussis infection in infants: 5 years’ experience of provision of a same-day real-time PCR service in England and Wales from 2002 to 2007" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:10 [ 0 => "N.K. Fry" 1 => "J. Duncan" 2 => "K. Wagner" 3 => "O. Tzivra" 4 => "N. Doshi" 5 => "D.J. Litt" 6 => "N. Crowcroft" 7 => "E. Miller" 8 => "R.C. George" 9 => "T.G. Harrison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmm.0.009878-0" "Revista" => array:6 [ "tituloSerie" => "J Med Microbiol" "fecha" => "2009" "volumen" => "58" "paginaInicial" => "1023" "paginaFinal" => "1029" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19528165" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0320" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Caracterización de la infección por Bordetella pertussis, Bordetella spp. y coqueluche en la provincia de Córdoba Argentina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V.O. Giayetto" 1 => "S. Blanco" 2 => "A. Mangeaud" 3 => "M.G. Barbás" 4 => "A. Cudolá" 5 => "S.V. Gallego" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4067/S0716-10182017000200002" "Revista" => array:6 [ "tituloSerie" => "Rev Chilena Infectol" "fecha" => "2017" "volumen" => "34" "paginaInicial" => "108" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28632823" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0325" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors influencing the spread of pertussis in households: a prospective study, Catalonia and Navarre Spain, 2012 to 2013" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:16 [ 0 => "P. Godoy" 1 => "M. García-Cenoz" 2 => "D. Toledo" 3 => "G. Carmona" 4 => "J.A. Caylà" 5 => "M. Alsedà" 6 => "J. Alvarez" 7 => "I. Barrabeig" 8 => "N. Camps" 9 => "P. Plans" 10 => "M. Company" 11 => "J. Castilla" 12 => "M. Sala-Farré" 13 => "C. Muñoz-Almagro" 14 => "C. Ruis" 15 => "A. Domínguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Euro Surveill" "fecha" => "2016" "volumen" => "21" "paginaInicial" => "45" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0330" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Real-time PCR-based detection of Bordetella pertussis and Bordetella parapertussis in an Irish paediatric population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.A. Grogan" 1 => "C. Logan" 2 => "J. O’Leary" 3 => "R. Rush" 4 => "N. O'Sullivan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmm.0.030049-0" "Revista" => array:6 [ "tituloSerie" => "J Med Microbiol" "fecha" => "2011" "volumen" => "60" "paginaInicial" => "722" "paginaFinal" => "729" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21393459" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0335" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection of Bordetella pertussis infection by culture, real-time polymerase chain reaction and serologic tests among children with prolonged cough" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "D. Gürsel" 1 => "A. Aslan" 2 => "C. Sönmez" 3 => "G. Koturoğlu" 4 => "N. Cöplü" 5 => "Z. Kurugöl" 6 => "Z. Aydemir" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mikrobiyol Bul" "fecha" => "2012" "volumen" => "46" "paginaInicial" => "211" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22639310" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0340" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidance and protocol for the use of real-time PCR in laboratory diagnosis of human infection with Bordetella pertussis or Bordetella parapertussis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "Q. He" 1 => "N. Fry" 2 => "S. Guillot" 3 => "N. Guiso" 4 => "C.H. Wirsing von König" 5 => "M. Riffelmann" 6 => "K.A. Krogfelt" 7 => "T. Dalby" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2012" "paginaInicial" => "1" "editorial" => "European Centre for Disease Prevention and Control (ECDC)" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0345" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bordetella pertussis pertactin knock-out strains reveal immunomodulatory properties of this virulence factor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:10 [ 0 => "E.S. Hovingh" 1 => "R. Mariman" 2 => "L. Solans" 3 => "D. Hijdra" 4 => "H.J. Hamstra" 5 => "I. Jongerius" 6 => "M. van Gent" 7 => "F. Mooi" 8 => "C. Locht" 9 => "E. Pinelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41426-018-0039-8" "Revista" => array:5 [ "tituloSerie" => "Emerg Microbes Infect" "fecha" => "2018" "volumen" => "7" "paginaInicial" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29559630" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0350" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of pertussis in Casablanca (Morocco): contribution of conventional and molecular diagnosis tools" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:9 [ 0 => "K. Katfy" 1 => "N. Guiso" 2 => "I. Diawara" 3 => "K. Zerouali" 4 => "B. Slaoui" 5 => "Z. Jouhadi" 6 => "A. Zineddine" 7 => "H. Belabbes" 8 => "N. Elmdaghri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12879-017-2452-3" "Revista" => array:5 [ "tituloSerie" => "BMC Infect Dis" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28511667" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0355" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bordetella pertussis infection: pathogenesis, diagnosis, management, and the role of protective immunity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.R. Kerr" 1 => "R.C. Matthews" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s100960050435" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Microbiol Infect Dis" "fecha" => "2000" "volumen" => "19" "paginaInicial" => "77" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10746492" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0360" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis: a reemerging infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Kline" 1 => "W.D. Lewis" 2 => "E.A. Smith" 3 => "L.R. Tracy" 4 => "S.K. Moerschel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2013" "volumen" => "88" "paginaInicial" => "507" "paginaFinal" => "514" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0365" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Real-time LightCycler PCR for detection and discrimination of Bordetella pertussis and Bordetella parapertussis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Kosters" 1 => "U. Reischl" 2 => "J. Schmetz" 3 => "M. Riffelmann" 4 => "C.H. Wirsing von Konig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/jcm.40.5.1719-1722.2002" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2002" "volumen" => "40" "paginaInicial" => "1719" "paginaFinal" => "1722" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11980949" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0370" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infección por Bordetella pertussis y Bordetella parapertussis en casos con sospecha de coqueluche (2011–2015). Mar del Plata Argentina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Lavayén" 1 => "C. Zotta" 2 => "M. Cepeda" 3 => "C. Lara" 4 => "A. Rearte" 5 => "M. Regueira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.17843/rpmesp.2017.341.2770" "Revista" => array:6 [ "tituloSerie" => "Rev Peru Med Exp Salud Publica" "fecha" => "2017" "volumen" => "34" "paginaInicial" => "85" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28538850" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0375" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis: relevant species and diagnostic update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.L. Leber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cll.2014.02.003" "Revista" => array:6 [ "tituloSerie" => "Clin Lab Med" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "237" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24856526" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0380" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of etiologic agents of the pertussis-like syndrome in children by real-time PCR method" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Mahmoudi" 1 => "M. Banar" 2 => "B. Pourakbari" 3 => "H.S. Alavi" 4 => "H. Eshaghi" 5 => "A.A. Ahari" 6 => "S. Mamishi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.14712/23362936.2018.6" "Revista" => array:6 [ "tituloSerie" => "Prague Med Rep" "fecha" => "2018" "volumen" => "119" "paginaInicial" => "61" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29665348" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0385" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gaceta Epidemiológica Ecuador SIVE-ALERTA N°" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Web Ministerio de Salud Pública" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2016" "paginaInicial" => "56" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0390" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis laboratory testing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Miller" 1 => "S. Ersted" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016" "paginaInicial" => "12" "editorial" => "Minnesota Department of Health" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0395" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterization of Bordetella holmesii isolates from patients with pertussis-like illness in the Netherlands" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "F.R. Mooi" 1 => "S. Bruisten" 2 => "I. Linde" 3 => "F. Reubsaet" 4 => "K. Heuvelman" 5 => "S. Van der Lee" 6 => "A.J. King" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1574-695X.2011.00911.x" "Revista" => array:6 [ "tituloSerie" => "FEMS Immunol Med Microbiol" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "289" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22098551" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0400" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Virulence factors variation among Bordetella Pertussis isolates in Iran" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "V.S. Nikbin" 1 => "N. Jannesar Ahmadi" 2 => "M. Hosseinpour" 3 => "M. Nakhost Lotfi" 4 => "F. Shooraj" 5 => "F.S. Sadeghpour" 6 => "F. Shahcheraghi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Mol Cell Med" "fecha" => "2015" "volumen" => "4" "paginaInicial" => "138" "paginaFinal" => "142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26261803" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0405" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluación de la Estrategia Nacional de Inmunizaciones" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Web Ministerio de Salud, Secretaría Nacional de Planificación y Desarrollo, Organización Panamericana de la Salud" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2017" "editorial" => "Quito-Ecuador" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0410" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative analysis of the genome sequences of Bordetella pertussis, Bordetella parapertussis and Bordetella bronchiseptica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:45 [ 0 => "J. Parkhill" 1 => "M. Sebaihia" 2 => "A. Preston" 3 => "L.D. Murphy" 4 => "N. Thomson" 5 => "D.E. Harris" 6 => "M.A. Quail" 7 => "M. Achtman" 8 => "R. Atkin" 9 => "S. Baker" 10 => "D. Basham" 11 => "N. Bason" 12 => "I. Cherevach" 13 => "T. Chillingworth" 14 => "M. Collins" 15 => "A. Cronin" 16 => "P. Davis" 17 => "J. Doggett" 18 => "T. Feltwell" 19 => "A. Goble" 20 => "N. Hamlin" 21 => "H. Hauser" 22 => "S. Holroyd" 23 => "K. Jagels" 24 => "S. Leather" 25 => "S. Moule" 26 => "H. Norberczak" 27 => "S. O’Neil" 28 => "D. Ormond" 29 => "C. Price" 30 => "E. Rabbinowitsch" 31 => "S. Rutter" 32 => "M. Sanders" 33 => "D. Saunders" 34 => "K. Seeger" 35 => "S. Sharp" 36 => "M. Simmonds" 37 => "J. Skelton" 38 => "R. Squares" 39 => "S. Squares" 40 => "K. Stevens" 41 => "L. Unwin" 42 => "S. Whitehead" 43 => "B.G. Barrell" 44 => "D.J. Maskell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ng1227" "Revista" => array:6 [ "tituloSerie" => "Nat Genet" "fecha" => "2003" "volumen" => "35" "paginaInicial" => "32" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12910271" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0415" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and molecular characterization of pertactin-deficient Bordetella pertussis in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:12 [ 0 => "L.C. Pawloski" 1 => "A.M. Queenan" 2 => "P.K. Cassiday" 3 => "A.S. Lynch" 4 => "M.J. Harrison" 5 => "W. Shang" 6 => "M.M. Williams" 7 => "K.E. Bowden" 8 => "B. Burgos-Rivera" 9 => "X. Qin" 10 => "N. Messonnier" 11 => "M.L. Tondella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/CVI.00717-13" "Revista" => array:6 [ "tituloSerie" => "Clin Vaccine Immunol" "fecha" => "2014" "volumen" => "21" "paginaInicial" => "119" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24256623" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0420" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis in Mexico, an epidemiological overview. A study of 19 years at the Instituto Mexicano del Seguro Social" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.F. Pérez-Pérez" 1 => "T. Rojas-Mendoza" 2 => "D.A. Cabrera-Gaytán" 3 => "C. Grajales-Muñiz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Med Inst Mex Seguro Soc" "fecha" => "2015" "volumen" => "53" "paginaInicial" => "164" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25760745" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0425" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expanding pertussis epidemiology in 6 Latin America Countries through the Latin American Pertussis Project" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "V.A. Pinell-McNamara" 1 => "A.M. Acosta" 2 => "M.C. Pedreira" 3 => "A.F. Carvalho" 4 => "L. Pawloski" 5 => "M.L. Tondella" 6 => "E. Briere" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "S94" "paginaFinal" => "S100" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0430" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of whooping cough in Switzerland: differentiating Bordetella pertussis from Bordetella holmesii by polymerase chain reaction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:9 [ 0 => "L.F. Pittet" 1 => "S. Emonet" 2 => "P. François" 3 => "E.-J. Bonetti" 4 => "J. Schrenzel" 5 => "M. Hug" 6 => "M. Altwegg" 7 => "C.-A. Siegrist" 8 => "K.M. Posfay-Barbe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0088936" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "e88936" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24586447" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0435" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pertussis: pertussis control strategies and the options for improving current vaccines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.A. Plotkin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1586/14760584.2014.944166" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Vaccines" "fecha" => "2014" "volumen" => "13" "paginaInicial" => "1071" "paginaFinal" => "1072" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25090359" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0440" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the Public Health Management of Pertussis in England" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Public Health England" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2016" ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0445" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bordetella filamentous hemagglutinin and fimbriae: critical adhesins with unrealized vaccine potential" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.V. Scheller" 1 => "P.A. Cotter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/femspd/ftv079" "Revista" => array:5 [ "tituloSerie" => "Pathog Dis" "fecha" => "2015" "volumen" => "73" "paginaInicial" => "ftv079" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26416077" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0450" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation and implementation of a diagnostic algorithm for DNA detection of Bordetella pertussis, B. parapertussis and B. holmesii in a pediatric referral hospital in Barcelona, Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "A. Valero-Rello" 1 => "D. Henares" 2 => "L. Acosta" 3 => "M. Jane" 4 => "I. Jordan" 5 => "P. Godoy" 6 => "C. Muñoz-Almagro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01231-18" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2019" "volumen" => "57" "paginaInicial" => "e01231" "paginaFinal" => "e1318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30404946" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0455" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global burden of pertussis: signs of hope but need for accurate data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.H.W. von Koenig" 1 => "N. Guiso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(17)30357-2" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "889" "paginaFinal" => "890" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28623145" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0460" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laboratory manual for the diagnosis of whooping cough caused by Bordetella pertussis/Bordetella parapertussis" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Web World Health Organization, Department of Immunization, Vaccines and Biologicals" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2014" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack519247" "titulo" => "Acknowledgments" "texto" => "We thank Nicolle Ramírez Cifuentes for her English language advice. 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Bordetella pertussis, un patógeno reemergente en infecciones respiratorias pediátricas, un estudio en Quito, Ecuador

Saidy Vásconez Nogueraa, Katherine Jaramillob, Andrés Zabalaa, José E. Villacísa,b,

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jevillacis@gmail.com

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a Carrera de Bioquímica Clínica, Facultad de Medicina, Pontificia Universidad Católica del Ecuador , Quito, Ecuador

b Centro de Referencia Nacional de Resistencia a los Antimicrobianos, Instituto Nacional de Investigación en Salud Pública “Leopoldo Izquieta Pérez”, Quito, Ecuador

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0025" class="elsevierStylePara elsevierViewall">During the past years&#44; a resurgence of pertussis cases has been observed worldwide and is considered a reemerging infectious disease by the World Health Organization &#40;WHO&#41;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">26&#44;39&#44;46</span></a>&#46; This disease is present in developing and developed countries&#44; despite high rates of vaccination&#46; It is caused by gram-negative bacteria belonging to the genus <span class="elsevierStyleItalic">Bordetella</span>&#44; namely&#44; <span class="elsevierStyleItalic">Bordetella pertussis</span> and <span class="elsevierStyleItalic">Bordetella parapertussis</span>&#44; the latter causing a less severe form of the disease<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">3&#44;10</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">B&#46; pertussis</span> is known to cause more severe disease than <span class="elsevierStyleItalic">B&#46; parapertussis</span> or <span class="elsevierStyleItalic">Bordetella holmesii</span>&#44; while <span class="elsevierStyleItalic">Bordetella bronchiseptica</span> affects immunocompromised patients more frequently<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">36</span></a>&#46; These three species of <span class="elsevierStyleItalic">Bordetella</span> share some virulence factors such as adhesins&#44; fimbriae&#44; filamentous hemagglutinin &#40;FHA&#41;&#44; pertactin &#40;PRN&#41;&#44; tracheal colonization factor&#44; and tracheal cytotoxin&#46; Conversely&#44; pertussis toxin and serum resistance protein are expressed only by <span class="elsevierStyleItalic">B&#46; pertussis</span>&#44; and the type III secretion system is expressed only by <span class="elsevierStyleItalic">B&#46;</span><span class="elsevierStyleItalic">bronchiseptica</span><a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Among the virulence factors&#44; it is possible to find adenylate cyclase toxin-hemolysin &#40;CyaA&#41;&#44; an adhesin that is frequently included as a component in acellular vaccines against <span class="elsevierStyleItalic">B&#46;</span><span class="elsevierStyleItalic">pertussis</span><a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">44</span></a>&#46; Moreover&#44; this factor is characterized by the presence of a hemolytic phenotype of virulent strains of <span class="elsevierStyleItalic">B&#46; pertussis</span>&#46; At present&#44; it has been reported that the hemolytic phenotype in <span class="elsevierStyleItalic">Bordetella</span> is lost once other genes replace the toxin&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The infection has shown a modified pattern of transmission in areas with high coverage of pertussis vaccination&#44; which is likely due to a change in circulating <span class="elsevierStyleItalic">B&#46; pertussis</span> strains<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">4</span></a>&#46; However&#44; according to some authors&#44; the resurgence of pertussis cases is either a consequence of bacterial host adaptation or due to vaccine influence<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">3</span></a>&#46; Of the vaccines available for the prevention of the disease&#44; the Center for Disease Control and Prevention &#40;CDC&#41; has recommended the use of the acellular vaccine as the primary choice for infants under one year of age&#44; as it has been proved to be less reactogenic<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In Ecuador&#44; based on the expanded immunization program &#40;EPI&#41;&#44; the pentavalent and trivalent whole-cell inactivated vaccines &#40;WCV&#41; are the pertussis vaccines being currently administered&#46; However&#44; in accordance with the biological drug release registry&#44; there are also acellular pertussis vaccines &#40;ACV&#41; being provided by the private sector&#46; Moreover&#44; a decreased vaccination coverage has been observed&#59; between 2001 and 2009 vaccination coverage was 100&#37;&#59; however&#44; since 2009&#44; this rate has been gradually decreasing<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Nowadays&#44; health organizations aim at reducing the morbidity and mortality rates in lactating infants&#44; who are under one year of age&#44; as this population registers the