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Complete Health Indicator Report of Pertussis Cases

Definition

For surveillance purposes, pertussis is a cough illness lasting at least 2 weeks with one of the following: paroxysms of coughing, inspiratory "whoop," or post-tussive vomiting, with or without laboratory evidence of infection.

Numerator

Number of pertussis cases reported in Utah (including cases identified in outbreak settings).

Denominator

Total Utah population per year.

Why Is This Important?

According to the Council for State and Territorial Epidemiologists, "Bordetella pertussis is the most poorly controlled bacterial vaccine-preventable disease in the U.S." Controlling pertussis is a difficult challenge addressed by increasing vaccination rates, decreasing contact between infected and non-infected individuals, prompt identification, and treatment of ill individuals. Pertussis is a contagious, bacterial, respiratory disease. Although pertussis may be a mild disease in older children and adults, these infected people may transmit the disease to other susceptible persons, including unimmunized or incompletely immunized infants. Young infants are at highest risk for acquiring pertussis and pertussis-associated complications, such as pneumonia and inflammation of the brain. Although not common, pertussis can cause death, especially in children under 1 year of age. Most children are protected against pertussis by vaccination during childhood; however, immunity decreases over time and leaves adolescents and adults unprotected. Provisional 2013 national figures indicate that infants aged less than 1 year, who are at greatest risk for severe disease and death, continue to have the highest reported rate of pertussis. School-aged children 7-10 years continue to contribute a significant proportion of reported pertussis cases. In 2005, the FDA approved Tdap, a pertussis vaccine for adolescents and adults. The rate of pertussis decreased in the years following approval of Tdap. However, there is evidence indicating that the highest level of protection from the Tdap booster lasts around 2 years then decreases over time. This has also been observed in individuals that have become infected with pertussis; these individuals are protected for a few years but then their immunity becomes less effective over time. This decreasing immunity is called waning immunity.

Healthy People Objective IID-1:

Reduce, eliminate, or maintain elimination of cases of vaccine-preventable diseases
U.S. Target: Not applicable, see subobjectives in this category

Other Objectives

Healthy People 2020 IID-1 sub-objectives related to pertussis: - IID-1.6: Reduce, eliminate, or maintain elimination of cases of vaccine-preventable diseases: Pertussis (children under age 1 year) U.S. Target: 2,500 cases State Target: 31 cases per year - IID-1.7: Reduce, eliminate, or maintain elimination of cases of vaccine-preventable diseases: Pertussis among adolescents aged 11 to 18 years U.S. Target: 2,000 cases State Target: 58 cases per year

How Are We Doing?

Pertussis has been on the rise in Utah steadily since 2009, with a notable increase in cases beginning in 2011. 2012 data indicated that pertussis activity reached pre-vaccine era rates (>40 cases per 100,000). There are several factors that may be contributing to the increase of pertussis rates in recent years, including: actual increases in disease occurrence, better laboratory tests, increased recognition by clinicians, the cyclical nature of pertussis peaking every 3-5 years, waning immunity of the adult booster (Tdap) around 2 years after the vaccine is given, and the higher risk of infection with pertussis in individuals who are not vaccinated (who have an eightfold greater risk if exposed). Overall, 2013 data indicate a decrease in pertussis activity which may allude to a downward trend in pertussis reports for the near future, following the typical pertussis cycle. Incidence rates for Utah in 2013 show a statewide rate of 45.5 cases per 100,000 person-years, a 18.5% decrease in cases compared to the incidence rate of 2012 which was 55.8 cases per 100,000 person-years. Preliminary adjusted (day of year) incidence rates for Utah in 2014 (January 1 to Aug 1) show a statewide rate of 34.4 cases per 100,000 person-years. 2013 age distribution data indicates that 71.5% of cases are age 18 years and younger. The incidence rates are highest in infants less than 1 year of age at 193 cases per 100,000 person-years, (n=97) which is 131.9/100,000 person-years (n=66) over the state target. Pertussis incidence in adolescents between the ages of 11 and 18 years is 97.56 per 100,000 person-years (n=366) which is 82.1/100,000 person-years above the state target (n=58). These age trends are continuing in the preliminary 2014 data.

