Complete Indicator Report of Pertussis Cases
DefinitionFor 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.
NumeratorNumber of pertussis cases reported in Utah (including cases identified in outbreak settings).
DenominatorTotal 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 ObjectivesHealthy 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 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 ServicesPublic 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.
Relevant Population CharacteristicsAlthough 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 FactorsYoung 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
Data NotesThe 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 SourcesUtah 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
Data NotesData calculated using Utah Department of Health NETSS database (National Electronic Telecommunication System for Surveillance) and NEDSS database (National Electronic Disease Surveillance System).
Data SourcesUtah Department of Health, Bureau of Epidemiology.
Pertussis Rates by Local Health District, Utah, 2013
Data SourcesUtah 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 Resourceshttp://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:
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:
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 LinksEvidence-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