majority of pertussis cases reported worldwide &#40;88&#46;7 out of 10<span class="elsevierStyleHsp" style=""></span>000&#41;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">41</span></a>&#46; To achieve this objective&#44; vaccination strategies should be evaluated&#59; vaccination and booster doses should be implemented to cover more than 90&#37; of the population&#46; Moreover&#44; epidemiological surveillance systems of the disease should be improved so that an increased number of probable cases of pertussis are identified and diagnosed<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">26</span></a>&#46; In Ecuador&#44; the Ministry of Public Health through the SIVE-Alerta program performs a passive surveillance of the disease by notifying probable cases of <span class="elsevierStyleItalic">B&#46; pertussis</span> infection&#46; In 2015&#44; 7 cases were reported and in 2016 there was an increase of 14 cases<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">35</span></a>&#46; Since 2016 a rapid rise in the number of cases of <span class="elsevierStyleItalic">B&#46; pertussis</span> infection has been observed&#59; in fact&#44; they have duplicated in comparison to the previous year&#44; which could be suggestive of a new outbreak&#46; Nonetheless&#44; the confirmation of positive cases is hampered due to a lack of highly sensitive and more specific tests&#44; such as the polymerase chain reaction &#40;PCR&#41;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">22&#44;46</span></a>&#46; This study aimed to identify the prevalence of <span class="elsevierStyleItalic">B&#46; pertussis</span>&#44; <span class="elsevierStyleItalic">B&#46; parapertussis</span> and <span class="elsevierStyleItalic">B&#46; holmesii</span> in infants under one year of age&#44; who were reported as probable cases of whooping cough&#46; Diagnosis was confirmed by microbiological culture and PCR&#44; for faster and more specific laboratory diagnosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Population sampling</span><p id="par0055" class="elsevierStylePara elsevierViewall">A cross-sectional study was carried out in the city of Quito&#44; Ecuador&#44; in coordination with the <span class="elsevierStyleItalic">Instituto Nacional de Investigaci&#243;n en Salud P&#250;blica</span> &#40;INSPI&#41;&#46; The Ecuadorian highland region was chosen for evaluation as it has reported the highest number of pertussis cases since 2016<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">35</span></a>&#46; The samples to be analyzed consisted of 86 nasopharyngeal swabs from children between 0 to 12 months of age&#44; who were described as probable cases of whooping cough after visiting the different health centers in the region&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The study was limited to a type of observational study that analyzes data from a population&#44; from the Epidemiological Surveillance System for this disease&#46; This study involves data collected at a defined time&#46; The study was reviewed and approved by the Human Research Ethics Committee of the Pontificia Universidad Cat&#243;lica del Ecuador&#44; which categorized it as scientifically acceptable&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Samples</span><p id="par0065" class="elsevierStylePara elsevierViewall">Samples were received either as nasopharyngeal swabs in the Regan-Lowe Semi-solid Transport Medium &#40;calcium alginate swab&#44; 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A database was created&#44; including the following information for each sample&#58; the age and gender of the patient&#44; place of origin&#44; type of sample&#44; elapsed time from symptom onset to primary diagnosis&#44; which was determined by the practitioner based on the clinical symptoms&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Microbiological culture</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nasopharyngeal swabs were cultured in Regan-Lowe medium &#40;Becton Dickinson&#41;&#44; containing 5&#37; cephalexin&#44; and were incubated in a humidity chamber at 37<span class="elsevierStyleHsp" style=""></span>&#176;C for 7&#8211;10 days&#46; After this period&#44; the presumptive <span class="elsevierStyleItalic">Bordetella</span> spp&#46; colonies were subjected to further testing to differentiate <span class="elsevierStyleItalic">B&#46; pertussis</span> from <span class="elsevierStyleItalic">B&#46; parapertussis</span>&#46; Microbiological and biochemical tests were used&#44; including Gram staining&#44; MacConkey agar&#44; oxidase&#44; and catalase tests&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">PCR for the detection of <span class="elsevierStyleItalic">B&#46; pertussis</span> and <span class="elsevierStyleItalic">B&#46; parapertussis</span></span><p id="par0080" class="elsevierStylePara elsevierViewall">Each swab sample was suspended in 500<span class="elsevierStyleHsp" style=""></span>&#956;l of PBS&#44; and genomic DNA was extracted using the High Pure PCR Template Preparation Kit &#40;Roche Germany&#41;&#44; according to the manufacturer&#39;s instructions&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">To differentiate among the <span class="elsevierStyleItalic">Bordetella</span> species&#44; specific primers were used for the following targets&#58; IS<span class="elsevierStyleItalic">481</span> and <span class="elsevierStyleItalic">ptxA</span>-Pr were used for the identification of <span class="elsevierStyleItalic">B&#46; pertussis</span>&#44; IS<span class="elsevierStyleItalic">1001</span>&#44; for the identification of <span class="elsevierStyleItalic">B&#46; parapertussis&#44;</span> and the hIS<span class="elsevierStyleItalic">1001</span> target for the identification of <span class="elsevierStyleItalic">B&#46;</span><span class="elsevierStyleItalic">holmesii</span><a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">22&#44;40</span></a> &#40;<a class="elsevierStyleCrossRef" href="#sec0070">Table S1</a>&#41;&#46; To amplify the bacterial genome&#44; 1<span class="elsevierStyleHsp" style=""></span>&#956;l of the extracted DNA was added to 11&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;l of the master mix preparation &#40;GoTaq&#174;&#41; to make up a final volume of 12&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;l&#46; The conditions used in the thermocycler were the following&#58; denaturation &#40;5<span class="elsevierStyleHsp" style=""></span>min at 94<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#59; annealing for IS<span class="elsevierStyleItalic">481</span> &#40;30s at 63&#46;6<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#59; annealing for <span class="elsevierStyleItalic">ptxA</span>-Pr &#40;30s at 55<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#59; annealing for IS<span class="elsevierStyleItalic">1001</span> &#40;30s at 60&#46;4<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#59; and annealing for hIS<span class="elsevierStyleItalic">1001</span> &#40;30s at 63&#46;6<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; extension &#40;30<span class="elsevierStyleHsp" style=""></span>s at 72<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#59; final extension &#40;10<span class="elsevierStyleHsp" style=""></span>min at 72<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#59; 25 cycles were used to amplify the genes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Statistical data analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">Descriptive statistics were used to analyze the clinical information of the patients&#44; and the results obtained from the microbiological cultures and PCR&#46; The non-parametric chi-square test &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41; was used to compare the results obtained from the cultures and PCR to establish a diagnostic value&#46; The parameters of sensitivity&#44; specificity&#44; positive predictive value and negative predictive value were also analyzed&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">Of the 86 samples of probable cases of whooping cough&#44; 29 &#40;35&#37;&#41; belonged to patients who were hospitalized in the pediatric unit at health centers in Quito&#46; No significant difference was observed between genders&#44; as 55&#37; of patients were male&#44; and 45&#37; were female&#46; The study included a population ranging from 0&#8211;12 months of age&#44; which was distributed as follows&#58; 59 patients were between 0&#8211;3 months old&#59; 20&#44; between 4&#8211;6 months old&#59; 4&#44; between 7&#8211;9 months old&#44; and 3 between 10&#8211;12 months old&#46; More than half of the samples used in the study&#44; 62 of 86 &#40;72&#37;&#41;&#44; came from patients going through the first 2 weeks since symptom onset&#44; whereas 24 &#40;28&#37;&#41; were past this time frame &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; From the epidemiological charts in our possession&#44; it was not possible to verify the vaccination status or the antimicrobial treatment of the patients&#59; therefore&#44; these factors&#44; if any&#44; were not included in our analysis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">From the samples that were analyzed&#44; 23&#37; &#40;20 of 86&#41; were found to be positive for <span class="elsevierStyleItalic">B&#46; pertussis</span> by culturing&#44; whereas the results obtained from PCR showed that 41&#37; &#40;30 of 86&#41; of cases were positive for IS<span class="elsevierStyleItalic">481</span> and <span class="elsevierStyleItalic">ptxA</span>-Pr&#44; which are specific to <span class="elsevierStyleItalic">B&#46; pertussis</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Moreover&#44; one case was identified as a co-infection of <span class="elsevierStyleItalic">B&#46; pertussis</span> and <span class="elsevierStyleItalic">B&#46; parapertussis</span>&#44; since both IS<span class="elsevierStyleItalic">481</span> and IS<span class="elsevierStyleItalic">1001</span> were amplified &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; while the hIS<span class="elsevierStyleItalic">1001</span> did not amplify any sample &#40;<a class="elsevierStyleCrossRef" href="#sec0070">Table S2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">By comparing the techniques used for the detection of the bacteria&#44; it was observed that the polymerase chain reaction showed a sensitivity of 79&#37; and a specificity of 71&#37;&#46; In contrast&#44; the gold standard method showed 100&#37; specificity&#44; and 23&#37; sensitivity &#40;20&#47;86&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Lastly&#44; a correlation between the different stages of the disease and an identification of the bacteria in culture was analyzed&#44; and a statistically significant result &#40;<span class="elsevierStyleItalic">p</span>-value &#60;0&#46;05&#41; was revealed for children whose swabs were collected between 1&#8211;15 days after the onset of symptoms&#44; otherwise known as the catarrhal stage of the disease &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Whooping cough is an endemic disease with eventual outbreaks and epidemic peaks&#44; which manifest every 2 to 5 years<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">13&#44;26</span></a>&#46; During the last decade&#44; Latin America has reported a resurgence