Pertussis is poorly controlled, with the highest rates of morbidity and mortality among infants. Although the source of infant pertussis is often unknown, when identified, mothers have historically ...been the most common reservoir of transmission. Despite high vaccination coverage, disease incidence has been increasing. We examined whether infant source of infection (SOI) has changed in the United States in light of the changing epidemiology.
Cases <1 year old were identified at Enhanced Pertussis Surveillance sites between January 1, 2006 to December 31, 2013. SOI was collected during patient interview and was defined as a suspected pertussis case in contact with the infant case 7 to 20 days before infant cough onset.
A total of 1306 infant cases were identified; 24.2% were <2 months old. An SOI was identified for 569 cases. Infants 0 to 1 months old were more likely to have an SOI identified than 2- to 11-month-olds (54.1% vs 40.2%, respectively; P < .0001). More than 66% of SOIs were immediate family members, most commonly siblings (35.5%), mothers (20.6%), and fathers (10.0%); mothers predominated until the transition to siblings beginning in 2008. Overall, the SOI median age was 14 years (range: 0-74 years); median age for sibling SOIs was 8 years.
In contrast to previous studies, our data suggest that the most common source of transmission to infants is now siblings. While continued monitoring of SOIs will optimize pertussis prevention strategies, recommendations for vaccination during pregnancy should directly increase protection of infants, regardless of SOI.
To assess the risk of pertussis by time since vaccination in children in Minnesota and Oregon who received 5 doses of acellular pertussis vaccines (DTaP).
These cohort analyses included Minnesota and ...Oregon children born between 1998 and 2003 who had 5 DTaP doses recorded in state Immunization Information Systems. Immunization records and statewide pertussis surveillance data were combined. Incidence rates and risk ratios for pertussis were calculated for the 6 years after receipt of the fifth DTaP dose.
The cohorts included 224,378 Minnesota children and 179,011 from Oregon; 458 and 89 pertussis cases were identified in Minnesota and Oregon, respectively. Pertussis incidence rates rose each year of follow-up: 15.6/100,000 (95% confidence interval CI: 11.1-21.4) at year 1 to 138.4/100,000 (CI: 113.3-166.9) at year 6 (Minnesota); 6.2/100,000 (CI: 3.3-10.6) in year 1 to 24.4/100,000 (CI: 15.0-37.8) in year 6 (Oregon). Risk ratios increased from 1.9 (CI: 1.3-2.9) in year 2 to 8.9 (CI: 6.0-13.0) in year 6 (Minnesota) and from 1.3 (CI: 0.6-2.8) in year 2 to 4.0 (CI: 1.9-8.4) in year 6 (Oregon).
This evaluation reports steady increase in risk of pertussis in the years after completion of the 5-dose DTaP series. This rise is likely attributable in part to waning immunity from DTaP vaccines. Continuing to monitor disease burden and vaccine effectiveness in fully vaccinated children in coming years will be important to assess ongoing risk as additional cohorts vaccinated solely with acellular pertussis vaccines are introduced.
Objective To assess whether, during a 2012 pertussis outbreak, unvaccinated and poorly vaccinated cases occurred earlier on a community level. Study design Pediatric pertussis among children 2 months ...to 10 years of age in the Oregon Sentinel Surveillance region during an epidemic starting at the beginning of 2012 were stratified by immunization status, age, zip code, and calendar date of disease onset. Differences in median onset as days between fully or mostly vaccinated, poorly vaccinated, and unvaccinated cases were examined overall and within local zip code areas. Disease clusters also were examined using SatScan analysis. Results Overall, 351 pertussis cases occurred among children aged 2 months to 10 years of age residing in 72 distinct zipcodes. Among unvaccinated or poorly vaccinated cases, their median date of onset was at calendar day 117 (April 26, 2012), whereas for those who were fully or mostly vaccinated the median date of onset was 41 days later, at day 158 (June 6, 2012). Within each local zip code area, the unvaccinated cases were 3.2 times more likely than vaccinated cases to have earlier median dates of onset (95% CI 2.9-3.6). Conclusion In this outbreak, pertussis cases among unvaccinated children represented an earlier spread of disease across local areas. Controlling outbreaks may require attention to the composition and location of the unvaccinated.
