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From control to re-emergence - the story of pertussis
Dr Suzanne CotterDr Sarah Gee (PhD)
Dr Darina O’FlanaganHealth Protection Surveillance Centre
www.hpsc.ie
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Winter Scientific MeetingWednesday, 5th December 2012
Background• Highly contagious respiratory disease• “100 day cough”• Morbidity and mortality highest among infants• Estimated worldwide deaths > 300,000/yr• Vaccine-preventable
2
Clinical Course (in weeks)
-3 0 2 128
Onset
Incubation period(typically 5-10 days;max 21 days)
Catarrhal stage(1-2 weeks)
Paroxysmal stage(1-6 weeks)
Convalescent stage(weeks to months)
Communicable period(onset to 3 weeks after start of paroxysmal cough)
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Source: ACIP May 2012. Stacey Martin. http://www.cdc.gov/vaccines/ed/ciinc/Pertussis.htm
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Trends Pertussis notifications, Ireland 1948- 2012*
*2012 data weeks 1-394
DTP replaced by DTaP
Tdap booster
Pertussis notifications, 2001-2012*
*2012 data weeks 1-39
114
229
372
5
Pertussis notifications by week, 2009-2012*
Pertussis outbreaks, Leitrim
NW -Late notifications 2011-2012
East and other
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Pertussis notifications and rate per 100,000 population, by HSE area*
ERHA MHB MWHB NEHB NWHB SEHB SHB WHBNational 0
50
100
150
200
250
300
350
400
0.0
5.0
10.0
15.0
20.0
25.0
30.0
7.8
3.92.4
4.5
26.3
7.1
12.3
7.6 8.2
HSE area
Num
ber n
otific
ation
s
Rate
/100
,000
pop
ulati
on
*Data as of 4/10/2012 (n=376)7
Pertussis notifications, by HSE Area, Interpreted Overall Lab Result, 2012*
(n= 372)
*2012 data weeks 1-398
Pertussis notifications, ASIR (/100,000) 2012* (n=372)
*2012 data weeks 1-399
Pertussis notifications, 2001-2012*ASIR (/100,000)
*2012 data weeks 1-3910
Pertussis notifications by age group and vaccination status (n=372)*
0-5mo 6-11 mo 1-2 yrs 3-4 yrs 5-9 yrs 10-14 yrs
15-19 yrs
20-24 yrs
25-34 yrs
35-44 yrs
45-54 yrs
55-64 yrs
65+ yrs0
20
40
60
80
100
120
140
Unk blankUnvaccinatedIncompleteComplete
Age group (months/years)
Num
ber n
otific
ation
s
11*2012 data weeks 1-39
Pertussis cases <1 year of age, by age in weeks at onset date and number of doses of pertussis vaccine.
(n=138)
*2012 data weeks 1-39. Onset date available for 98 of 138 events < 1 year12
Reported fatalities, 2011-2012• 2012 – 2 infant deaths
• 2011 – 1 infant death
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Pertussis notifications, England and Wales 2005-2012
14Source: HPA http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136496345
Year
Australia 1991-2011
Disease Watch. March 2012, Volume 16, Issue 1 » Ongoing pertussis epidemic in Western Australia
Summary
• Increase in pertussis in Ireland similar to that seen in other countries
• Waning immunity contributory factor• Additional control measures needed
– Booster doses for adolescents and HCWs• Antenatal vaccination • Cocooning strategy (difficult)
– Diagnosis, chemoprophylaxis of susceptible
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Acknowledgements
• Departments of Public Health• Clinicians, microbiologists• Notifying GPs