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Complete 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?

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 wanes over time and leaves adolescents and adults unprotected. National figures from 2012 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; however, 2012 data indicate that pertussis is increasing among adolescents 13 and 14 years of age. In 2005, the FDA approved Tdap, a pertussis vaccine for adolescents and adults. The rate of pertussis decreased in years following approval of Tdap. However, since 2009, Utah rates of pertussis have been on the rise, and there is new evidence indicating that duration of immunity from the Tdap booster lasts around 2 years, which is less than originally was expected.

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 indicate 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 5-6 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 (they have an eightfold greater risk if exposed).

In 2005, Tdap, a new pertussis vaccine licensed for people aged 11 to 64 years, was approved by the FDA. Tdap is effective at preventing pertussis, but its protective effect may not last as long as it was originally thought. Current evidence indicates immunity for a minimum of 2 years after receiving the Tdap vaccine.

Recommendations for Tdap are currently that adults and children between the ages of 7 and 64 years should receive one lifetime dose. Recent outbreaks across the country in California in 2011 and in Washington State in 2012 have prompted an in-depth investigation by the Centers for Disease Control and Prevention to determine the duration of immunity of Tdap and to propose new recommendations for dosing.

Incidence rates for Utah in 2012 show a statewide rate of 48.1 cases per 100,000 person-years, more than double the incidence rate of 2011 which was 22.9 cases per 100,000 person-years (data not shown). Preliminary incidence rates for Utah in 2013 (January to October) show a statewide rate of 38.7 cases per 100,000 person-years, a significant decrease from 2012, but still higher than previous years.

The age breakdown of cases of pertussis in Utah during 2012 shows that 65% of cases were in children aged 19 years and younger. Incidence rates were highest in infants less than 1 year of age and children between the ages of 5 and 19 years. This trend continues with the preliminary 2013 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 shows national rates to be double what they were in 2011, which is the same trend seen in Utah. However, Utah rates have been substantially higher than national rates since 2011.

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 19 to 64 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., 2002-2012

::chart - missing::

Geog: Utah vs. U.S. Year Number of Reported Cases per 100,000 Person-Years
Record Count: 22
Utah 2002 5.9
Utah 2003 6.9
Utah 2004 12.3
Utah 2005 25.6
Utah 2006 29.9
Utah 2007 16.2
Utah 2008 8.2
Utah 2009 8.6
Utah 2010 12.3
Utah 2011 22.9
Utah 2012 48.1
U.S. 2002 3.4
U.S. 2003 4.0
U.S. 2004 8.8
U.S. 2005 8.7
U.S. 2006 5.2
U.S. 2007 3.5
U.S. 2008 3.6
U.S. 2009 5.5
U.S. 2010 9.1
U.S. 2011 6.0
U.S. 2012 13.3

Data Notes

The U.S. rates are derived from the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Reports. The 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. 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, 2002-2012

::chart - missing::

Age Groups: <1, 1-4, 5-9, 10-19, 20-44, 45-64, 65+ Year Number of Cases
Record Count: 77
<1 2002 23
<1 2003 33
<1 2004 41
<1 2005 54
<1 2006 45
<1 2007 25
<1 2008 9
<1 2009 14
<1 2010 23
<1 2011 34
<1 2012 128
1-4 2002 37
1-4 2003 15
1-4 2004 30
1-4 2005 65
1-4 2006 52
1-4 2007 25
1-4 2008 13
1-4 2009 28
1-4 2010 24
1-4 2011 70
1-4 2012 174
5-9 2002 18
5-9 2003 10
5-9 2004 18
5-9 2005 54
5-9 2006 52
5-9 2007 22
5-9 2008 9
5-9 2009 25
5-9 2010 24
5-9 2011 98
5-9 2012 238
10-19 2002 20
10-19 2003 22
10-19 2004 70
10-19 2005 171
10-19 2006 232
10-19 2007 71
10-19 2008 18
10-19 2009 50
10-19 2010 47
10-19 2011 138
10-19 2012 464
20-44 2002 14
20-44 2003 27
20-44 2004 77
20-44 2005 157
20-44 2006 227
20-44 2007 129
20-44 2008 19
20-44 2009 67
20-44 2010 107
20-44 2011 152
20-44 2012 313
45-64 2002 3
45-64 2003 17
45-64 2004 37
45-64 2005 90
45-64 2006 143
45-64 2007 97
45-64 2008 8
45-64 2009 26
45-64 2010 61
45-64 2011 99
45-64 2012 166
65+ 2002 0
65+ 2003 2
65+ 2004 2
65+ 2005 24
65+ 2006 26
65+ 2007 22
65+ 2008 3
65+ 2009 13
65+ 2010 17
65+ 2011 36
65+ 2012 57

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 Sources

Utah Department of Health, Bureau of Epidemiology.



Pertussis Rates by Local Health District, Utah, 2012

::chart - missing::

Local Health District Rate per 100,000 Population
Record Count: 13
Bear River 38.3
Central 48.6
Davis County 43.9
Salt Lake County 62.7
Southeastern 3.5
Southwest 21.7
Summit 31.9
Tooele 8.4
TriCounty 5.6
Utah County 77.9
Wasatch 155.6
Weber-Morgan 53.7
State 48.1

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.


References and Community Resources

http://health.utah.gov/epi/index.html

"Guidelines for the Control of Pertussis Outbreaks"
http://www.cdc.gov/vaccines/pubs/pertussis-guide/guide.htm

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 10/21/2013, Published on 11/07/2013
The information provided above is from the Utah Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.utah.gov). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Sat, 25 October 2014 19:49:27 from Utah Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.utah.gov".

Content updated: Tue, 19 Nov 2013 23:09:24 MST