of pertussis post-vaccination era&#44; the annual incidence of the disease continues to rise&#44; and the pertussis-related mortality rate in infants younger than 6 months old is estimated at 0&#46;2&#37;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">9&#44;14&#44;38</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In our study&#44; the majority of positive cases of <span class="elsevierStyleItalic">B&#46; pertussis</span> infections corresponded to those infants belonging to the group of 0&#8211;3 months of age&#44; reaching a prevalence of 65&#37;&#46; This percentage was similar to that identified in a study carried out in Peru&#44; in which 70&#37; of positive cases corresponded to infants younger than 3 months old<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">7</span></a> as one of the main risk factors for the disease at this age is incomplete vaccination<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">2&#44;9</span></a>&#46; Nonetheless&#44; it is worth mentioning that neither vaccination nor natural infection confers complete&#44; lifelong immunity to the disease<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">42</span></a>&#59; in fact&#44; a minimum of two doses should be administered for vaccination to be effective&#46; For this reason&#44; lactating infants under 4 months of age are at an increased risk of contracting the infection<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">6&#44;42</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Recently&#44; there has been a resurgence of cases of pertussis caused by <span class="elsevierStyleItalic">B&#46; pertussis</span>&#44; despite good vaccination coverage<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">1&#44;25</span></a>&#46; This resurgence has been attributed to the introduction of the acellular vaccine &#40;ACV&#41;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">34</span></a>&#46; However&#44; the genomic variation of pertactin &#40;PRN&#41; and pertussis toxin &#40;Ptx&#41; of <span class="elsevierStyleItalic">B&#46; pertussis</span> has been described since the introduction of the whole-cell vaccine &#40;WCV&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Most strains used for the production of WCV and ACV express antigens such as PtxA2 or PtxA4 and Prn1 or Prn7&#44; whereas circulating clinical isolates have other variants&#44; namely&#44; PtxA1 and Prn2 or Prn335&#46; In addition&#44; strains of <span class="elsevierStyleItalic">B&#46; pertussis</span> have been isolated from countries with high vaccination coverage&#44; which have lost antigens such as filamentous hemagglutinin &#40;FHA&#41;&#44; pertactin &#40;Prn&#41;&#44; Ptx subunit A &#40;PtxA&#41;&#44; serotype 2 fimbriae &#40;Fim2&#41;&#44; serotype 3 fimbriae &#40;Fim3&#41;&#44; and tracheal colonization factor &#40;TcfA&#41;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">44</span></a>&#46; While in countries with low vaccination coverage&#44; the emergence of new cases of pertussis has been attributed to the presence of <span class="elsevierStyleItalic">B&#46; pertussis</span> strains that express a new allele for the pertussis toxin promoter&#44; which enhances the production of the pertussis toxin &#40;Ptx&#41;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">34</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">To this day&#44; strains of <span class="elsevierStyleItalic">B&#46; pertussis</span> that do not produce Prn have been isolated mainly in countries that report pertussis epidemics&#46; In the United States&#44; during an outbreak in 2012&#44; it was recorded that more than 60&#37; of isolates did not produce Prn43&#46; Additionally&#59; studies have shown that <span class="elsevierStyleItalic">B&#46; pertussis</span> strains that do not produce Prn induce a stronger pro-inflammatory response&#44; and increase cell death after infection<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Given that the symptoms of the disease tend to be non-specific&#44; clinical data are vital for the adequate diagnosis of probable cases of pertussis<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">31</span></a>&#46; In this study&#44; none of the epidemiological charts contained information about the vaccination status of the patient&#44; mother or other family members&#44; which is necessary to monitor vaccination compliance&#46; Furthermore&#44; there is an immunity window of vulnerability for infants under 2 months of age<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">11&#44;19</span></a>&#46; For this reason&#44; the WHO considers maternal immunization as an effective strategy for the prevention of pertussis in infants&#44; as passive immunization is reached after the transfer of maternal antibodies<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">4&#44;19&#44;25</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In this study&#44; two techniques were used for the detection of <span class="elsevierStyleItalic">B&#46; pertussis</span> in our samples to evaluate the efficiency of the molecular technique PCR&#46; It was identified that culturing yielded 23&#37; of positive cases&#44; whereas PCR detected 41&#37;&#59; this variation was expected since other studies estimated that without PCR&#44; 9&#37; to 26&#37; of positive cases could be missed every year<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The results obtained from this study have shown that the application of PCR assays for the laboratory confirmation of <span class="elsevierStyleItalic">B&#46; pertussis</span> and <span class="elsevierStyleItalic">B&#46; parapertussis</span>&#44; provides increased sensitivity&#44; as it can detect minimum amounts of bacterial DNA from a sample&#46; Moreover&#44; to identify and differentiate among <span class="elsevierStyleItalic">Bordetella</span> species&#44; two assays were used&#44; each designed to amplify species-specific DNA sequences<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">20&#44;27&#44;45</span></a>&#46; For this reason&#44; the CDC has recommended the use of PCR as the primary method for the detection of pertussis infection<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">16&#44;30</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">A statistically significant correlation was observed in our study population between the catarrhal stage of the disease&#44; which extends from day 1 to 15 after the onset of symptoms&#44; an identification of the bacteria in culture<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">26&#44;29</span></a>&#46; In contrast&#44; the use of PCR as a laboratory diagnostic tool amplified the window for the detection of the microorganism&#59; the onset of symptoms can extend from day 1 to 30&#44; including the catarrhal stage of the disease as well as the paroxysmal stage 2&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The different methodologies applied for the identification of pertussis allowed to extend the period in which the disease was detected&#44; in comparison to the detection time of a test used in isolation<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">28</span></a>&#46; Several health organizations such as the Minnesota Department of Health suggest that the optimal time for the detection of pertussis by culture should be calculated from samples collected during the first 2 weeks since the onset of symptoms<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">33</span></a>&#46; Similarly&#44; Leber AL in 2014 observed that cultures have a sensitivity of 12&#8211;60&#37; if the analysis is performed at the beginning of the disease &#40;&#60;2 weeks&#41;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">29</span></a>&#44; that is&#44; during the catarrhal stage of the disease&#44; when there is an increased bacterial load that favors the diagnosis by culture&#46; Moreover&#44; Leite et al&#46; note that in their study the sensitivity of cultures and PCR decreased after the second week since the onset of symptoms&#44; dropping from 70&#37; and 80&#37; respectively to 10&#37; and 21&#37;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">30</span></a>&#46; Infections caused by <span class="elsevierStyleItalic">B&#46; pertussis</span> and <span class="elsevierStyleItalic">B&#46; parapertussis</span> that cause a pertussis-like syndrome or co-infection might be undistinguishable<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">18</span></a>&#46; For this reason&#44; a laboratory diagnosis of the etiological agent is necessary&#46; Recently&#44; studies have shown that the prevalence of <span class="elsevierStyleItalic">B&#46; parapertussis</span> infections has increased<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">8</span></a>&#59; however&#44; the pertussis vaccine provides little to no protection against <span class="elsevierStyleItalic">B&#46; parapertussis</span> infection&#46; Based on this fact&#44; the information obtained from this research will be made available to healthcare professionals&#44; so that decisions are made in the clinical-epidemiological setting by taking into account the frequencies identified here for the first time&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The reemergence of pertussis is a public health concern that poses a significant challenge to existing health policies&#46; This emphasizes that there is an atypical clinical diagnosis&#44; as the disease manifests itself differently depending on the age&#44; stage of the disease&#44; immunological status&#44; or region where it is located&#59; these factors&#44; therefore&#44; complicate the epidemiological surveillance of the disease in Ecuador&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In this study&#44; we analyzed the effectiveness of laboratory diagnostic tools for the identification of pertussis&#46; It was observed that the use of PCR was more sensitive for the detection of the bacteria than culturing&#44; probably because it can detect and amplify a single copy of bacterial DNA<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">21&#44;24</span></a>&#46; It is therefore likely that the negative results yielded by culture might have been false-negatives&#44; which further supports the increased sensitivity of PCR &#40;79&#37;&#41; over the cultures<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">12&#44;15</span></a>&#46; Finally&#44; the results from the study suggest the incorporation of PCR testing as a tool for early detection of whooping cough in hospitals and epidemiological surveillance in Ecuador&#46; We provided a rapid and accurate diagnosis of the disease to reduce the time response for the treatment of the infection&#44; especially for infants under three months of age&#44; considering that clinical suspicion alone is often not enough to accurately diagnose the disease<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">43&#44;45&#44;46</span></a>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ethics approval</span><p id="par0175" class="elsevierStylePara elsevierViewall">This study has been reviewed and approved by the Ethics Committee of Human Research of the PUCE&#44; considering it scientifically acceptable&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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      "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Presence of positive cases of B&#46; pertussis infections in pediatric population ranging from 0-12 months of age of Quito&#44; Ecuador&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Accurate diagnosis of the disease to reduce the time response for the treatment of the infection&#46;</p></li></ul>This work emphasizes the need for an active surveillance for the early detection of Bordetella infections&#46;</p></span>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Bordetella pertussis</span> is the causative agent of pertussis&#44; which mainly affects unvaccinated children&#44; while <span class="elsevierStyleItalic">Bordetella parapertussis</span> causes a disease presenting clinical characteristics that are indistinguishable from whooping cough&#46; Despite high vaccination coverage&#44; pertussis remains a public health concern worldwide&#44; with approximately 140<span class="elsevierStyleHsp" style=""></span>000 cases reported annually&#46; Here we determined the prevalence of <span class="elsevierStyleItalic">B&#46; pertussis</span> and <span class="elsevierStyleItalic">B&#46; parapertussis</span> infection among infants under one year of age by polymerase chain reaction &#40;PCR&#41;&#59; our aim being to identify whether the data obtained relates to the relevant sociodemographic and clinical data&#46; The study included 86 samples of nasopharyngeal swabs from infants aged between 0&#8211;12 months&#44; who were reported as probable cases of whooping cough by the health centers around the Ecuadorian highlands&#44; from August 2016 to July 2017&#46; The nasopharyngeal swabs were cultured and microbiological and molecular analyses were performed&#46; <span class="elsevierStyleItalic">B&#46; pertussis</span> was identified by PCR in 41&#37; of the samples &#40;30&#47;86&#41;&#44; more than half of which corresponded to infants aged between 0&#8211;3 months&#46; Moreover&#44; a statistically significant correlation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the identification of bacteria in culture and the catarrhal stage of the disease was observed&#46; The results obtained from the study highlighted the need for an active national surveillance of pertussis&#44; in particular for laboratory testing&#44; to provide a highly sensitive and more specific diagnosis of <span class="elsevierStyleItalic">Bordetella</span> infection&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Bordetella pertussis</span> es el agente causal de la tosferina&#44; que afecta principalmente a poblaci&#243;n pedi&#225;trica no vacunada&#59; mientras que <span class="elsevierStyleItalic">Bordetella parapertussis</span> ocasiona un cuadro cl&#237;nico similar indistinguible de tosferina&#46; A pesar de la alta cobertura de vacunaci&#243;n&#44; pertussis sigue siendo un problema de salud p&#250;blica a nivel mundial&#44; con aproximadamente 140&#46;000 casos reportados anualmente&#46; Se determin&#243; la prevalencia de la infecci&#243;n por <span class="elsevierStyleItalic">B&#46; pertussis</span> y <span class="elsevierStyleItalic">B&#46; parapertussis</span> en ni&#241;os menores de un a&#241;o&#44; por reacci&#243;n en cadena de la polimerasa &#40;PCR&#41;&#44; y se identific&#243; la relaci&#243;n entre los datos obtenidos y los datos sociodemogr&#225;ficos y cl&#237;nicos relevantes&#46; El estudio incluy&#243; 86 muestras nasofar&#237;ngeas de menores entre 0 a 12 meses de edad&#44; quienes fueron reportados como casos probables de tosferina por centros de salud de la regi&#243;n Sierra de Ecuador&#44; desde agosto de 2016 hasta julio de 2017&#46; Las muestras nasofar&#237;ngeas fueron analizadas mediante el m&#233;todo de cultivo&#44; pruebas microbiol&#243;gicas y moleculares&#46; Se identific&#243; <span class="elsevierStyleItalic">B&#46; pertussis</span> por PCR en el 41&#37; de muestras &#40;30&#47;86&#41;&#44; m&#225;s de la mitad de estas muestras correspondieron a ni&#241;os de entre 0 y tres meses de edad&#46; Adem&#225;s&#44; se identific&#243; una correlaci&#243;n estad&#237;sticamente significativa &#40;<span class="elsevierStyleItalic">p</span> &#60; 0&#44;05&#41; entre la detecci&#243;n de las bacterias mediante cultivo y la fase catarral de la enfermedad&#46; Con base en estos resultados&#44; es necesario mejorar el sistema de vigilancia epidemiol&#243;gica del pa&#237;s&#44; principalmente&#44; en la confirmaci&#243;n de casos por laboratorio&#44; para una detecci&#243;n altamente sensible y espec&#237;fica del microorganismo causante de la tosferina&#46;</p></span>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0200" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 592
            "Ancho" => 2091
            "Tamanyo" => 117157
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Amplification of IS<span class="elsevierStyleItalic">481</span>&#44; ptxA-Pr and IS<span class="elsevierStyleItalic">1001</span> of <span class="elsevierStyleItalic">Bordetella pertussis</span>&#46; PCR products were analyzed in a 2&#37; agarose gel by electrophoresis&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2083
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            "Tamanyo" => 132741
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Amplification of IS<span class="elsevierStyleItalic">481</span> and IS<span class="elsevierStyleItalic">1001</span> to confirm the co-infection of <span class="elsevierStyleItalic">Bordetella pertussis</span> and <span class="elsevierStyleItalic">Bordetella parapertussis</span> &#40;BP17-82&#41;&#46; PCR products were analyzed in a 2&#37; agarose gel by electrophoresis&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The data was retrieved from the epidemiological charts of patients reported as probable cases of whooping cough in Quito&#44; Ecuador&#46;</p>"
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            0 => array:2 [
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#8211;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>7&#8211;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>10&#8211;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#8211;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6&#8211;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>11&#8211;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>16&#8211;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>21&#8211;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Medical care</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ambulatory&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Season</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rainy &#40;winter&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dry &#40;summer&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TOTAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">2 &#215; 2 Contingency table&#58; Sensitivity &#61; &#40;15&#47;19&#41; &#61; 78&#46;9&#37;&#59; Specificity &#61; &#40;47&#47;66&#41; &#61; 71&#46;2&#37;&#59; PPV &#61; &#40;15&#47;44&#41; &#61; 44&#46;1&#37;&#59; NPV &#61; &#40;47&#47;51&#41; &#61; 92&#46;1&#37;&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Culture</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">PCR</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TOTAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Onset of symptoms &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Culture</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive for <span class="elsevierStyleItalic">B&#46; pertussis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Negative for <span class="elsevierStyleItalic">B&#46; pertussis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8211;5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8211;10 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#8211;15 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#8211;20 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#8211;25 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                    0 => array:2 [
                      "titulo" => "Neonatal immunity to <span class="elsevierStyleItalic">Bordetella pertussis</span> infection and current prevention strategies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Argondizo-Correia"
                            1 => "A&#46;K&#46;S&#46; Rodrigues"
                            2 => "C&#46;A&#46; de Brito"
                          ]
                        ]
                      ]
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                        "tituloSerie" => "J Immunol Res"
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                        "volumen" => "10"
                        "paginaInicial" => "1"
                        "paginaFinal" => "10"
                      ]
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              "etiqueta" => "2"
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                    0 => array:2 [
                      "titulo" => "Increase in pertussis cases along with high prevalence of two emerging genotypes of <span class="elsevierStyleItalic">Bordetella pertussis</span> in Per&#250;&#44; 2012"
                      "autores" => array:1 [
                        0 => array:2 [
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                            1 => "N&#46; Le&#243;n-Janampa"
                            2 => "C&#46; Padilla"
                            3 => "D&#46; Hozbor"
                          ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1186/s12879-016-1700-2"
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                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2016"
                        "volumen" => "16"
                        "paginaInicial" => "422"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27530444"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0245"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pertussis&#58; a re-emerging disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46; Benamrouche"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "Revista" => array:4 [
                        "tituloSerie" => "Eur J Clin Microbiol Infect Dis"
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                        "volumen" => "1"
                        "paginaInicial" => "3"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0250"
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                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Bordetella pertussis</span>&#44; <span class="elsevierStyleItalic">B&#46; parapertussis</span>&#44; vaccines and cycles of whooping cough"
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                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Pathog Dis"
                        "fecha" => "2015"
                        "volumen" => "73"
                        "paginaInicial" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of <span class="elsevierStyleItalic">Bordetella pertussis</span> pertactin and pertussis toxin types from Queensland Australia&#44; 1999&#8211;2003"
                      "autores" => array:1 [
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                          "autores" => array:2 [
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                            1 => "A&#46;T&#46; Slack"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2334-6-1"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2016"
