Increased Burden of Pertussis Among Adolescents and Adults With Asthma or COPD in the United States, 2007 to 2019.

BACKGROUND: Individuals with chronic respiratory illnesses may be at higher risk of pertussis infection and severe pertussis than those without. RESEARCH QUESTION: What is the incidence of pertussis and pertussis complications in cohorts with preexisting asthma or COPD vs age- and sex-matched control patients from the general population in the United States? STUDY DESIGN AND METHODS: This observational, retrospective study included individuals aged ≥ 10 years from an administrative health claims system between 2007 and 2019. Individuals with preexisting asthma or COPD were matched with control patients from the general population. The incidence of pertussis infections and pertussis-related complications were assessed overall and by age. The incidence of asthma or COPD exacerbations was also assessed before and after diagnosis of pertussis. RESULTS: In the general population, incidence per 100,000 person-years of pertussis infection ranged from 5.33 in 2007 to 13.04 in 2012, with highest (all years) in those aged 10 to 17 years. The risk of pertussis was higher for the asthma (rate ratio, 3.57; 95% CI, 3.25-3.92) and COPD cohorts (rate ratio, 1.83; 95% CI, 1.57-2.12) than the general population. Those with asthma or COPD had a 4.12-fold (95% CI, 3.16-5.38) and 2.82-fold (95% CI, 2.14-3.27) increased risk of pertussis with complications than the general population, respectively. Exacerbations were most frequent 30 days before pertussis diagnosis (incidence rate [IR], 25%) in the asthma cohort and 30 days before (IR, 26%) and after (IR, 22%) pertussis diagnosis, remaining elevated for 180 days after diagnosis, in the COPD cohort. INTERPRETATION: Among these insured individuals, asthma or COPD increased the risk for pertussis disease and complications vs the general population. COPD and asthma exacerbations were observed most frequently within 30 days of receiving a pertussis diagnosis and remained elevated, suggesting a long-term effect of pertussis in the COPD cohort.

Burden of Pertussis in COPD: A Retrospective Database Study in England.

Chronic obstructive pulmonary disease (COPD) may increase the risk and severity of pertussis infection. Health care resource utilization (HCRU) and direct medical costs (DMC) of treating pertussis among patients with COPD are unknown. Reported incidence of pertussis among individuals aged ≥ 50 years with COPD was assessed in Clinical Practice Research Datalink and Hospital Episode Statistics databases during 2009-2018 using a retrospective cohort design. HCRU and DMC from the National Health Service perspective were compared between patients with COPD and pertussis and propensity score-matched patients with COPD without pertussis. Seventy-eight new pertussis events were identified among 387 086 patients with COPD aged ≥ 50 years (incidence rate: 4.73; 95% confidence interval 3.74-5.91 per 100 000 person-years). HCRU and DMC were assessed among 67 patients with COPD and pertussis and 267 matched controls. During the month before the pertussis diagnosis, the rates of general practitioner (GP)/nurse visits (4289 vs. 1774 per 100 patient-years) and accident and emergency visits (182 vs. 18 per 100 patient-years) were higher in the pertussis cohort; GP/nurse visits (2935 vs. 1705 per 100 patient-years) were also higher during the following 2 months (all p < 0.001). During the month before the pertussis diagnosis, annualized per-patient total DMC were £2012 higher in the pertussis cohort (£3729 vs. £1717; p < 0.001); during the following 2 months, they were £2407 higher (£5498 vs. £3091; p < 0.001). In conclusion, a pertussis episode among individuals with COPD resulted in significant increases in HCRU and DMC around the pertussis event.

Burden of Children Hospitalized With Pertussis in Canada in the Acellular Pertussis Vaccine Era, 1999-2015.

BACKGROUND: Recent increases in pertussis morbidity and mortality rates among young infants have led to a recommendation in some countries for vaccination against pertussis during pregnancy. Having data on the burden of pediatric pertussis in a large population over time is important for establishing the true burden of disease in the acellular pertussis (aP) vaccine era. Here, we describe age-specific epidemiology and morbidity and mortality rates in children hospitalized with pertussis over 17 years across Canada in the aP vaccine era. METHODS: Patients aged ≤16 years who were admitted to 1 of 12 pediatric tertiary-care hospitals across Canada between 1999 and 2015 with confirmed (laboratory-confirmed or epidemiologically linked) or probable (clinically diagnosed) pertussis were included. RESULTS: Overall, 1402 patients with pertussis were included. Infants aged <2 months had the highest mean annual incidences of pertussis hospitalization and intensive care unit (ICU) admission (116.40 [95% confidence interval (CI), 85.32-147.49] and 33.48 [95% CI, 26.35-40.62] per 100 000 population, respectively). The overall proportion of children who required ICU admission was 25.46%, and the proportion was highest in infants aged <2 months (37.90%). Over the span of this study, 21 deaths occurred. Age of <16 weeks, prematurity, encephalopathy, and a confirmed pertussis diagnosis were independent risk factors for ICU admission. Age of <4 weeks, prematurity, and female sex were independent risk factors for death. CONCLUSIONS: In the aP vaccine era, endemic pertussis still contributes considerably to childhood morbidity and death, particularly in infants aged <2 months. Vaccination against pertussis during pregnancy has the potential to reduce this disease burden.