Oregon continues to face epidemics of pertussis, and infants younger than 2 months of age have the highest incidence and rates of hospitalization and complications. We describe the medical course and ...sequelae of an infant’s severe pertussis illness through age 5½ years. The child has failed to meet developmental milestones, requires substantial medical care, and bears the burdens of chronic lung disease, stroke, epilepsy, impaired neurodevelopment, and problems with vision. The medical and social burden of pertussis among infants too young to be vaccinated underscores the importance of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination during pregnancy.
A young man with X-linked severe combined immunodeficiency developed a persistent vaccine-derived rubella virus (VDRV) infection, with the emergence of cutaneous granulomas more than fifteen years ...after receipt of two doses of measles-mumps-rubella (MMR) vaccine. Following nasopharyngeal swab (NP) collection, VDRV was detected by real-time polymerase chain reaction (RT-qPCR) and sequencing, and live, replication-competent VDRV was isolated in cell culture. To assess duration and intensity of viral shedding, sequential respiratory samples, one cerebrospinal fluid sample, and two urine samples were collected over 15 months, and VDRV RNA was detected in all samples by RT-qPCR. Live VDRV was cultured from nine of the eleven respiratory specimens and from one urine specimen. To our knowledge, this was the first reported instance of VDRV cultured from respiratory specimens or from urine. To assess potential transmission to close contacts, NP specimens and sera were collected from all household contacts, all of whom were immunocompetent and previously vaccinated with MMR. VDRV RNA was not detected in any NP swabs from the contacts, nor did serologic investigations suggest VDRV transmission to any contacts. This report highlights the need to understand the prevalence and duration of VDRV shedding in granuloma patients and to estimate the risk of VDRV transmission to immune and non-immune contacts.
We calculated the effectiveness of pertussis vaccine in preventing parapertussis among Oregon children 2 months to 10 years of age using 2 methods. During 2011–2016, the 2 VE methods found 66% (95% ...CI, 59–75%) and 82% (95% CI, 69–90%) effectiveness against parapertussis. Pertussis vaccine may induce cross-immunity.
Abstract
Background
Little is known about pertussis among pregnant women, a population at increased risk for severe morbidity from respiratory infections such as influenza. We used the Centers for ...Disease Control and Prevention’s Enhanced Pertussis Surveillance (EPS) system to describe pertussis epidemiology among pregnant and nonpregnant women of childbearing age.
Methods
Pertussis cases in women aged 18–44 years with cough onset between 1 January 2012 and 31 December 2017 were identified in 7 EPS states. Surveillance data were collected through patient and provider interviews and immunization registries. Bridged-race, intercensal population data and live birth estimates were used as denominators.
Results
We identified 1582 pertussis cases among women aged 18–44 years; 5.1% (76/1499) of patients with a known pregnancy status were pregnant at cough onset. Of the pregnant patients with complete information, 81.7% (49/60) reported onset during the second or third trimester. The median ages of pregnant and nonpregnant patients were 29.0 and 33.0 years, respectively. Most pregnant and nonpregnant patients were White (78.3% vs. 86.4%, respectively; P = .09) and non-Hispanic (72.6% vs. 77.3%, respectively; P = .35). The average annual incidence of pertussis was 7.7/100000 among pregnancy women and 7/3/100000 among nonpregnant women. Compared to nonpregnant patients, more pregnant patients reported whoop (41.9% vs. 31.3%, respectively), posttussive vomiting (58.1% vs. 47.9%, respectively), and apnea (37.3% vs. 29.0%, respectively); however, these differences were not statistically significant (P values > .05 for all). A similar proportion of pregnant and nonpregnant patients reported ever having received Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; 31.6% vs. 32.7%, respectively; P = .84).
Conclusions
Our analysis suggests that incidence of pertussis and clinical characteristics of disease are similar among pregnant and nonpregnant women. Continued monitoring is important to further define pertussis epidemiology in pregnant women.
During 2012–2017, 1582 pertussis cases occurred among women aged 18–44 years; 5.1% (76/1499) of patients with known status were pregnant at cough onset. Pertussis incidences and the clinical presentations of infection were similar between pregnant and nonpregnant women.
Abstract
Fifteen Oregon schools excluded undervaccinated students when struck by pertussis outbreaks during the 2017–2018 school year. Of 243 under- or unvaccinated, exposed, students in these ...schools, 134 (55%) accepted vaccination, and 87 (36%) were excluded and missed a total of 975½ school days. No excluded students were subsequently reported as cases.
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