                        "volumen" => "6"
                        "paginaInicial" => "1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16390553"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            5 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tendencia de la mortalidad y la morbilidad por tos ferina en Colombia&#44; 2002&#8211;2012"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Cardona"
                            1 => "M&#46;O&#46; Garz&#243;n"
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                            3 => "M&#46;C&#46; Agudelo"
                            4 => "&#193;&#46; Segura"
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                      "doi" => "10.7705/biomedica.v36i3.3117"
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                        "tituloSerie" => "Biomedica"
                        "fecha" => "2016"
                        "volumen" => "36"
                        "paginaInicial" => "397"
                        "paginaFinal" => "405"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27869387"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0265"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of <span class="elsevierStyleItalic">Bordetella pertussis</span> using a PCR test in infants younger than one year old hospitalized with whooping cough in five Peruvian hospitals"
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                        0 => array:2 [
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                            2 => "O&#46; del Aguila"
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                            5 => "I&#46; Reyes"
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                    0 => array:2 [
                      "doi" => "10.1016/j.ijid.2015.10.020"
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                        "tituloSerie" => "Int J Infect Dis"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "36"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26523641"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0270"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patterns of <span class="elsevierStyleItalic">Bordetella parapertussis</span> respiratory illnesses&#58; 2008&#8211;2010"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/cid/cir860"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2012"
                        "volumen" => "54"
                        "paginaInicial" => "534"
                        "paginaFinal" => "537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22156857"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pertussis re-emergence in the post-vaccination era"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Chiappini"
                            1 => "A&#46; Stival"
                            2 => "L&#46; Galli"
                            3 => "M&#46; de Martino"
                          ]
                        ]
                      ]
                    ]
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                      "doi" => "10.1186/1471-2334-13-1"
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                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2013"
                        "volumen" => "13"
                        "paginaInicial" => "1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23280237"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0280"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Reemergence of pertussis in the highly vaccinated population of The Netherlands&#58; observations on surveillance data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3201/eid0604.000404"
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                        "tituloSerie" => "Emerg Infect Dis"
                        "fecha" => "2000"
                        "volumen" => "6"
                        "paginaInicial" => "348"
                        "paginaFinal" => "357"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10905967"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0285"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Bordetella pertussis</span> in children hospitalized with a respiratory infection&#58; clinical characteristics and pathogen detection in household contacts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "J&#46; del Valle-Mendoza"
                            1 => "W&#46; Silva-Caso"
                            2 => "M&#46;A&#46; Aguilar-Luis"
                            3 => "C&#46; del Valle-Vargas"
                            4 => "E&#46; Cieza-Mora"
                            5 => "J&#46; Martins-Luna"
                            6 => "R&#46; Aquino-Ortega"
                            7 => "A&#46; Silva-V&#225;squez"
                            8 => "J&#46; Baz&#225;n-Mayra"
                            9 => "P&#46; Weilg"
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                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13104-018-3405-7"
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                        "tituloSerie" => "BMC Res Notes"
                        "fecha" => "2018"
                        "volumen" => "11"
                        "paginaInicial" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29776433"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of culture and PCR for detection of <span class="elsevierStyleItalic">Bordetella pertussis</span> and <span class="elsevierStyleItalic">Bordetella parapertussis</span> under routine laboratory conditions"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:4 [
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                            2 => "J&#46; Madsen"
                            3 => "J&#46;S&#46; Jensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1099/jmm.0.45585-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Microbiol"
                        "fecha" => "2004"
                        "volumen" => "53"
                        "paginaInicial" => "749"
                        "paginaFinal" => "754"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15272061"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0295"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Annual Epidemiological Report 2012&#46; Reporting on 2010 surveillance data and 2011 epidemic intelligence data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "European Centre for Disease Prevention and Control"
                          "etal" => false
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2013"
                        "editorial" => "ECDC"
                        "editorialLocalizacion" => "Stockholm"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pertussis in Latin America&#58; epidemiology and control strategies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;H&#46; Falleiros Arlant"
                            1 => "A&#46; de Colsa"
                            2 => "D&#46; Flores"
                            3 => "J&#46; Brea"
                            4 => "M&#46;L&#46; Avila Aguero"
                            5 => "D&#46;F&#46; Hozbor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1586/14787210.2014.948846"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Rev Anti Infect Ther"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "1265"
                        "paginaFinal" => "1275"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25139010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0305"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio comparativo de la sensibilidad entre el cultivo y la reacci&#243;n en cadena de la polimerasa para la detecci&#243;n de <span class="elsevierStyleItalic">Bordetella pertussis</span> a partir de muestras de hisopado nasofar&#237;ngeo"
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                            4 => "D&#46; Payares"
                            5 => "N&#46; Cuaical"
                            6 => "C&#46; Ugarte"
                            7 => "N&#46; Salgado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Inst Nac Hig&#46;"
                        "fecha" => "2015"
                        "volumen" => "46"
                        "paginaInicial" => "38"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pertussis&#58; manual for the surveillance of vaccine-preventable diseases &#91;Online&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Faulkner"
                            1 => "T&#46; Skoff"
                            2 => "S&#46; Martin"
                            3 => "P&#46; Cassiday"
                            4 => "M&#46;L&#46; Tondella"
                            5 => "J&#46; Liang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
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            16 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of PCR in the diagnosis of pertussis infection in infants&#58; 5 years&#8217; experience of provision of a same-day real-time PCR service in England and Wales from 2002 to 2007"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "N&#46;K&#46; Fry"
                            1 => "J&#46; Duncan"
                            2 => "K&#46; Wagner"
                            3 => "O&#46; Tzivra"
                            4 => "N&#46; Doshi"
                            5 => "D&#46;J&#46; Litt"
                            6 => "N&#46; Crowcroft"
                            7 => "E&#46; Miller"
                            8 => "R&#46;C&#46; George"
                            9 => "T&#46;G&#46; Harrison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1099/jmm.0.009878-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Microbiol"
                        "fecha" => "2009"
                        "volumen" => "58"
                        "paginaInicial" => "1023"
                        "paginaFinal" => "1029"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19528165"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0320"
              "etiqueta" => "18"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                    0 => array:2 [
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                      "titulo" => "Factors influencing the spread of pertussis in households&#58; a prospective study&#44; Catalonia and Navarre Spain&#44; 2012 to 2013"
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                        0 => array:2 [
                          "etal" => false
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                            1 => "M&#46; Garc&#237;a-Cenoz"
                            2 => "D&#46; Toledo"
                            3 => "G&#46; Carmona"
                            4 => "J&#46;A&#46; Cayl&#224;"
                            5 => "M&#46; Alsed&#224;"
                            6 => "J&#46; Alvarez"
                            7 => "I&#46; Barrabeig"
                            8 => "N&#46; Camps"
                            9 => "P&#46; Plans"
                            10 => "M&#46; Company"
                            11 => "J&#46; Castilla"
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                            13 => "C&#46; Mu&#241;oz-Almagro"