A Whooping Cough Education Module for WIC Clients in Utah.

BACKGROUND: Clients in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are required to complete education modules quarterly to maintain eligibility. The purposes of this project were to: (1) create a whooping cough vaccination education module for WIC clients; (2) evaluate baseline perceptions of WIC clients on the whooping cough vaccine and disease; and (3) evaluate whooping cough knowledge following completion of the module. PROBLEM: A decline in vaccination rates among infants and children using WIC services was reported by a local WIC program director who requested whooping cough vaccination education materials. This quality improvement project included development of a whooping cough education module and evaluation of learning. METHODS: Learning was evaluated using a pre- and posttest design. Client feedback was solicited via open-ended questions. Quantitative analysis was performed on visual analog-type questions with paired t-tests and a Cohen's d. Content analysis was conducted on open-ended items. INTERVENTIONS: The module was designed by a team of vaccination experts and included general definitions, signs and symptoms during the three stages of disease, recommendations to prevent whooping cough, and vaccination recommendations. Learning of users of the module was then evaluated. RESULTS: After using the module, clients indicated they were significantly more likely to vaccinate themselves and their child against whooping cough, and to recommend the vaccination to their family members. The greatest concern of participants about whooping cough was how it affected infants. Participants reported they learned new information on disease seriousness, recognition of symptoms, and treatment options but still requested additional information on the whooping cough disease and vaccine. CONCLUSIONS: A whooping cough education module is an effective strategy to improve whooping cough knowledge and promote the whooping cough vaccine.

Suffer the Infants: A Severe Case of Pertussis in Oregon, 2012.

Pertussis remains a public health concern in Oregon, especially among young infants. The disease can be severe in this age group and is associated with a high inpatient cost. This report describes an Oregon infant who was hospitalized with pertussis for 90 days, required extracorporeal oxygenation for 43 days, suffered complications including stroke, and had hospital charges totaling $1.5 million. Pertussis morbidity among young infants argues for vaccination of women during each pregnancy and of infants beginning promptly at two months of age.

The Burden of Pertussis in Patients with and without Recurrent Ischaemic Vascular Events.

Pertussis seroepidemiology and associated factors in older adults aged ≥40 years with and without acute myocardial infarction (AMI) were studied to investigate whether unrecognised pertussis may precipitate AMI. Sera were obtained from a previous case-control study investigating the role of influenza in precipitating AMIs. Baseline sera were considered pertussis toxin (PT) IgG seropositive at levels ≥5 IU/mL. Levels ≥v62.5 IU/mL were considered indicative of infection in the previous year, and recent infection was indicative at levels ≥125 IU/mL. Of the serum samples tested, 55% (122/222) were seropositive for PT IgG, 5% (11/222) had evidence of infection in the past year and 1.4% (3/222) had evidence of recent infection. Evidence of infection in the past year was found in 3.2% of those aged 65-74 years. Overall, 47.8% of 40-64 year olds and 43.2% of those aged ≥65 years were seronegative for pertussis. Serological evidence of pertussis was not associated with AMI (46/92, 50.0% cases vs. 76/130, 58.5% controls, p=0.2). After adjusting for age, AMI and self-reported pertussis and GP verified influenza vaccination, females (OR = 2.2, 95% CI = 1.1-4.1, p=0.02) were more likely to be seronegative. Just under half of participants had no detectable pertussis immunity and are therefore susceptible to infection. Our study supports the need for an adult pertussis booster to supplement current recommendations.

Pertussis in adolescents and adults: should we vaccinate?