How Do We Compare With the U.S.?

Throughout the 1990s and up through 2004 (with the exception of 1998, when a statewide outbreak of pertussis occurred in Utah), the rate of pertussis in Utah mirrored national trends. Utah pertussis rates began to climb in 2005, and in 2006 Utah had a rate of pertussis nearly six times the national average. However, in Utah a substantial decrease in the rate of pertussis occurred in 2007 and continued to decline to near the U.S. average in 2008. Pertussis began to increase again in 2009 with rates remaining above the national average. 2012 data showed national rates to be double what they were in 2011, which was the same trend seen in Utah. However, Utah rates have been substantially higher than national rates since 2011 but continue to follow the national trend as seen in the 2013 provisional national data.

What Is Being Done?

Surveillance data are used to identify persons or areas in which additional efforts are required to reduce disease incidence. Surveillance data help to promptly identify outbreaks in which prophylaxis (treatment to prevent or mitigate disease) of contacts can help limit the spread of disease. Surveillance data are also used in evaluating vaccination policies at the state level. Childhood immunization is the most effective weapon against pertussis infection. The UDOH Immunization Program works with parents, physicians, and local health departments to provide immunization histories for all children under age 2 years and remind parents when vaccinations are due. The adult pertussis vaccine (Tdap) is recommended for adolescents aged 7 to 18 years. Also, routine use of a single dose of Tdap for adults over 19 years of age is recommended to replace the next booster dose of tetanus and diphtheria toxoids vaccine (Td). Tdap is also recommended for adults who have close contact with infants less than 1 year of age. Per Communicable Disease Rule R386-702-3, health care providers and laboratories are required to report suspected cases of pertussis to the Bureau of Epidemiology or the local health department within 3 business days of identification. The Bureau of Epidemiology assists local health departments with the investigation of cases and implementation of control measures to prevent further cases. The Bureau of Epidemiology conducts ongoing statewide surveillance of pertussis cases.

Available Services

Public health clinics and private provider offices offer vaccine to adults, adolescents, and children in their communities. For general information about immunizations please call the UDOH Immunization Program at 1-800-275-0659 or visit us at our web site: www.immunize-utah.org.


Related Indicators

Relevant Population Characteristics

Although pertussis affects all populations, the majority of cases in Utah and the U.S. are seen in children less than 14 years of age. Adolescents and adults generally have milder symptoms often without the characteristic "whoop" that alerts clinicians to the possibility of pertussis. Because of this, pertussis is most likely highly under-detected and under-reported in older age groups. Infants and young children are more likely to be accurately diagnosed with pertussis because they tend to have more severe symptoms and often suffer complications. A major source of pertussis infection in infants and young children is an older sibling or adult caregiver (mom, dad, grandparent, etc.).

Related Relevant Population Characteristics Indicators:


Related Health Care System Factors Indicators:


Risk Factors

Young infants are at the highest risk for clinical disease and complications (pneumonia and encephalitis).

Related Risk Factors Indicators:


Related Health Status Outcomes Indicators:




Graphical Data Views

Number of Reported Pertussis Cases per 100,000 Person-Years, Utah and U.S., 2003-2013

::chart - missing::

Utah vs. U.S.YearNumber of Reported Cases per 100,000 Person-Years
Record Count: 22
Utah20036.9
Utah200412.3
Utah200525.6
Utah200629.9
Utah200716.2
Utah20088.2
Utah20098.6
Utah201012.8
Utah201123.0
Utah201255.8
Utah201345.5
U.S.20034.0
U.S.20048.8
U.S.20058.7
U.S.20065.2
U.S.20073.5
U.S.20083.6
U.S.20095.5
U.S.20109.1
U.S.20116.0
U.S.201213.3
U.S.20137.7

Data Notes

The U.S. rates are derived from the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Reports. All 2013 U.S. rates are provisional and may change. Utah rates are derived from Utah annual surveillance reports.