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                            15 => "A&#46; Dom&#237;nguez"
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                    ]
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                        "tituloSerie" => "Euro Surveill"
                        "fecha" => "2016"
                        "volumen" => "21"
                        "paginaInicial" => "45"
                      ]
                    ]
                  ]
                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Real-time PCR-based detection of <span class="elsevierStyleItalic">Bordetella pertussis</span> and <span class="elsevierStyleItalic">Bordetella parapertussis</span> in an Irish paediatric population"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "C&#46; Logan"
                            2 => "J&#46; O&#8217;Leary"
                            3 => "R&#46; Rush"
                            4 => "N&#46; O&#39;Sullivan"
                          ]
                        ]
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                        "tituloSerie" => "J Med Microbiol"
                        "fecha" => "2011"
                        "volumen" => "60"
                        "paginaInicial" => "722"
                        "paginaFinal" => "729"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21393459"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of <span class="elsevierStyleItalic">Bordetella pertussis</span> infection by culture&#44; real-time polymerase chain reaction and serologic tests among children with prolonged cough"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "D&#46; G&#252;rsel"
                            1 => "A&#46; Aslan"
                            2 => "C&#46; S&#246;nmez"
                            3 => "G&#46; Koturo&#287;lu"
                            4 => "N&#46; C&#246;pl&#252;"
                            5 => "Z&#46; Kurug&#246;l"
                            6 => "Z&#46; Aydemir"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Mikrobiyol Bul"
                        "fecha" => "2012"
                        "volumen" => "46"
                        "paginaInicial" => "211"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22639310"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0340"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidance and protocol for the use of real-time PCR in laboratory diagnosis of human infection with <span class="elsevierStyleItalic">Bordetella pertussis</span> or <span class="elsevierStyleItalic">Bordetella parapertussis</span>"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "Q&#46; He"
                            1 => "N&#46; Fry"
                            2 => "S&#46; Guillot"
                            3 => "N&#46; Guiso"
                            4 => "C&#46;H&#46; Wirsing von K&#246;nig"
                            5 => "M&#46; Riffelmann"
                            6 => "K&#46;A&#46; Krogfelt"
                            7 => "T&#46; Dalby"
                          ]
                        ]
                      ]
                    ]
                  ]
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              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Bordetella pertussis</span> pertactin knock-out strains reveal immunomodulatory properties of this virulence factor"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
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                            1 => "R&#46; Mariman"
                            2 => "L&#46; Solans"
                            3 => "D&#46; Hijdra"
                            4 => "H&#46;J&#46; Hamstra"
                            5 => "I&#46; Jongerius"
                            6 => "M&#46; van Gent"
                            7 => "F&#46; Mooi"
                            8 => "C&#46; Locht"
                            9 => "E&#46; Pinelli"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Emerg Microbes Infect"
                        "fecha" => "2018"
                        "volumen" => "7"
                        "paginaInicial" => "39"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29559630"
                            "web" => "Medline"
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                  ]
                ]
              ]
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            23 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of pertussis in Casablanca &#40;Morocco&#41;&#58; contribution of conventional and molecular diagnosis tools"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
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                            1 => "N&#46; Guiso"
                            2 => "I&#46; Diawara"
                            3 => "K&#46; Zerouali"
                            4 => "B&#46; Slaoui"
                            5 => "Z&#46; Jouhadi"
                            6 => "A&#46; Zineddine"
                            7 => "H&#46; Belabbes"
                            8 => "N&#46; Elmdaghri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12879-017-2452-3"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2017"
                        "volumen" => "17"
                        "paginaInicial" => "348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28511667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0355"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Bordetella pertussis</span> infection&#58; pathogenesis&#44; diagnosis&#44; management&#44; and the role of protective immunity"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:2 [
                            0 => "J&#46;R&#46; Kerr"
                            1 => "R&#46;C&#46; Matthews"
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                        "tituloSerie" => "Eur J Clin Microbiol Infect Dis"
                        "fecha" => "2000"
                        "volumen" => "19"
                        "paginaInicial" => "77"
                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10746492"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0360"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pertussis&#58; a reemerging infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "E&#46;A&#46; Smith"
                            3 => "L&#46;R&#46; Tracy"
                            4 => "S&#46;K&#46; Moerschel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am Fam Physician"
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                        "volumen" => "88"
                        "paginaInicial" => "507"
                        "paginaFinal" => "514"
                      ]
                    ]
                  ]
                ]
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              "etiqueta" => "27"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Real-time LightCycler PCR for detection and discrimination of <span class="elsevierStyleItalic">Bordetella pertussis</span> and <span class="elsevierStyleItalic">Bordetella parapertussis</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "U&#46; Reischl"
                            2 => "J&#46; Schmetz"
                            3 => "M&#46; Riffelmann"
                            4 => "C&#46;H&#46; Wirsing von Konig"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "J Clin Microbiol"
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                        "volumen" => "40"
                        "paginaInicial" => "1719"
                        "paginaFinal" => "1722"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11980949"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0370"
              "etiqueta" => "28"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infecci&#243;n por <span class="elsevierStyleItalic">Bordetella pertussis</span> y <span class="elsevierStyleItalic">Bordetella parapertussis</span> en casos con sospecha de coqueluche &#40;2011&#8211;2015&#41;&#46; Mar del Plata Argentina"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "S&#46; Lavay&#233;n"
                            1 => "C&#46; Zotta"
                            2 => "M&#46; Cepeda"
                            3 => "C&#46; Lara"
                            4 => "A&#46; Rearte"
                            5 => "M&#46; Regueira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.17843/rpmesp.2017.341.2770"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Peru Med Exp Salud Publica"
                        "fecha" => "2017"
                        "volumen" => "34"
                        "paginaInicial" => "85"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28538850"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "29"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pertussis&#58; relevant species and diagnostic update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;L&#46; Leber"
                          ]
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.cll.2014.02.003"
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                        "tituloSerie" => "Clin Lab Med"
                        "fecha" => "2014"
                        "volumen" => "34"
                        "paginaInicial" => "237"
                        "paginaFinal" => "255"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24856526"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0380"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identification of etiologic agents of the pertussis-like syndrome in children by real-time PCR method"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
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                            2 => "B&#46; Pourakbari"
                            3 => "H&#46;S&#46; Alavi"
                            4 => "H&#46; Eshaghi"
                            5 => "A&#46;A&#46; Ahari"
                            6 => "S&#46; Mamishi"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "Prague Med Rep"
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                        "volumen" => "119"
                        "paginaInicial" => "61"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29665348"
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                    0 => array:2 [
                      "titulo" => "Gaceta Epidemiol&#243;gica Ecuador SIVE-ALERTA N&#176;"
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                          "colaboracion" => "Web Ministerio de Salud P&#250;blica"
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                  "host" => array:1 [
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                        "paginaInicial" => "56"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pertussis laboratory testing"
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                          "autores" => array:2 [
                            0 => "C&#46; Miller"
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                      ]
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                    0 => array:2 [
                      "titulo" => "Characterization of <span class="elsevierStyleItalic">Bordetella holmesii</span> isolates from patients with pertussis-like illness in the Netherlands"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "I&#46; Linde"