BACKGROUND: The incidence of reported pertussis among adolescents, adults, and young infants has increased sharply over the past decade. Combined acellular pertussis vaccines for adolescents and adults are available in Canada, Australia, and Germany and may soon be considered for use in the United States. OBJECTIVE: To evaluate the potential health benefits, risks, and costs of a national pertussis vaccination program for adolescents and/or adults. DESIGN, SETTING, AND POPULATION: The projected health states and immunity levels associated with pertussis disease and vaccination were simulated with a Markov model. The following strategies were examined from the health care payer and societal perspectives: (1) no vaccination; (2) 1-time adolescent vaccination; (3) 1-time adult vaccination; (4) adult vaccination with boosters; (5) adolescent and adult vaccination with boosters; and (6) postpartum vaccination. Data on disease incidence, costs, outcomes, vaccine efficacy, and adverse events were based on published studies, recent unpublished clinical trials, and expert panel input. MAIN OUTCOME MEASURES: Cases prevented, adverse events, costs (in 2004 US dollars), cost per case prevented, and cost per quality-adjusted life-year (QALY) saved. RESULTS: One-time adolescent vaccination would prevent 30800 cases of pertussis (36% of projected cases) and would result in 91000 vaccine adverse events (67% local reactions). If pertussis vaccination cost $15 and vaccine coverage was 76%, then 1-time adolescent vaccination would cost $1100 per case prevented (or $1200 per case prevented) or $20000 per QALY (or $23000 per QALY) saved, from the societal (or health care payer) perspective. With a threshold of $50000 per QALY saved, the adolescent and adult vaccination with boosters strategy became potentially cost-effective from the societal perspective only if 2 conditions were met simultaneously, ie, (1) the disease incidence for adolescents and adults was > or =6 times higher than base-case assumptions and (2) the cost of vaccination was less than $10. Adult vaccination strategies were more costly and less effective than adolescent vaccination strategies. The results were sensitive to assumptions about disease incidence, vaccine efficacy, frequency of vaccine adverse events, and vaccine costs. CONCLUSIONS: Routine pertussis vaccination of adolescents results in net health benefits and may be relatively cost-effective.

Economic considerations for pertussis booster vaccination in adolescents.

BACKGROUND: Despite good acellular pertussis vaccine safety and protective efficacy, as well as high vaccination rates among young children, the incidence of pertussis in the United States has steadily increased since the 1980s. This is especially true for adolescents and adults who are susceptible because of waning immunity, which is not long lived. Other populations are at increased risk for morbidity of infection, although infants younger than 6 months of age who have not completed the primary immunization series have the greatest morbidity and mortality. Other groups who might benefit from booster immunizations include hospital workers, family contacts, and individuals with compromised health. Although older individuals generally have milder illnesses, they are often the source of infection for younger children. An adolescent/adult formulation of acellular pertussis vaccine requires a lower dose of pertussis antigens and can be combined with currently recommended diphtheria and tetanus toxoids (Tdap). These new vaccines for adolescents and adults are safe, immunogenic, and protective. METHODS: Through an extensive review of the literature, the direct and indirect costs associated with pertussis and its complications are examined, cost-benefit analyses of pertussis booster vaccination are evaluated for different groups, and the economic considerations involved in implementing a pertussis booster vaccination program in adolescents are discussed. RESULTS: Pertussis infections cause outbreaks in schools, families, and workplaces, resulting in prolonged morbidity and significant costs for medical care, lost time, and wages. Physician visits, chest radiographs, and antibiotics comprise the majority of direct costs, and costs associated with work loss often comprise the majority of indirect costs related to pertussis illness. Adolescents and adults also transmit their infections to nonimmune children. A cost-benefit analysis evaluated the health and economic benefits of seven strategies for administering a pertussis booster. The most economical strategy is to immunize all adolescents 10-19 years of age, which may prevent 0.4-1.8 million cases of pertussis and save US 0.3-1.6 billion dollars in a decade. A tetanus and diphtheria booster (Td) is currently recommended for children 11-12 years of age. The Tdap vaccine offers an enhancement for the Td booster by providing protection against pertussis, and it will not require an additional injection or office visit. CONCLUSIONS: Immunizing adolescents with a pertussis booster in the form of Tdap is the most economical and easiest-to-implement strategy and should provide significant health and economic benefits.

Societal costs and morbidity of pertussis in adolescents and adults.

BACKGROUND: Since the 1980s, the reported incidence of pertussis among adolescents and adults has been steadily increasing. To understand whether the benefits of an acellular pertussis vaccine formulated for adolescents and adults might offset its costs, policy makers will need information about morbidity and societal (medical and nonmedical) costs of pertussis. METHODS: Adolescents (age, 10-17 years) and adults (age, >or=18 years) with confirmed pertussis illness were identified by the Massachusetts enhanced pertussis surveillance system. We evaluated medical costs in a cohort of patients who had confirmed pertussis during the period of January 1998 through December 2000; nonmedical costs, by means of prospective interviews, in a cohort of patients who had confirmed pertussis during the period of December 2001 through January 2003; and morbidity in both cohorts. Our main outcome measures were mean costs per case, in 2002 US dollars. RESULTS: In the analysis of medical costs, 1679 adolescents and 936 adults were found to have mean costs of 242 dollars and 326 dollars, respectively (P<.05). In interviews with 314 adolescents and 203 adults, adults had significantly higher nonmedical costs (447 dollars) than those of adolescents (155 dollars). A total of 83% of adolescents missed a mean of 5.5 days from school (range, 0.4-32 days), and 61% of adults missed a mean of 9.8 days from work (range, 0.1-180 days) because of pertussis. Thirty-eight percent of adolescents and 61% of adults were still coughing at the time of the interview, which occurred an average of 106 days and 94 days, respectively, after cough onset. CONCLUSIONS: Pertussis causes significant morbidity in and costs for adolescents and adults, with time losses comprising the largest proportion of the cost. Societal costs should be considered when making decisions about potential vaccine use in the future.

