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California Pertussis Epidemic, 2010

      Objective

      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.

      Results

      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.

      Conclusions

      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)
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      Linked Article

      • Pertussis epidemic
        The Journal of PediatricsVol. 162Issue 5
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          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.
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