California Pertussis Epidemic, 2010


      In 2010, California experienced the highest number of pertussis cases in >60 years, with >9000 cases, 809 hospitalizations, and 10 deaths. This report provides a descriptive epidemiologic analysis of this epidemic and describes public health mitigation strategies that were used, including expanded pertussis vaccine recommendations.

      Study design

      Clinical and demographic information were evaluated for all pertussis cases with onset from January 1, 2010, through December 31, 2010, and reported to the California Department of Public Health.


      Hispanic infants younger than 6 months had the highest disease rates; all deaths and most hospitalizations occurred in infants younger than 3 months. Most pediatric cases were vaccinated according to national recommendations, although 9% of those aged 6 months to 18 years were completely unvaccinated against pertussis. High disease rates also were observed in fully vaccinated preadolescents, especially 10-year-olds. Mitigation strategies included expanded tetanus, diphtheria, and acellular pertussis vaccine recommendations, public and provider education, distribution of free vaccine for postpartum women and contacts of infants, and clinical guidance on diagnosis and treatment of pertussis in young infants.


      Infants too young to be fully vaccinated against pertussis remain at highest risk of severe disease and death. Data are needed to evaluate strategies offering direct protection of this vulnerable population, such as immunization of pregnant women and of newborns. The high rate of disease among preadolescents suggests waning of immunity from the diphtheria, tetanus, and acellular pertussis series; additional studies are warranted to evaluate the efficacy and duration of protection of the diphtheria, tetanus, and acellular pertussis series and the tetanus, diphtheria, and acellular pertussis series.
      ACIP (Advisory Committee on Immunization Practices), CDPH (California Department of Public Health), DTaP (Diphtheria, tetanus, and acellular pertussis), PCR (Polymerase chain reaction), Tdap (Tetanus, diphtheria, and acellular pertussis)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Von Konig C.H.
        • Halperin S.
        • Riffelmann M.
        • Guiso N.
        Pertussis in adults and infants.
        Lancet Infect Dis. 2002; 2: 744-750
        • Cherry J.D.
        The present and future control of pertussis.
        Clin Infect Dis. 2010; 51: 663-667
        • Brooks G.F.
        • Buchanan T.M.
        Pertussis in the United States.
        J Infect Dis. 1970; 122: 123-125
        • Centers for Disease Control and Prevention
        Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine.
        MMWR Morb Mortal Wkly Rep. 2006; 55: 1-37
        • Schmitt H.J.
        • Wirsing von Konig C.H.
        • Neiss A.
        • Bogaerts H.
        • Bock H.L.
        • Schulte-Wissermann H.
        • et al.
        Efficacy of acellular pertussis vaccine in early childhood after household exposure.
        JAMA. 1996; 275: 37-41
        • Liese J.G.
        • Meschievitz C.K.
        • Harzer E.
        • Froeschle J.
        • Hosbach P.
        • Hoppe J.E.
        • et al.
        Efficacy of a two-component acellular pertussis vaccine in infants.
        Pediatr Infect Dis J. 1997; 16: 1038-1044
        • Simondon F.
        • Preziosi M.P.
        • Yam A.
        • Kane C.T.
        • Chabirand L.
        • Iteman I.
        • et al.
        A randomized double-blind trial comparing a two-component acellular to a whole-cell pertussis vaccine in Senegal.
        Vaccine. 1997; 15: 1606-1612
        • Olin P.
        • Rasmussen F.
        • Gustafsson L.
        • Hallander H.O.
        • Heijbel H.
        • The Ad Hoc Group for the Study of Pertussis Vaccines
        Randomised controlled trial of two-component, three-component, and five-component acellular pertussis vaccines compared with whole-cell pertussis vaccine.
        Lancet. 1997; 350: 1569-1577
        • Stehr K.
        • Cherry J.D.
        • Heininger U.
        • Schmitt-Grohe S.
        • Uberall M.
        • Laussucq S.
        • et al.
        A comparative efficacy trial in Germany in infants who received either the Lederle/Takeda acellular pertussis component DTP (DTaP) vaccine, the Lederle whole-cell component DTP vaccine, or DT vaccine.
        Pediatrics. 1998; 101: 1-11
      1. California Department of Public Health. Pertussis Report 10-6-2010. Accessed November 11, 2011.

      2. Centers for Disease Control and Prevention. Nationally notifiable diseases surveillance system pertussis (whooping cough) 1997 case definition. Accessed on June 20, 2012.

      3. State of California, Department of Finance. Race/ethnic population with age and sex detail, 2000-2050. Sacramento (CA): July 2007.

      4. California Department of Public Health. Pertussis (whooping cough). Accessed January 20, 2012.

      5. California Department of Public Health. Pertussis Report 1-6-2012. Accessed January 10, 2012.

        • Centers for Disease Control and Prevention
        Summary of notifiable diseases—United States, 2008.
        MMWR Morb Mortal Wkly Rep. 2009; 58 (32): 13-14
        • Vitek C.R.
        • Pascual F.B.
        • Baughman A.L.
        • Murphy T.V.
        Increase in deaths from pertussis among young infants in the United States in the 1990s.
        Pediatr Infect Dis J. 2003; 22: 628-634
        • Wortis N.
        • Strebel P.M.
        • Wharton M.
        • Bardenheier B.
        • Hardy I.R.B.
        Pertussis deaths: report of 23 cases in the United States, 1992 and 1993.
        Pediatrics. 1996; 97: 607-612
      6. Centers for Disease Control and Prevention. Estimated vaccination coverage with 3+DTaP among children 19-35 months of age by race/ethnicity, and by state and local area—US, National Immunization Survey, Q1/2010-Q4/2010. Accessed on January 10, 2012.