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                            4 => "K&#46; Heuvelman"
                            5 => "S&#46; Van der Lee"
                            6 => "A&#46;J&#46; King"
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                    0 => array:2 [
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                        "tituloSerie" => "FEMS Immunol Med Microbiol"
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                        "paginaInicial" => "289"
                        "paginaFinal" => "291"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22098551"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Virulence factors variation among <span class="elsevierStyleItalic">Bordetella Pertussis</span> isolates in Iran"
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                          "autores" => array:7 [
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                            6 => "F&#46; Shahcheraghi"
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                      ]
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                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Mol Cell Med"
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                        "paginaInicial" => "138"
                        "paginaFinal" => "142"
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                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Evaluaci&#243;n de la Estrategia Nacional de Inmunizaciones"
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                        "fecha" => "2017"
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                ]
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                        0 => array:2 [
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                            1 => "M&#46; Sebaihia"
                            2 => "A&#46; Preston"
                            3 => "L&#46;D&#46; Murphy"
                            4 => "N&#46; Thomson"
                            5 => "D&#46;E&#46; Harris"
                            6 => "M&#46;A&#46; Quail"
                            7 => "M&#46; Achtman"
                            8 => "R&#46; Atkin"
                            9 => "S&#46; Baker"
                            10 => "D&#46; Basham"
                            11 => "N&#46; Bason"
                            12 => "I&#46; Cherevach"
                            13 => "T&#46; Chillingworth"
                            14 => "M&#46; Collins"
                            15 => "A&#46; Cronin"
                            16 => "P&#46; Davis"
                            17 => "J&#46; Doggett"
                            18 => "T&#46; Feltwell"
                            19 => "A&#46; Goble"
                            20 => "N&#46; Hamlin"
                            21 => "H&#46; Hauser"
                            22 => "S&#46; Holroyd"
                            23 => "K&#46; Jagels"
                            24 => "S&#46; Leather"
                            25 => "S&#46; Moule"
                            26 => "H&#46; Norberczak"
                            27 => "S&#46; O&#8217;Neil"
                            28 => "D&#46; Ormond"
                            29 => "C&#46; Price"
                            30 => "E&#46; Rabbinowitsch"
                            31 => "S&#46; Rutter"
                            32 => "M&#46; Sanders"
                            33 => "D&#46; Saunders"
                            34 => "K&#46; Seeger"
                            35 => "S&#46; Sharp"
                            36 => "M&#46; Simmonds"
                            37 => "J&#46; Skelton"
                            38 => "R&#46; Squares"
                            39 => "S&#46; Squares"
                            40 => "K&#46; Stevens"
                            41 => "L&#46; Unwin"
                            42 => "S&#46; Whitehead"
                            43 => "B&#46;G&#46; Barrell"
                            44 => "D&#46;J&#46; Maskell"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1038/ng1227"
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                        "tituloSerie" => "Nat Genet"
                        "fecha" => "2003"
                        "volumen" => "35"
                        "paginaInicial" => "32"
                        "paginaFinal" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12910271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0415"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and molecular characterization of pertactin-deficient <span class="elsevierStyleItalic">Bordetella pertussis</span> in the United States"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:12 [
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                            1 => "A&#46;M&#46; Queenan"
                            2 => "P&#46;K&#46; Cassiday"
                            3 => "A&#46;S&#46; Lynch"
                            4 => "M&#46;J&#46; Harrison"
                            5 => "W&#46; Shang"
                            6 => "M&#46;M&#46; Williams"
                            7 => "K&#46;E&#46; Bowden"
                            8 => "B&#46; Burgos-Rivera"
                            9 => "X&#46; Qin"
                            10 => "N&#46; Messonnier"
                            11 => "M&#46;L&#46; Tondella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CVI.00717-13"
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                        "tituloSerie" => "Clin Vaccine Immunol"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "paginaInicial" => "119"
                        "paginaFinal" => "125"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24256623"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0420"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pertussis in Mexico&#44; an epidemiological overview&#46; A study of 19 years at the Instituto Mexicano del Seguro Social"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;F&#46; P&#233;rez-P&#233;rez"
                            1 => "T&#46; Rojas-Mendoza"
                            2 => "D&#46;A&#46; Cabrera-Gayt&#225;n"
                            3 => "C&#46; Grajales-Mu&#241;iz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Med Inst Mex Seguro Soc"
                        "fecha" => "2015"
                        "volumen" => "53"
                        "paginaInicial" => "164"
                        "paginaFinal" => "170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25760745"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expanding pertussis epidemiology in 6 Latin America Countries through the Latin American Pertussis Project"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
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                            1 => "A&#46;M&#46; Acosta"
                            2 => "M&#46;C&#46; Pedreira"
                            3 => "A&#46;F&#46; Carvalho"
                            4 => "L&#46; Pawloski"
                            5 => "M&#46;L&#46; Tondella"
                            6 => "E&#46; Briere"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Emerg Infect Dis"
                        "fecha" => "2017"
                        "volumen" => "23"
                        "paginaInicial" => "S94"
                        "paginaFinal" => "S100"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0430"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of whooping cough in Switzerland&#58; differentiating <span class="elsevierStyleItalic">Bordetella pertussis</span> from <span class="elsevierStyleItalic">Bordetella holmesii</span> by polymerase chain reaction"
                      "autores" => array:1 [
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                          "etal" => false
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                            2 => "P&#46; Fran&#231;ois"
                            3 => "E&#46;-J&#46; Bonetti"
                            4 => "J&#46; Schrenzel"
                            5 => "M&#46; Hug"
                            6 => "M&#46; Altwegg"
                            7 => "C&#46;-A&#46; Siegrist"
                            8 => "K&#46;M&#46; Posfay-Barbe"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0088936"
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                        "tituloSerie" => "PLoS ONE"
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                        "paginaInicial" => "e88936"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24586447"
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                  ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pertussis&#58; pertussis control strategies and the options for improving current vaccines"
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                          "etal" => false
                          "autores" => array:1 [
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                    0 => array:2 [
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                        "tituloSerie" => "Expert Rev Vaccines"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "1071"
                        "paginaFinal" => "1072"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25090359"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Guidelines for the Public Health Management of Pertussis in England"
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                        0 => array:2 [
                          "colaboracion" => "Public Health England"
                          "etal" => false
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                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
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                      "titulo" => "<span class="elsevierStyleItalic">Bordetella</span> filamentous hemagglutinin and fimbriae&#58; critical adhesins with unrealized vaccine potential"
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                        "tituloSerie" => "Pathog Dis"
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                        "paginaInicial" => "ftv079"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26416077"
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Article information

ISSN: 03257541
Original language: English

DOI:10.1016/j.ram.2020.07.001

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Year/Month	Html	Pdf	Total

2024 November	8	1	9
2024 October	178	40	218
2024 September	193	44	237
2024 August	174	29	203
2024 July	177	20	197
2024 June	100	15	115
2024 May	125	23	148
2024 April	121	39	160
2024 March	109	12	121
2024 February	130	12	142
2024 January	134	13	147
2023 December	162	19	181
2023 November	222	30	252
2023 October	202	20	222
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2023 July	97	11	108
2023 June	120	10	130
2023 May	169	18	187
2023 April	153	19	172
2023 March	84	21	105
2023 February	77	13	90
2023 January	54	26	80
2022 December	82	25	107
2022 November	103	36	139
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2021 July	126	17	143
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2021 May	60	27	87
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