Increased risk of reported pertussis and hospitalization associated with pertussis in low birth weight children.

OBJECTIVES: To determine whether low birth weight (LBW) children are at greater risk of reported pertussis and complications of pertussis in the first 2 years of life than are normal birth weight (NBW) children. STUDY DESIGN: We performed a secondary analysis of three data sets containing statewide information among Wisconsin residents for children born between January 1, 1981, and December 31, 1990. We identified all reported cases of pertussis among children younger than 2 years of age and linked this information with birth certificate data and hospitalization data to determine the relative risk of reported pertussis in LBW compared with NBW children. We also compared the frequency of reported complications of pertussis in LBW and NBW children. RESULTS: We analyzed reports of 549 pertussis cases; 49 cases occurred in LBW children. The LBW children were significantly more likely to have reported pertussis than were NBW children (relative risk 1.86; 95% confidence interval 1.33, 2.38). The rates of pneumonia and seizures did not differ among LBW and NBW children; however, LBW children with reported pertussis were significantly more likely to be hospitalized than were NBW children (relative risk 1.40; 95% confidence interval 1.11, 1.69). CONCLUSION: In addition to timely vaccination of all infants, efforts are needed to determine additional ways to reduce the risk of pertussis among LBW infants and children.

Pertussis and pertussis vaccine. Reanalysis of benefits, risks, and costs.

Using recently published information, we examined the experience of a hypothetical cohort of 1 million children followed up from birth to 6 years of age without and with a pertussis vaccination program. Costs associated with death or lost wages were not estimated. A vaccination program reaching 90% of children would reduce disease incidence and disease-related costs by 90%. Taking into account costs associated with vaccine and vaccine reactions, the costs are reduced 82%. The ratio of overall costs without a program to those with a program is 5.7:1. The benefit-cost ratio is 11.1:1. Because we did not include indirect costs, this is a conservative estimate. Until improved vaccines are available, continued use of our present vaccines, with careful attention to possible contraindications, seems the only prudent course to follow.

KIE: An analysis was performed on the experience of a hypothetical cohort of one million children followed from birth to 6 years of age with and without a pertussis vaccination program. The results indicated that a vaccination program reaching 90% of children would reduce disease incidence and disease-related costs by 90%. Based on a conservative approach that considered only direct costs associated with vaccine and vaccine reactions, the authors calculated that the benefit-cost ratio of an immunization program is 11.1:1. They conclude that, until improved vaccines are developed, it is prudent to continue use of present vaccines with careful attention to possible contraindications.

The structure and change of mortality in a Maya community.

PIP: This is the first known report on the demographic details of a Maya group. The predominantly Maya town of Santiago Atitlan is in the Guatemalan highlands in the Department of Solola. The town contains 2 distinct cultural groups, the Ladinos and Indians. Ladinos is a term applied to persons whose style of life is not predominantly Indian. They are 3.8% of the town's population. Racial composition is unimportant. The age and sex distribution is characterized by high birth and death rates. The total fertility rate indicates that the average Atitlan family has 8 live births during its reproductive period. There is little deliberate population control. From 1960 to 1968 the crude death rate averaged 23 per 1000 population. Previously it had been much higher. In the 1960 decade the life expectancy at birth was 43.3 for males and 41 for females. Female mortality in childbirth is believed to be the cause of their higher mortality in early life. A higher mortality in later life, is not explained. The infant and preschool age group contribute 50 to 70% of all deaths each year. The effect of migration is negligible. The population increase is 3% per year. As most are subsistence farmers and a land shortage exists, problems are expected to develop. A colonial record written in 1585 estimated that a larger population of about 12,000 had occupied the are before 1524. By 1650 the population was about 1000 people. An 1689 estimate was 2235 persons. In 1770 the population was recorded as about 900. Currently they are regaining their PreColumbian level with 10,462 people in 1964. Present records of births, deaths, and population numbers are considered to be accurate.^ieng