        • Haberling D.L.
        • Holman R.C.
        • Paddock C.D.
        • Murphy T.V.
        Infant and maternal risk factors for pertussis-related infant mortality in the United States, 1999 to 2004.
        Pediatr Infect Dis J. 2009; 28: 194-198
        • Bisgard K.M.
        • Pascual F.B.
        • Ehresmann K.R.
        • Miller C.A.
        • Cianfrini C.
        • Jennings C.E.
        • et al.
        Infant pertussis: who was the source?.
        Pediatr Infect Dis J. 2004; 23: 985-989
        • Wendelboe A.M.
        • Njamkepo E.
        • Bourillon A.
        • Floret D.D.
        • Gaudelus J.
        • Gerber M.
        • et al.
        Transmission of Bordetella pertussis to young infants.
        Pediatr Infect Dis J. 2007; 26: 293-299
        • Skowronski D.M.
        • Janjua N.Z.
        • Sonfack Tsafack E.P.
        • Ouakki M.
        • Hoang L.
        • De Serres G.
        The number needed to vaccinate to prevent infant pertussis hospitalization and death through parent cocoon immunization.
        Clin Infect Dis. 2012; 54: 318-327
        • Wood N.
        • McIntyre P.
        • Marshall H.
        • Roberton D.
        Acellular pertussis vaccine at birth and one month induces antibody response by two months of age.
        Pediatr Infect Dis J. 2010; 29: 209-215
        • Ad Hoc Group for the Study of Pertussis Vaccines
        Placebo-controlled trial of two acellular pertussis vaccines in Sweden: protective efficacy and adverse events.
        Lancet. 1988; 1: 955-960
        • Blackwelder W.C.
        • Storsaeter J.
        • Olin P.
        • Hallander H.O.
        Acellular pertussis vaccines efficacy and evaluation of clinical case definitions.
        Am J Dis Child. 1991; 145: 1285-1289
        • Rank C.
        • Quinn H.E.
        • McIntyre P.B.
        Pertussis vaccine effectiveness after mass immunization of high school students in Australia.
        Pediatr Infect Dis J. 2009; 28: 152-153
        • Wei S.C.
        • Tatti K.
        • Cushing K.
        • et al.
        Effectiveness of adolescent and adult tetanus, reduced-dose diphtheria, and acellular pertussis vaccine against pertussis.
        Clin Infect Dis. 2010; 51: 315-321
        • Fine P.
        Herd immunity: history, theory, practice.
        Epidemiol Rev. 1993; 15: 265-302
        • Anderson R.M.
        • May R.M.
        Vaccination and herd immunity to infectious diseases.
        Nature. 1985; 318: 323-329
      7. California Department of Public Health. Accessed January 10, 2012.

        • Centers for Disease Control and Prevention
        National, state and local area vaccination coverage among adolescents aged 13-17 years—United States, 2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1117-1123
        • Centers for Disease Control and Prevention
        Adult vaccination coverage—United States, 2010.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 66-72
        • Yih W.K.
        • Lett S.M.
        • des Vignes F.N.
        • Garrison K.M.
        • Sipe P.L.
        • Marchant C.D.
        The increasing incidence of pertussis in Massachusetts adolescents and adults, 1989-1998.
        J Infect Dis. 2000; 182: 1409-1416
        • Mandal S.
        • Tatti K.M.
        • Woods-Stout D.
        • Cassiday P.K.
        • Faulkner A.E.
        • Griffith M.M.
        • et al.
        Pertussis pseudo-outbreak linked to specimens contaminated by Bordetella pertussis DNA from clinical surfaces.
        Pediatrics. 2012; 129: e424-e430
        • Miller B.L.
        • Kretsinger K.
        • Euler G.L.
        • Lu P.J.
        • Ahmed F.
        Barriers to early uptake of tetanus, diphtheria and acellular pertussis vaccine (Tdap) among adults—United States, 2005-2007.
        Vaccine. 2011; 29: 3850-3856

      Linked Article

      • Pertussis epidemic
        The Journal of PediatricsVol. 162Issue 5
        • Preview
          Winter et al1 describe the clinical and epidemiologic characteristics of the 2010 California pertussis epidemic. They illustrate high disease burden and mortality in Hispanic patients, especially among infants, despite comparable vaccination coverage. The authors speculate that the high burden of disease in Hispanic patients might be caused by having larger households and possibly more contacts. Because the inference of a causal relationship between household size and high pertussis burden among Hispanics was not supported by data in this study, it would be beneficial if the authors considered doing an ecologic analysis by geocoding cases to census tract, aggregating case count by census tract, then using the census tract economic and housing data to understand factors that could further explain the high burden of disease as demonstrated in a similar study in which the authors used county-wide coverage levels.
        • Full-Text
        • PDF