Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC
Volume 21, Number 9—September 2015
THEME ISSUE
Emerging Infections Program
Emerging Infections Program
Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States
Tami H. Skoff
, Joan Baumbach, and Paul R. Cieslak
, Joan Baumbach, and Paul R. CieslakAbstract
Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in understanding the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis.
Figure 1. Reported pertussis cases from the National Notifiable Diseases Surveillance System, United States, 1922–2013. Inset show cases during 1990–2013. Data for 1950–2013 were obtained from the Centers for Disease Control and Prevention...
Pertussis (whooping cough) has proven to be a frustratingly persistent public health problem. Although annual numbers of reported cases decreased >99% in the United States after introduction of whole-cell pertussis vaccines in the 1940s, this highly contagious respiratory illness has refused to go the way of other vaccine-preventable diseases of childhood, such as polio, Haemophilus influenzae type b infection, and diphtheria. Pertussis remains endemic to the United States, and the number of reported cases has been increasing steadily since the late 1980s, with notable epidemic peaks in recent years (Figure 1). In 2012, more than 48,000 cases were reported nationally, the largest number since 1955. Possible reasons for the observed increase include changes in diagnostic testing and reporting, increased provider and public awareness, mismatch of vaccine antigens and circulating strains, and reduced duration of immunity from acellular pertussis (aP) vaccines that replaced whole-cell vaccines in the United States during the 1990s.
The cough illness associated with pertussis can be quite severe and the disease debilitating in persons of all ages, but illness and death rates remain highest among young infants, especially those too young to be directly protected by vaccination. Recently, the epidemiology of pertussis has indicated an increasing burden of disease among school-age children and adolescents, most of whom are up-to-date on pertussis vaccinations (1,2). Changes have also been identified in Bordetella pertussis at the molecular level, such as loss of pertactin, a key aP vaccine antigen (3).
Pertussis has been a reportable disease in the United States since 1922. Case-based surveillance data are captured through the National Notifiable Diseases Surveillance System (NNDSS) from 57 public health jurisdictions (50 states; 5 US territories; New York, NY; and Washington, DC) (4). NNDSS is a passive system that relies on reports from health care providers and laboratories, probably resulting in underreporting of cases. In addition, because case investigation requires the effort and resources of disparate local and state public health agencies, the quantity and quality of pertussis case reports vary, and data elements fundamental to the understanding of pertussis, including case demographics, clinical symptoms and pertussis vaccination history, are often incomplete. NNDSS is a relatively inflexible system that cannot readily accommodate newly desired data elements, and complex data transmission processes and challenges might compromise the quality of data received at the Centers for Disease Control and Prevention (CDC).
Although NNDSS has been essential for monitoring the national burden of pertussis and age-related trends in disease over time, data are of insufficient detail and consistency to answer reliably the many urgent questions relevant to public health. Are current pertussis prevention and control strategies effective, specifically, vaccination and postexposure antimicrobial chemoprophylaxis (PEP)? Has the spectrum of clinical illness changed, and does it differ by factors such as age and vaccination status? In the setting of waning aP-induced immunity, should additional doses of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) be recommended, and if so, for which populations? Is B. pertussis evolving in key ways at the molecular level, and what, if any, is the clinical and epidemiologic relevance of identified changes? What are the disease burden and epidemiologic and molecular characteristics of other Bordetella species, and how might these species be contributing to the resurgence of pertussis-like cough illness?
Ms. Skoff is an epidemiologist in the Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Her research interests are pertussis and other vaccine-preventable diseases.
Acknowledgments
We thank Amanda Faulkner, Christine Miner, Amy Blain, Elizabeth Briere, Stacey W. Martin, Maria L. Tondella, Pam Cassiday, Margaret Williams, Lucia Pawloski, Nancy Messonnier, Thomas Clark; Lisa Miller, Ken Gershman, Meghan Barnes, Tracy Woodall, Nereida Corral, Kathy Kudish, Lynn Sosa, Matt Cartter, Roxanne Ryan, Jessica Tuttle, Monica Farley, Stepy Thomas, Ebony Thomas, Cynthia Kenyon, Ruth Lynfield, Rachel Ostadkar, Melissa McMahon, Geraldine Salo, Victoria Lappi, Larry Carroll, David Selvage, Marisa Bargsten, Brooke Doman, Karen Scherzinger, Julianna Ferreira, Dana Moore-Smith, Bernadette Gutierrez, Kevin Aicher, Shelley Zansky, Debra Blog, Suzanne McGuire, Greg Giambrone, Salvatore Currenti, Cynthia Schulte, Bridget Whitney, Amy Sullivan, Rita Gillam, Russel Barlow, Juventila Liko, Laura Reynolds, and Allison Ryan for their contributions to this study.
Enhanced Pertussis Surveillance and other pertussis special studies are supported through a CDC cooperative agreement.
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Suggested citation for this article: Skoff TH, Baumbach J, Cieslak PR. Tracking pertussis and evaluating control measures through enhanced pertussis surveillance, Emerging Infections Programs, United States. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150023
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