Data Sources

  • Utah Department of Health, Bureau of Epidemiology
  • Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2013
  • U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC)


Number of Reported Pertussis Cases by Age and Year, Utah, 2003-2013

::chart - missing::

Age: <1, 1-4, 5-9, 10-19, 20-44, 45-64, 65+YearNumber of Cases
Record Count: 77
<1200333
<1200441
<1200554
<1200645
<1200725
<120089
<1200914
<1201023
<1201134
<12012128
<1201397
1-4200315
1-4200430
1-4200565
1-4200652
1-4200725
1-4200813
1-4200928
1-4201024
1-4201170
1-42012174
1-42013182
5-9200310
5-9200418
5-9200554
5-9200652
5-9200722
5-920089
5-9200925
5-9201024
5-9201198
5-92012238
5-92013226
10-19200322
10-19200470
10-192005171
10-192006232
10-19200771
10-19200818
10-19200950
10-19201047
10-192011138
10-192012464
10-192013437
20-44200327
20-44200477
20-442005157
20-442006227
20-442007129
20-44200819
20-44200967
20-442010107
20-442011152
20-442012313
20-442013211
45-64200317
45-64200437
45-64200590
45-642006143
45-64200797
45-6420088
45-64200926
45-64201061
45-64201199
45-642012166
45-642013100
65+20032
65+20042
65+200524
65+200626
65+200722
65+20083
65+200913
65+201017
65+201136
65+201257
65+201342

Data Notes

Data calculated using Utah Department of Health NETSS database (National Electronic Telecommunication System for Surveillance) and NEDSS database (National Electronic Disease Surveillance System).

Data Source

Utah Department of Health, Bureau of Epidemiology


Pertussis Rates by Local Health District, Utah, 2013

::chart - missing::

Local Health DistrictRate per 100,000 Population
Record Count: 13
Bear River17.1
Central21.0
Davis County32.9
Salt Lake County54.7
Southeast1.8
Southwest93.7
Summit54.6
Tooele29.6
TriCounty7.0
Utah County44.8
Wasatch22.7
Weber-Morgan22.9
State45.1

Data Sources

  • Utah Department of Health, Bureau of Epidemiology
  • Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2013

References and Community Resources

http://health.utah.gov/epi/index.html Pertussis FAQs, Centers for Disease Control and Prevention; Retrieved on 08/19/2014 from:http://www.cdc.gov/pertussis/about/faqs.html "Guidelines for the Control of Pertussis Outbreaks", Centers for Disease Control and Prevention: http://www.cdc.gov/vaccines/pubs/pertussis-guide/guide.htm Health, United States, 2007; National Center For Health Statistics; Retrieved on 8/19/2014 from: http://www.cdc.gov/nchs/data/hus/hus07.pdf Health, United States, 2010; National Center For Health Statistics; Retrieved on 8/19/2014 from: http://www.cdc.gov/nchs/data/hus/hus10.pdf Health, United States, 2013; National Center For Health Statistics, Retrieved on 8/19/2014 from: http://www.cdc.gov/nchs/data/hus/hus13.pdf Reported pertussis incidence by age group: 1990-2013, Centers for Disease Control and Prevention; Retrieved on 08/20/2014 from: http://www.cdc.gov/pertussis/images/incidence-graph-age.jpg Weekly Pertussis Report; Utah Department of Health; Retrieved on 08/19/2014 from: http://health.utah.gov/epi/diseases/pertussis/surveillance/pertussis_wkly_rpt_122713.pdf Weekly Pertussis Report; Utah Department of Health; Retrieved on 08/19/2014 from: http://health.utah.gov/epi/diseases/pertussis/surveillance/pertussis_wkly_rpt_122912.pdf CSTE Position Statement, Pertussis (2014); Retrieved on 8/20/2014 from: http://wwwn.cdc.gov/nndss/script/casedef.aspx?CondYrID=950&DatePub=1/1/2014%2012:00:00%20AM

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

Page Content Updated On 10/16/2014, Published on 10/27/2014
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 31 July 2015 15:25:40 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Tue, 28 Jul 2015 19:46:18 MDT